:00:09. > :00:14.That is the end of the day hn the House of Commons and we will now be
:00:15. > :00:18.going over live to the Housd of Lords. You can watch recorddd
:00:19. > :00:25.coverage of all of the business in the Lords after the Daily Politics
:00:26. > :00:36.later tonight. I do not know how to apply the mental capacity act. This
:00:37. > :00:39.was reported in 2014. My Lords, there is also insufficient `ttention
:00:40. > :00:43.to making reasonable adjustlents to support the delivery of equ`l
:00:44. > :00:48.treatment and a failure to provide the annual health tax that dvery
:00:49. > :00:55.adult with learning disabilhty should be offered. In 2013, only 44%
:00:56. > :01:02.of eligible people with a ldarning disability received an annu`l health
:01:03. > :01:04.check. And there are delays in diagnosis and treatment and
:01:05. > :01:09.difficulties accessing assessment and treatment for general hdalth
:01:10. > :01:15.problems. There are also a number of system level issues, such as lack of
:01:16. > :01:19.learning from reviews of de`ths or a failure to identify that a person
:01:20. > :01:26.has a learning disability in their health care record. Meaning that the
:01:27. > :01:30.specific health needs of people with learning disabilities are invisible,
:01:31. > :01:37.both to health professionals, but also invisible to researchers and to
:01:38. > :01:40.public health practitioners. Could I ask the noble Baroness, the
:01:41. > :01:45.minister, what the government is doing to improve our knowledge and
:01:46. > :01:49.understanding about the needs of this vulnerable group, for which
:01:50. > :01:53.comprehensive and accurate identification is an essenthal
:01:54. > :01:57.prerequisite? If we do not know which of our patient has a learning
:01:58. > :02:04.disability, then how can we make the reasonable adjustments?
:02:05. > :02:11.It is important that we keep monitoring these issues for evidence
:02:12. > :02:16.of improvement. Following a confidential inquiry into thousand
:02:17. > :02:22.and 15, the first three-year national learning disabilithes
:02:23. > :02:26.review was set up at the Unhversity of Bristol. Its aim is to drive
:02:27. > :02:32.improvement and the quality of health and social care provhsion for
:02:33. > :02:39.people with learning disabilities and to reduce premature mortality in
:02:40. > :02:43.health inequalities. The mortality review supports local agenches to
:02:44. > :02:48.conduct reviews of the deaths of people with learning disabilities
:02:49. > :02:53.between the ages of four and 74 and to learn from these reviews to
:02:54. > :02:58.improve services. The progr`mme supports reviews of all deaths,
:02:59. > :03:04.regardless of the cause or place of death, death set home or in
:03:05. > :03:07.hospital, any deaths. It is supported by family carers `nd by
:03:08. > :03:22.people with learning disabilities, both of whom actors revises. -- act
:03:23. > :03:25.as advisers. My Lords, the establishment of the agency is keep
:03:26. > :03:28.the key is how the NHS and Government will use the dat` from
:03:29. > :03:35.Les Kiss reduced implement ` national strategy to tackle this
:03:36. > :03:40.continuing scandal. Could I have them to commit the Government will
:03:41. > :03:43.regularly inform Parliament of progress and improving outcomes for
:03:44. > :03:49.people with learning disabilities. The programme has developed a
:03:50. > :03:57.website, illustrated guides and fax streets. Each NHS region is now
:03:58. > :04:05.introducing a a review procdss by learning and sharing. Unlikd the
:04:06. > :04:09.child death review process `nd other inquiries, the learning dis`bility
:04:10. > :04:14.programme is not mandatory. Agencies can choose to contribute to the
:04:15. > :04:20.views of deaths of people whth learning disabilities or not. It is
:04:21. > :04:25.time-limited and not permandnt. The most important change that hs needed
:04:26. > :04:31.is a changing culture within all responsible services at all levels
:04:32. > :04:34.and this includes making le`rning disability a sustained priority
:04:35. > :04:38.Send their learning disabilhty is a priority is not the same as acting
:04:39. > :04:44.to end the discrimination which we all know exists. Could Ascot the
:04:45. > :04:47.Minister if it is time now to mandate reviews and to all deaths of
:04:48. > :04:56.people with learning disabilities on an ongoing basis and for thdse
:04:57. > :05:00.reviews to be scrutinised. To have any chance of success, this
:05:01. > :05:03.programme requires multi-agdncies sign up and commitment from all
:05:04. > :05:07.agencies and services that provide support for people with learning
:05:08. > :05:10.disabilities and this is a comprehensive review of the
:05:11. > :05:16.circumstances leading to thd death of any individual person can be
:05:17. > :05:20.thought about fully. I have another question for the Noble Lady. Can the
:05:21. > :05:24.Government give a clear message to local authorities and social care
:05:25. > :05:31.agencies that they staff must be released to contribute to rdviews of
:05:32. > :05:35.death is. -- reviews of death. We already know a lot about
:05:36. > :05:38.contributing factors may nedd to go beyond just identifying what has
:05:39. > :05:42.gone wrong into making changes in practice. There is no point review
:05:43. > :05:49.deaths of subsequent changes to reduce premature deaths are
:05:50. > :05:51.inadequately resourced. I ask what can people with learning
:05:52. > :05:54.disabilities and their families expect from Government in tdrms of
:05:55. > :06:01.additional resources to prevent premature deaths and probably expect
:06:02. > :06:06.that? There are some urgent action is the Kabul and printed. I would
:06:07. > :06:10.like is to empower people whth learning disabilities themsdlves by
:06:11. > :06:14.assuring they have a better understanding of the health issues
:06:15. > :06:20.that affect them personally. I spoke about this in a debate on the role
:06:21. > :06:25.of libraries in independent book shops and mentioned the importance
:06:26. > :06:30.of reading to help with understanding. People with learning
:06:31. > :06:34.disabilities need access to information. They require vhsual
:06:35. > :06:38.methods of communication to help enable people to demonstratd their
:06:39. > :06:43.understanding, their wishes, and their capacity to consent. Laking it
:06:44. > :06:49.easier for health professionals to be able to use the mental c`pacity
:06:50. > :06:55.act. Sometimes understanding can lead to better outcomes, just as it
:06:56. > :07:00.can in literate people. An improvement in quality life removed,
:07:01. > :07:08.for example. As found a recdnt study at University of Hertfordshhre,
:07:09. > :07:15.having just their own need to understand these advocates can
:07:16. > :07:18.deliver training. Positive non-discriminatory attitude should
:07:19. > :07:22.be assessed and universities and trusts because they are the core
:07:23. > :07:29.skills and attitudes needed by all staff, not just doctors and nurses
:07:30. > :07:33.but dentists, receptionists as well. I believe that these skills will
:07:34. > :07:37.only be acquired through direct contact with people with le`rning
:07:38. > :07:44.disabilities. The learning disabilities core skills edtcation
:07:45. > :07:49.and training framework, is hugely welcome. So is the work of the GMC
:07:50. > :07:53.that has been developing totrs for doctors and I've contributed to this
:07:54. > :07:56.myself. Mencap has developed training within the framework which
:07:57. > :08:03.is core delivered with people with a learning disability and thehr causes
:08:04. > :08:07.are oversubscribed already. Could I have my remarks by our skin how the
:08:08. > :08:12.Government, the Department of Health, and health education England
:08:13. > :08:17.will make sure that training is an absolute priority for trusts in
:08:18. > :08:24.universities. -- trusts and universities. What first drdw me to
:08:25. > :08:30.pick my name down for this debate was quite simply the fact that when
:08:31. > :08:34.it comes to any minority group that is interacting with any public
:08:35. > :08:38.service, particularly the hdalth service, if there is a commtnication
:08:39. > :08:42.problem decency problems and results. If you cannot access the
:08:43. > :08:47.system, you suddenly find ott you're not getting the best. The f`ct of
:08:48. > :08:53.the matter is that most forls of health care is based on a doctor
:08:54. > :08:57.talking to a patient. All of the groups, and the noble Barondss did
:08:58. > :09:02.took away some of the thunddr from my speech by pointing it out, all
:09:03. > :09:06.groups of problem with communication, what we would regard
:09:07. > :09:10.as normal conversational communication, suffer in terms of
:09:11. > :09:18.health care and interacting with all other bits of the state strtctures.
:09:19. > :09:24.When you start to look at this, looking at how you extract
:09:25. > :09:27.information from the patient to make sure you get appropriate trdatment
:09:28. > :09:32.and reaction is bound to be more difficult and if you know you're
:09:33. > :09:38.going to interact with this you must have some way of correcting this.
:09:39. > :09:44.Otherwise you are guaranteehng a level of failure. There are various
:09:45. > :09:48.bits of legislation going through and if everything worked correctly
:09:49. > :09:52.I'm sure the noble Baroness will not have bothered having this ddbate. It
:09:53. > :09:59.is clear that they are not. You can go back to contributing factors like
:10:00. > :10:02.lifestyle. It is difficult to get people with learning disabilities
:10:03. > :10:05.into things like sports and activity because that is not a structure for
:10:06. > :10:13.them. This leads to other hdalth problems later on. But if wd're only
:10:14. > :10:17.talking that interface with the GP, or possibly in Norris or
:10:18. > :10:22.receptionist, and the noble Baroness was very bright to mention those two
:10:23. > :10:28.are the gatekeeper to the sdrvice, unless there is training to do this
:10:29. > :10:33.you are good to have problels. If you do not have generalised
:10:34. > :10:37.training, you must have somd awareness that means that pdrson
:10:38. > :10:45.must know when they should back off and call the expert. Possibly you
:10:46. > :10:49.need both. The idea that yot think it is acceptable to say I nded help
:10:50. > :11:04.and support and it does not go against you. You are in a job,
:11:05. > :11:10.you're supposed to be dealing with a person, do I have the authority
:11:11. > :11:12.right to ask for extra help to do with the situation? In many
:11:13. > :11:21.situations to do that underlines your professional competencd, quite
:11:22. > :11:23.fundamentally. Unless you allow this to happen, you're not going to get
:11:24. > :11:26.the best outcomes. People l`ugh and get through, it is a natural
:11:27. > :11:29.reaction, we have all done ht to some extent. The fact that xou want
:11:30. > :11:32.to cover up of the fact that you are having a problem doing something
:11:33. > :11:35.you'd expected to do. Unless you can call its expertise, or know it is OK
:11:36. > :11:41.to Colin expertise, you're going to have problems. I could go on for a
:11:42. > :11:46.considerable length of time about this but at this time of night and
:11:47. > :11:54.with a more interesting maiden speech on its way I will kedp my
:11:55. > :12:01.remarks short. Unless being raised the idea -- unless we embrace the
:12:02. > :12:08.idea of calling in expertisd and it is naked -- and making it acceptable
:12:09. > :12:11.to do so we will continue to have these problems. These probldms are
:12:12. > :12:15.only one manifestation of this and it will not just be in the health
:12:16. > :12:20.service, it is within all the services the lead up to continuing
:12:21. > :12:26.conditions are stress and mdntal health. Trying to get a good example
:12:27. > :12:30.from the Department of Health about this would be a simple step forward
:12:31. > :12:35.and giving some assurance that it is acceptable and required, yot have
:12:36. > :12:42.that flexibility, would be something very good to hear tonight. Before
:12:43. > :12:49.addressing the question before us tonight, can I join the Noble Lady
:12:50. > :12:52.in adding a few words about our new colleague who certainly would've
:12:53. > :12:59.been participating tonight was he still with us. The House is very
:13:00. > :13:06.much poorer having lost atthre is campaigner, who last book hdre in
:13:07. > :13:13.December during the welfare reform act despite his fealty. It hs
:13:14. > :13:16.appropriate to remember his campaigning on these issues. His
:13:17. > :13:24.daughter, who had Down's syndrome, inspired his life of activism,
:13:25. > :13:29.particularly for mencap in which I declare an interest as his vice
:13:30. > :13:35.president. He was a much loved actor and use that popularity to raise
:13:36. > :13:39.millions of pounds for the Royal mencap Society, becoming its general
:13:40. > :13:43.secretary in 1980 and it is chairman and president. After becoming a
:13:44. > :13:47.member of this House in 1992, he focused his attention on thd rights
:13:48. > :13:50.of people with learning difficulties and families, drawing on his own
:13:51. > :13:54.experience and that of tens of thousands of people that he met and
:13:55. > :13:59.helped. He was particularly concerned with the matters covered
:14:00. > :14:03.by the short debate. He spoke in Parliament debates on more than 300
:14:04. > :14:09.occasions and his focus was always on getting a voice to those too
:14:10. > :14:16.often ignored. He leaves thd much loved children, his wife passed away
:14:17. > :14:24.in 2013. There will be a trhbute event in the near celebrating his
:14:25. > :14:28.life and achievements. -- in the New Year. I now turn to the points
:14:29. > :14:38.raised by the Baroness in hdr opening speech. She has been a
:14:39. > :14:43.trailblazer over many years on these matters. It is clear that there is
:14:44. > :14:46.still much progress to be m`de and I look forward to the Minister
:14:47. > :14:51.providing this with an update on progress on tackling the prdmature
:14:52. > :14:55.death of people with learning disabilities. I speak to highlight
:14:56. > :14:58.the importance of training for health care professionals to improve
:14:59. > :15:02.health care outcomes for people with learning disabilities. This is
:15:03. > :15:06.something of critical importance to us in Wales and I have servdd on
:15:07. > :15:11.investigatory panels on these issues both in Wales and in England.
:15:12. > :15:15.Overcoming the national scandal of premature death among peopld with
:15:16. > :15:21.the learning disability reqtires a significant improvement in both the
:15:22. > :15:26.quantity and quality of trahning. This is among doctors, nursds and
:15:27. > :15:30.other care professionals. Workforce development, minimum standards for
:15:31. > :15:34.health care support and guidance for commissioners are all lacking and
:15:35. > :15:39.the Government must address the situation. I'm pleased that some
:15:40. > :15:43.progress is being made. Health education England and the skills for
:15:44. > :15:47.health and skills for care launched a learning disabilities chorus girls
:15:48. > :15:53.education and training framdwork, that is quite a mouthful, in July.
:15:54. > :15:58.The framework provides the knowledge and skills needed for those
:15:59. > :16:01.delivering training to help them care professionals. Mencap have
:16:02. > :16:05.adopted the framework to develop training currently being called a
:16:06. > :16:11.liver by people with a learning disability, which has been piloted
:16:12. > :16:14.with the NHS. This is welcole and underscores but the capabilhty of
:16:15. > :16:17.people with learning disabilities and the vital importance of
:16:18. > :16:25.including them in the delivdry of services. This training foctses on
:16:26. > :16:28.identifying learning disability developing communication skhlls and
:16:29. > :16:33.highlighting the importance of reasonable adjustments such as
:16:34. > :16:35.longer appointment times and accessible information. May I
:16:36. > :16:40.congratulate the Baroness on her work chairing a group supported by
:16:41. > :16:44.the General medical Council, the Nursing and Midwifery Counchl and
:16:45. > :16:48.health education England whhch is looking at how good practicd can be
:16:49. > :16:51.promoted so that all medical students and current staff received
:16:52. > :16:58.the training they need to bdtter equip them to support peopld with
:16:59. > :17:05.learning disabilities. I call on the Minister in his response, and her
:17:06. > :17:10.response to commit to ensurhng that this framework is widely adopted and
:17:11. > :17:14.best practice is spread. Without all health care professionals of
:17:15. > :17:18.receiving appropriate trainhng, people with a learning disability
:17:19. > :17:23.will continue to be let down and premature deaths will continue to
:17:24. > :17:29.occur. This is a very seriots matter and it requires a serious rdsponse.
:17:30. > :17:35.My Lords, growing up during the Cold War, this Parliament was a beacon of
:17:36. > :17:40.hope, freedom and democracy in a world struggling against
:17:41. > :17:45.totalitarianism and war. I never could have imagined that I would be
:17:46. > :17:49.part of it one day, so it is an honour to address your Lordships for
:17:50. > :17:52.the first time, and I would like to congratulate the noble Baroness
:17:53. > :17:58.Hollins for bringing this vdry important matter to your Lordships'
:17:59. > :18:01.attention this evening. Although introduced to your Lordships'
:18:02. > :18:05.chamber last year, I was not permitted to speak until now, and
:18:06. > :18:10.whilst I can see the attraction of a fully voting but silent peer from
:18:11. > :18:14.before you today with those days before you today with those days
:18:15. > :18:21.firmly behind me. I am deeply indebted to both Mike sponsors, to
:18:22. > :18:25.buy noble friends, Baroness Rawlings and Lord Fells of Elstree, for their
:18:26. > :18:32.support, wisdom and friendship over many years. And I wants to page of
:18:33. > :18:35.you to my wonderful mental, my wonderful friend Lord Sherbtrne to
:18:36. > :18:39.the officials of this house, and as well as your Lordships on all sides
:18:40. > :18:45.of the chamber, for the kindness and patience you have shown me over
:18:46. > :18:49.these past months. My lords, my first political memory was of the
:18:50. > :18:54.Falklands War, when I was tdn years old. My father was working for the
:18:55. > :19:00.then Foreign Secretary my noble friend Lord Carrington, a mtch loved
:19:01. > :19:05.and respected member of this house. His resignation taught me mx first
:19:06. > :19:10.lesson in politics, that political lives, even of the best of ts, are
:19:11. > :19:16.precarious things. The resignation of another good man brings le to
:19:17. > :19:20.this chamber today. I am imlensely proud to have served David Cameron
:19:21. > :19:24.for six years when he was Prime Minister, and five years as Leader
:19:25. > :19:30.of the Opposition, and I pax tribute to all he achieved for our country,
:19:31. > :19:35.in mending our broken econoly, creating many new good schools, in
:19:36. > :19:41.meeting our commitment of 2$ to our Nato allies, whilst not turning our
:19:42. > :19:48.back on the world's port, and most of all, and helping so many back to
:19:49. > :19:51.work in this country on a f`ir wage. Being part of the legislator is
:19:52. > :19:57.certainly a whole new thing for me, and now that I unable to sed it
:19:58. > :20:00.first hand, how your Lordshhps shape and improve legislation, as well as
:20:01. > :20:05.informing our country's deb`te, I'm still more honoured, and I very much
:20:06. > :20:11.look forward to playing my part in the future work of this house. My
:20:12. > :20:13.lords, I am the daughter of an American mother and a
:20:14. > :20:18.diplomat. I admit to being ` diplomat. I admit to being `
:20:19. > :20:24.hereditary Atlanta's it, and I dedicated some of my early career to
:20:25. > :20:32.the transatlantic relationship. -- Atlantacist. I work at the founding
:20:33. > :20:34.director of the white partisan think tank Atlantic Partnership. Ly
:20:35. > :20:38.father's generation were thd Cold father's generation were thd Cold
:20:39. > :20:40.War warriors, many of him sht on both sides of this house today, so
:20:41. > :20:44.my upbringing taught me somdthing else, which is that we must fight
:20:45. > :20:49.for the values that we hold dear, and they can never be taken for
:20:50. > :20:54.generation to safeguard what is generation to safeguard what is
:20:55. > :21:00.precious to us, otherwise, we will have failed in our duty. For there
:21:01. > :21:05.on the values of a society than how on the values of a society than how
:21:06. > :21:11.we treat our most vulnerabld, which is why I am pleased to speak briefly
:21:12. > :21:15.in this debate today. My Lords, there are some amongst us who
:21:16. > :21:18.dedicate their lives to the care of those with learning disabilhties,
:21:19. > :21:24.like my wonderful sister, and so many other mothers, fathers,
:21:25. > :21:29.siblings, carers, as well as teachers in specialist schools like
:21:30. > :21:35.the one where I was a governor for years. We owe them our respdct and
:21:36. > :21:41.our gratitude. We take great pride as a nation in our National Health
:21:42. > :21:44.Service. That it is available to all, and free fall. And we hope that
:21:45. > :21:52.everyone is treated with kindness and humanity, and, my lords, treated
:21:53. > :21:55.as equals. And yet, the tragedy of the original Mencap study that
:21:56. > :22:01.prompted this debate today hs that there are not always, there is not
:22:02. > :22:05.always a quality of care, at least not for the six men and womdn with
:22:06. > :22:11.were judged premature in thd were judged premature in thd
:22:12. > :22:16.original report. And at the crux, the crux of the problem, thdre seems
:22:17. > :22:20.to lie a simple truth. Thosd with learning disabilities often struggle
:22:21. > :22:26.with the system when they most need it, often because they are `fraid or
:22:27. > :22:31.confused, can't explain what is wrong, and have many medical
:22:32. > :22:35.problems in the first place, and so there are issues with diagnosis
:22:36. > :22:39.then with the treatment, and sometimes, my lords, let's face it,
:22:40. > :22:46.a solution is made about wh`t sort of care they should or should not
:22:47. > :22:48.receive. These problems takdn together put those with learning
:22:49. > :22:55.disabilities at a serious disadvantage. Sir Jonathan Lichael,
:22:56. > :22:59.the chair of the independent enquiry, put it very well when he
:23:00. > :23:04.said, I have learned that epual does not mean the same, and that
:23:05. > :23:08.reasonable adjustments that are needed to make services equ`lly
:23:09. > :23:14.accessibility people with ldarning disabilities are not partictlarly
:23:15. > :23:18.adjustments, my Lords, to s`ve adjustments, my Lords, to s`ve
:23:19. > :23:23.lives. My lords, I commend the work of all those who seek progrdss in
:23:24. > :23:28.this area, and would ask th`t we do not take our eye off the ball. We
:23:29. > :23:33.owe it to the vulnerable amongst us, to their families and friends, and
:23:34. > :23:39.to our society as a whole, to be the best we can.
:23:40. > :23:47.My Lords, the honour and grdat pleasure of following my noble
:23:48. > :23:50.friend Baroness Fall falls to me from these benches, to welcome her
:23:51. > :23:55.warmly in the name of the whole house, and to congratulate her on
:23:56. > :24:02.her remarkable maiden speech. It was outstanding by any standards, from
:24:03. > :24:10.Moscow to the Lords. This does not come as a surprise to anyond who
:24:11. > :24:15.knows the noble Baroness, as her CV hardly begins to do her justice
:24:16. > :24:19.Early on in her career, aftdr having excelled at Oxford, she stedred me
:24:20. > :24:24.through many difficult negotiations after the fall of the Berlin Wall,
:24:25. > :24:30.the act session of Austria, Finland and Sweden into the European Union,
:24:31. > :24:37.-- the accession, extending the Fulbright scholarship progr`mme and
:24:38. > :24:40.much more. But it is not just her dedication which distinguishes her,
:24:41. > :24:46.but also her other special qualities, of loyalty, humility
:24:47. > :24:53.astuteness, style, intelligdnce and genuine care for others. Thdse
:24:54. > :24:58.qualities were revealed between the lines in her excellent and
:24:59. > :25:03.interesting maiden speech. We all hope that she will play a prominent
:25:04. > :25:07.part now in your Lordships' house, and that we shall hear a grdat deal
:25:08. > :25:14.more from her in the future and this many other subjects. Before making
:25:15. > :25:18.my modest contribution, I too would like to thank the noble ladx,
:25:19. > :25:24.Baroness Holland is, for introducing this debate. I started my c`reer
:25:25. > :25:33.working for the London County Council in Stepney, Bow and Poplar,
:25:34. > :25:37.for the Children's Care Comlittee, then trained LA nurse with the Red
:25:38. > :25:42.Cross, hence my interest in this debate. My Lords, people with
:25:43. > :25:45.learning disabilities experhence, as we have heard, worse results,
:25:46. > :25:51.significantly worse results, than the rest of the population. Bristol
:25:52. > :25:59.University's confidential enquiry that the noble Baroness, Lady
:26:00. > :26:03.Hollins, mentioned earlier, from 2010 until 2012, into the ddaths of
:26:04. > :26:11.247 people with learning disabilities, discovered th`t men
:26:12. > :26:16.with learning disabilities died on average 13 years sooner than men in
:26:17. > :26:24.the general population. And women with learning disabilities died 20
:26:25. > :26:29.years sooner too. These studies show the urgent need to improve practice
:26:30. > :26:33.within the National Health Service. I therefore welcome all efforts that
:26:34. > :26:41.the NHS is making to tackle the mature mortality amongst people with
:26:42. > :26:45.a learning disability. -- premature mortality. I wish to mention two
:26:46. > :26:50.learn lessons about how to hmprove learn lessons about how to hmprove
:26:51. > :26:57.on these results. The Clinical Commissioning Group Assessmdnt And
:26:58. > :27:01.Improvement Framework was l`unched in March. It includes two indicators
:27:02. > :27:05.on disability, reliance on special in patient care, and the proportion
:27:06. > :27:13.of people and GP learning dhsability registers receiving an annu`l health
:27:14. > :27:18.check. I hope this will enable us to see clearer how Clinical
:27:19. > :27:23.Commissioning Group 's are performing. In March 2015, the
:27:24. > :27:29.National Health Service and commissioned the learning
:27:30. > :27:34.disabilities mortality revidw programme, a programme which aims to
:27:35. > :27:39.support local and regional `reas, conduct reviews of deaths of people
:27:40. > :27:46.with learning disabilities, and implement the recommendations and
:27:47. > :27:51.plans of action. My Lords, H hope the minister might be able to
:27:52. > :27:54.address these viewpoints, and that they will contribute to alldviating
:27:55. > :28:00.the unhappiness and stressed that this causes for families. -,
:28:01. > :28:04.unhappiness and stress. My Lords, I would like to
:28:05. > :28:07.congratulate the noble lady, Baroness Hollins, for securhng this
:28:08. > :28:11.debate, and for being such ` tireless champion for the rhghts of
:28:12. > :28:16.people with learning disabilities to receive the same access to, and
:28:17. > :28:22.quality of, health care as the rest of the population takes for granted.
:28:23. > :28:26.My Lords, I would also like to congratulate the noble lady,
:28:27. > :28:30.Baroness Fall on her excelldnt Baroness Fall on her excelldnt
:28:31. > :28:34.maiden speech. I am sure we will be hearing many more from her. And I
:28:35. > :28:37.would like to associate mysdlf with the very fulsome tributes p`id,
:28:38. > :28:43.quite rightly and quite movhngly, to our late colleague, the noble Lord,
:28:44. > :28:49.Lord Rix. As we have alreadx heard from Baroness Hollings, the 213 --
:28:50. > :28:53.2013 confidential enquiry into the deaths of people with learnhng his
:28:54. > :28:58.abilities was set up to invdstigate the avoidable or premature deaths of
:28:59. > :29:02.people with learning disabilities through a series of retrospdctive
:29:03. > :29:05.reviews. And if noble Lords will forgive me
:29:06. > :29:11.for one moment for just repdating several statistics, which I know
:29:12. > :29:13.people in the chamber tonight will be familiar with, because they are
:29:14. > :29:18.passionately concerned with this issue, but which I think thdir
:29:19. > :29:24.repetition, because in a wax, they say it all. We have already heard
:29:25. > :29:28.from the noble lady Baroness Rawlings, which I consider the
:29:29. > :29:32.absolutely stocking statisthcs that men with learning disabilithes died
:29:33. > :29:36.on average 13 years sooner than men in the general population, `nd women
:29:37. > :29:41.with learning disabilities died 20 years sooner than women in the
:29:42. > :29:47.general population. My Lords, overall, 22% of those peopld were
:29:48. > :29:51.under the age of 50 when thdy died. My Lords, these are not just dry
:29:52. > :29:55.statistics. They are deeply, deeply shocking. My Lords, they ard in my
:29:56. > :30:01.view nothing short of a nathonal disgrace. And perhaps the most
:30:02. > :30:07.shocking of all of these st`tistics, the confidential enquiry, found that
:30:08. > :30:12.37% of deaths would have bedn potentially avoidable if good
:30:13. > :30:18.quality health care had been provided. And as so often h`ppens,
:30:19. > :30:22.when you start to delve down into statistics, the situation across the
:30:23. > :30:26.country, of course, is very variable. Indeed, an independent
:30:27. > :30:31.review of deaths of people with learning disability or ment`l health
:30:32. > :30:36.problems in contact with Sotthern Health Trust Foundation Trust
:30:37. > :30:41.between 2011 and 2015, commhssioned by NHS England, found a number of
:30:42. > :30:45.serious failings. These included that the trust had no effective way
:30:46. > :30:52.of reporting investigating `nd learning from deaths. It also found
:30:53. > :30:55.that whilst 30% of deaths in adult mental health services were
:30:56. > :31:04.investigated, only 1% of those people with learning disabilities
:31:05. > :31:09.were investigated. 1%, my Lords So, my lord, what are we to makd of the
:31:10. > :31:15.statement made by the former chief executive of Southern Health Trust,
:31:16. > :31:18.who said, and I quote, "We believe that Southern Helmand Will Toggle's
:31:19. > :31:25.Rate Of Investigations Into Debt Is In Line With Similar Nhs
:31:26. > :31:28.Organisations. . -- we belidve that Southern Health Trust rate of
:31:29. > :31:31.investigations. One of the key recommendations of the 18
:31:32. > :31:35.recommendations, as we have already heard from the Cumberland shall
:31:36. > :31:40.enquiry, with the establishlent of a national learning disabilitx
:31:41. > :31:44.the review programme, commissioned the review programme, commissioned
:31:45. > :31:47.again by NHS England, is to support local areas to review the ddaths of
:31:48. > :31:52.people with learning disabilities and take forth the lessons learned,
:31:53. > :31:55.in order to improve services. Absolutely, I am sure we all think
:31:56. > :31:59.that is what should happen. So far, so good. But, and it is a point
:32:00. > :32:06.already referred to by the noble Baroness, participation in the
:32:07. > :32:10.programme is not mandatory, so unlike the child death revidw
:32:11. > :32:13.process, and indeed, many other enquiries, agencies can choose
:32:14. > :32:17.whether or not to contributd to the review of deaths of people with
:32:18. > :32:20.learning disabilities, and H guess it is understandable in the current
:32:21. > :32:27.financial climate that many organisations are only choosing to
:32:28. > :32:29.do what they have to do will. Giving it a mandatory stasis in my view
:32:30. > :32:33.would undoubtedly raise the profile of the work and show that the lives
:32:34. > :32:37.and deaths of people with ldarning disabilities are valued. I think
:32:38. > :32:42.that is the crux of what we're talking about tonight.
:32:43. > :32:48.I know there are also concerns about the sustainability of local reviews
:32:49. > :32:55.of deaths of people with le`rning disabilities. In responding, could
:32:56. > :33:00.the Noble Lady the Minister update the House on the reviews ovdrall
:33:01. > :33:04.progress and also say whethdr she agrees that if we really want to
:33:05. > :33:07.stop people with learning disabilities from dying prelaturely
:33:08. > :33:12.because they are not getting good quality health care bendy mdtallic
:33:13. > :33:20.to review should have a mandate today rather than optional status.
:33:21. > :33:27.On a related issue of sustainability, the Public Health
:33:28. > :33:30.England Observatory, set up in the wake of the independent inqtiry was
:33:31. > :33:34.established to keep watch on the help of people with learning
:33:35. > :33:40.disabilities and the health care they receive. It also provides data
:33:41. > :33:44.information and advice to commissioners, families and people
:33:45. > :33:48.with learning disabilities `bout good practice and local performance
:33:49. > :33:53.in achieving improvement. The current funding for the Obsdrvatory
:33:54. > :33:59.is only guaranteed until March 000 17. What assurances can the Minister
:34:00. > :34:05.gave that funding will conthnue to be available for the vital work that
:34:06. > :34:14.the Observatory is carrying out My Lord's my thanks to the Baroness for
:34:15. > :34:17.introducing this debate. Shd is right to speak about the
:34:18. > :34:24.inequalities faced by indivhduals with learning difficulties `nd we
:34:25. > :34:30.should aim to make sure that disability is not a barrier help. We
:34:31. > :34:36.need to make sure that we hhghlight it at every opportunity as `
:34:37. > :34:42.necessity that everyone can access the same health benefits as the rest
:34:43. > :34:47.of the population. At this point I would like to congratulate ly noble
:34:48. > :34:51.friend for her thoughtful and eloquent maiden speech tonight. I
:34:52. > :35:02.also wanted to declare my interest as set out in the registry that I am
:35:03. > :35:07.the vice care of the care alliance and sustainability health Committee.
:35:08. > :35:12.We heard earlier from the B`roness in her opening speech regarding
:35:13. > :35:20.performance of people suffering from learning disabilities. Sadlx we have
:35:21. > :35:26.20 of people with learning disabilities were under the age of
:35:27. > :35:34.50 when they died. I welcomd NHS England attempting to close the
:35:35. > :35:38.health gap of inequalities by 2 20. We have to ensure and work to
:35:39. > :35:46.continue support for and turning a skilled workforce and welcoling back
:35:47. > :35:49.experience social workers. Training and education is so important to
:35:50. > :35:59.give staff the competence and confidence. We need good partnership
:36:00. > :36:02.working to challenge complex behaviour and to reduce admhssions
:36:03. > :36:08.to hospital 's as they support individuals. Do not forget their
:36:09. > :36:12.families during the journey from childhood to adulthood and hnto old
:36:13. > :36:17.age. And please the Governmdnt have said they want to build on the
:36:18. > :36:27.achievements and skills of the current public health force. So far
:36:28. > :36:34.we have a well trained and lotivated workforce. The saying is, m`ke it
:36:35. > :36:38.happen. Stop bad practice and strife are excellent practice.
:36:39. > :36:43.Unfortunately there are gaps there are too many people with le`rning
:36:44. > :36:49.disabilities can be found in an appropriate patient settings and
:36:50. > :36:52.staying longer than necessary. We can all remember the hospit`l
:36:53. > :37:03.tributes that we do not want to see again. -- the hospital abusd. Some
:37:04. > :37:07.inpatient care can be good. Disabled people want and desire the same
:37:08. > :37:14.thing. They want homes rathdr than hospitals. The hospital must aim for
:37:15. > :37:18.everyone with a learning disability to have an annual health chdck
:37:19. > :37:27.together with the personal plan There is still a long way to go I
:37:28. > :37:31.am pleased there are more pdople in receipt of a personal payment to
:37:32. > :37:37.lead them to have greater choice and control over how they live their
:37:38. > :37:42.lives, to be more creative `s individuals. A light touch for
:37:43. > :37:46.support but with good outcoles. By helping individuals to have access
:37:47. > :37:52.to activities unemployment hn North Lincolnshire we are seen an increase
:37:53. > :37:55.of five points 3% of people with complex learning disabilitids in
:37:56. > :38:01.paid employment as well as opportunities to engage a l`rger
:38:02. > :38:07.circle of friends. We have seen in new purpose-built House in the
:38:08. > :38:11.scheme partnered with the local housing association supporthng
:38:12. > :38:16.people who are far from thehr families or have moved from a
:38:17. > :38:21.residential setting and are now living and independent life in their
:38:22. > :38:27.own homes. If I may, added like to highlight Mary's story. Marx has a
:38:28. > :38:32.learning disability and livds with her elderly parents and has a
:38:33. > :38:37.voluntary work placement. She was unhappy and felt isolated from her
:38:38. > :38:41.community and she wanted to make friends and build confidencd. The
:38:42. > :38:47.service listen to what she said she wanted to do and supported her
:38:48. > :38:54.goals. She has never applied for any benefits and with supported help she
:38:55. > :39:01.applied for them. She attended a healthy cooking and eating session
:39:02. > :39:06.and a music club with in her area. Mary is now going to local
:39:07. > :39:11.activities independently and more importantly, she is making friends.
:39:12. > :39:16.I am pleased my counsel togdther with other local authorities who
:39:17. > :39:19.have also joined the changing places national campaign to improvd access
:39:20. > :39:27.to public toilet facilities for people of all ages with profound
:39:28. > :39:31.disability. As access to tohlet facilities for disabled people is
:39:32. > :39:36.the key barrier to their participation in community life
:39:37. > :39:42.Building the right support to make sure it young people and adtlts with
:39:43. > :39:46.learning disabilities, autism, have the same opportunities as everyone
:39:47. > :39:52.else to lead satisfying and viable lives and are treated with dignity
:39:53. > :39:59.and respect. We all have to do more to raise the bar. I welcome the
:40:00. > :40:02.Government's increase support to achieve those outcomes and H look
:40:03. > :40:13.forward to further updates from the Minister. I thank the Barondss for
:40:14. > :40:18.bringing the debates and pax tribute to late member. I would likd to
:40:19. > :40:27.share some information about the individuals we support. We have
:40:28. > :40:34.supported over 450 people whth learning disabilities across
:40:35. > :40:40.England. They experience varies greatly across the country. There
:40:41. > :40:44.are some representatives from a service that shows that while some
:40:45. > :40:53.progress has been made more needs to be done. It is a reality chdck. The
:40:54. > :40:57.people we support experiencds and hospitals we find we still have to
:40:58. > :41:02.question do not attempt resuscitation orders for people we
:41:03. > :41:08.support. The people we support find that they health care provision
:41:09. > :41:13.varies across the country whth gaps. The people we support struggle to
:41:14. > :41:18.get fixed time GP appointments, particularly for people with autism
:41:19. > :41:27.or behavioural challenges. The people we support find their well
:41:28. > :41:31.brewing needs filtered by pdople using expressions like health wants
:41:32. > :41:36.and needs in their reviews. At the end of life, the people we support
:41:37. > :41:42.experience delays in being `ssessed for different needs as their needs
:41:43. > :41:47.change. The people we support, we were glad to join Warwickshhre
:41:48. > :41:51.Council in a review that gives information and advice around health
:41:52. > :41:56.and well-being and helps improve access to health and well-bding
:41:57. > :42:01.services. To our knowledge this kind of provision is quite uniqud. We are
:42:02. > :42:05.also seeing the impacts of funding cots and these have been colpounded
:42:06. > :42:14.by the increased cost of delivery. -- funding cuts. Commissiondrs
:42:15. > :42:17.continued to reduce budgets and as a result they faced difficult
:42:18. > :42:24.decisions to cut the servicds to those we are here to support. The
:42:25. > :42:31.number of people requiring support continued to be those bearing the
:42:32. > :42:34.brunt. In Britain is import`nt make sure people are safe and hydrated
:42:35. > :42:38.but this is deemed an offer many areas. People with learning
:42:39. > :42:44.difficulties must get the s`me kind of care is everybody else and they
:42:45. > :42:48.should receive the same levdl of determination from the Government to
:42:49. > :42:52.lead the changes required. Change this to happen faster to improve the
:42:53. > :42:57.health care of people with learning disabilities everywhere. It is a
:42:58. > :43:01.case that more funding for social care is needed to ensure disability
:43:02. > :43:11.services are able to offer lore than the bare minimum. Like the Noble
:43:12. > :43:20.Lady, all of us on these benches very much mess the late Lord of
:43:21. > :43:25.Whitehall. We miss his expertise on subjects like this. We missdd the
:43:26. > :43:31.inspiration that he gave to us because of that work and we miss his
:43:32. > :43:35.wonderful sense of humour. Therefore I thank the noble Baroness for what
:43:36. > :43:41.she said about him and we all agree with her. I also want to th`nk her
:43:42. > :43:47.for initiating this debate. She has been consistent in her scrutiny on
:43:48. > :43:51.this issue, having wasted every year since the confidential inquhry into
:43:52. > :43:57.the premature deaths of people with learning disabilities reported in
:43:58. > :44:01.2013. That this is necessarx demonstrate is the enormity of the
:44:02. > :44:04.challenge of making sure th`t people with a learning disability have
:44:05. > :44:09.equal access to health care which caters their particular needs and
:44:10. > :44:15.ensures that the reasonable adjustments that should be lade for
:44:16. > :44:19.them are made. I would like to congratulate the noble Baroness for
:44:20. > :44:29.her excellent maiden speech and her use of the word equality. A quality
:44:30. > :44:34.does not mean the same as epual Equality of opportunity to dnjoy
:44:35. > :44:40.good health and good treatmdnt is what we should be aiming for.
:44:41. > :44:45.Progress has been too slow `nd headway is required from thd noble
:44:46. > :44:50.Baroness and her Government. I would like to raise, in particular, the
:44:51. > :44:56.need to reverse the trend of falling numbers of learning disabilhty
:44:57. > :45:01.nurses. The Royal College of Nursing report says that the total number of
:45:02. > :45:08.learning disability nurses hn the NHS has fallen by nearly ond third
:45:09. > :45:14.since 2010, a reduction of 0726 Equally worrying is the fact that
:45:15. > :45:21.more senior nurses have been lost then any other in this dischpline.
:45:22. > :45:27.If 40% reduction. We need ntrses to be seasoned and expert and
:45:28. > :45:31.particularly in this discipline The current Government has decided over
:45:32. > :45:35.a reduction in expertise and quantity. Can the noble Baroness the
:45:36. > :45:41.ministers say how her department is planning to correct that. Ldarning
:45:42. > :45:47.disability nurses provide much-needed advocacy and support and
:45:48. > :45:51.are a key tie into social c`re. They speak in the interests of pdople
:45:52. > :45:55.with a learning disability. They provide assistance to carers and
:45:56. > :46:01.family members and give much-needed advice and support to doctors. The
:46:02. > :46:06.case that is in the report, which I found extremely moving, shall
:46:07. > :46:11.clearly what happens when this help is not available. My Lords ht cannot
:46:12. > :46:15.be right there with 1.4 million people with a learning disability,
:46:16. > :46:20.more of whom I now diagnosed earlier in life and live longer and possess
:46:21. > :46:27.complex needs, that support available only for five years ago is
:46:28. > :46:30.no longer available. This f`ll in the numbers of professionals also
:46:31. > :46:38.means that people with a le`rning disability face a lottery as to
:46:39. > :46:43.hospital coverage. In 2014 lencap found that few hospitals have
:46:44. > :46:47.full-time cover and some have none at all. This sometimes means that
:46:48. > :46:53.people with learning disabilities are unable to make their pahn now to
:46:54. > :46:58.those who are treating them. They may not have a traffic light card or
:46:59. > :47:04.a hospital passport type document. These have proved useful to so many.
:47:05. > :47:08.There are several examples of that in the report. The also become
:47:09. > :47:15.confused in a strange environment and among people who are not known
:47:16. > :47:18.them. Their car or may not be able to send somebody with them because
:47:19. > :47:23.of the pressures they face. That is why we need the special nurses.
:47:24. > :47:28.While learning disability ntrses are important, so to is the trahning of
:47:29. > :47:32.other health and care staff. We cannot and should not leave
:47:33. > :47:37.everything up to the learning disability nurses, not least because
:47:38. > :47:42.of their dwindling numbers. Doctors and nurses and other care
:47:43. > :47:45.professionals need an understanding of learning disability and
:47:46. > :47:50.conditions such as altars and mental health problems which might also be
:47:51. > :47:54.a barrier to communication. Understanding how to communhcate in
:47:55. > :48:01.both directions is vital to ensuring that patients understand procedure
:48:02. > :48:04.is, diagnosis and importantly what to do following operations `nd
:48:05. > :48:08.consultations about their own care and medicines.
:48:09. > :48:13.I am heartened to hear about the good work happening in St Gdorge 's,
:48:14. > :48:17.and am looking forward to hdaring how the government and NHS Dngland
:48:18. > :48:21.will promote that good practice People with a learning disability
:48:22. > :48:27.also need more support, and a proactive policy to ensure they lead
:48:28. > :48:31.healthy lives. Annual health checks can uncover underlying condhtions,
:48:32. > :48:36.yet as we've heard, less th`n half of people with a learning dhsability
:48:37. > :48:41.receive them. Accessibility donation can empower people with a ldarning
:48:42. > :48:44.disability to take control of their health, so we need that, soletimes
:48:45. > :48:49.with pictures to help the understanding. The NHS accessibility
:48:50. > :48:54.made in standard, launched this summer, could not be more thmely,
:48:55. > :48:58.and I wish it well. My Lords, action is urgent to ensure that no more
:48:59. > :49:03.people with a learning disability guide you to avoidable circtmstances
:49:04. > :49:07.-- die due to avoidable circumstances. The noble Baroness
:49:08. > :49:10.has been a champion in standing up for people with a learning
:49:11. > :49:14.disability and access to he`lth care, so I hope to hear much better
:49:15. > :49:19.news the next time she raisds this issue.
:49:20. > :49:25.I warmly welcome this debatd, and thank the noble Baroness for her
:49:26. > :49:31.excellent introduction. I would also very much congratulate
:49:32. > :49:35.the noble Baroness Lady Fall on her maiden speech. I hope she whll make
:49:36. > :49:39.up for her earlier enforced silence by speaking more often in the house.
:49:40. > :49:44.Perhaps she would look a little more kindly on their Lordships than in
:49:45. > :49:51.the position she did in her previous post. My Lords, what can ond say
:49:52. > :49:56.an extraordinary man he was. What an extraordinary man he was. What
:49:57. > :50:02.next ordinary Humanitarian. And above all, his passionate advocacy
:50:03. > :50:05.for people with learning disabilities is surely a be`con to
:50:06. > :50:12.us all, and I hope in this way tonight it is some small trhbute to
:50:13. > :50:17.him for all that he did for so many. My Lords, the noble Baroness, I
:50:18. > :50:23.thought, was very telling when she talked about too many peopld in
:50:24. > :50:26.health and social not listening to people with learning disabilities or
:50:27. > :50:31.people who know about peopld with learning disabilities, and when one
:50:32. > :50:38.looks at the issues that have been raised, the statistics that the
:50:39. > :50:43.noble Baroness raised, or the noble lady raised, the issues of the
:50:44. > :50:46.Southern Health Trust Eight And Trust, it seems to me that what is
:50:47. > :50:51.most striking, my Lords,, is the most striking, my Lords,, is the
:50:52. > :50:55.failure of so many bodies in health and social care to treat people with
:50:56. > :51:05.learning disabilities with ` sense of equality and respect. Thd report
:51:06. > :51:10.is really shocking in relathon to the Southern Health foundathon
:51:11. > :51:14.trust. They identified the lack of leadership, focus, and suffhcient
:51:15. > :51:19.time in the trust spent on carefully reporting and investigating an
:51:20. > :51:23.expected deaths. This, my Lords was then followed up by the Card Quality
:51:24. > :51:27.Commission, who found the trust failed to mitigate against the
:51:28. > :51:29.significant risks posed by some of the physical environments from which
:51:30. > :51:33.delivered mental health learning disability services. It did not
:51:34. > :51:37.operate effective governancd arrangements to ensure robust
:51:38. > :51:43.investigation of incidents hncluding deaths. Following those two reports,
:51:44. > :51:50.we then had the saga of the former chief executive being offerdd an
:51:51. > :51:58.same salary, and my Lords, she has same salary, and my Lords, she has
:51:59. > :52:02.now left. And I can't help being struck by whether underlying it was
:52:03. > :52:09.a board that actually did not accept those reports, and I don't know if
:52:10. > :52:14.the noble Baroness is able to say any more about it. It did sdem to me
:52:15. > :52:22.problem that the noble Baroness Lady problem that the noble Baroness Lady
:52:23. > :52:27.Hollings has suggested, and although I'm sure that many parts of health
:52:28. > :52:32.and social do their very best by people with learning disabilities,
:52:33. > :52:39.the cold statistic would suggest that we've got an awful long way to
:52:40. > :52:41.go before we can be satisfidd that actually, attitudes, policids and
:52:42. > :52:45.procedures are right for thdse procedures are right for thdse
:52:46. > :52:50.vulnerable people. In the thme available, I don't want to say very
:52:51. > :52:54.much more, but I do want to ask the noble Baroness three questions. The
:52:55. > :53:03.first relates to the key recommendations from the review of
:53:04. > :53:06.deaths, the 18 recommendations. My Lords, of course, she cannot go
:53:07. > :53:09.through all 18 recommendations tonight, but I wonder whethdr she
:53:10. > :53:14.would be able to write to noble Lords who have spoken in thhs debate
:53:15. > :53:16.to actually set out how the government considers the he`lth and
:53:17. > :53:22.social assistance, and indedd, the government itself, is actually
:53:23. > :53:28.responding to those 18 reports. And will she, in particular, pick up the
:53:29. > :53:32.points raised by the noble Baroness about whether the local acthon that
:53:33. > :53:39.NHS England has instituted, which is not mandatory, can be seen to be a
:53:40. > :53:39.response to the recommendathon of a national learning disabilitx
:53:40. > :53:44.mortality review body. I, mx Lords, mortality review body. I, mx Lords,
:53:45. > :53:52.don't think it can be unless there is a proper mandate shin of the NHS
:53:53. > :53:56.to take part in it. The second question comes back to the point the
:53:57. > :54:02.noble lady raised, about a national strategy. My Lords, do we h`ve a
:54:03. > :54:06.national strategy? If not, with the noble Baroness say how the
:54:07. > :54:13.government intends there should be a proper national strategy, n`tionally
:54:14. > :54:16.led, which would ensure that the kind of changes that need to happen
:54:17. > :54:23.are actually going to take lace Finally, can I ask, and funding -- I
:54:24. > :54:27.don't think funding is the only problem. I think attitudes `re
:54:28. > :54:31.actually much more important, but no one can deny the issue of a funding
:54:32. > :54:36.challenge in health and sochal at the moment, nor that despitd the
:54:37. > :54:39.government's intention that more money should be spent on mental
:54:40. > :54:44.health, it is quite clear that Clinical Commissioning Group 's are
:54:45. > :54:48.not going to do that. The rdason for that is that they are under intense
:54:49. > :54:51.pressure to balance the books, and it has become clear that balancing
:54:52. > :54:58.the books is trumping any other policy, so I think the further
:54:59. > :55:00.question I would like to put the noble Baroness is, essentially, what
:55:01. > :55:04.is going to happen to protect the funding of those services which
:55:05. > :55:13.actually impact directly on people with learning disabilities?
:55:14. > :55:19.My Lords, I congratulate thd noble lady, Baroness Hollings on securing
:55:20. > :55:23.this debate, on an issue of great importance that Israeli of concern
:55:24. > :55:28.to your Lordships, and indedd, to the government. I would likd to
:55:29. > :55:34.begin by paying tribute to the noble lady for her unfailing commhtment in
:55:35. > :55:36.highlighting the qualities, in experiences and poor outcomds are
:55:37. > :55:41.people with learning disabilities and their families have facdd for
:55:42. > :55:45.many years. And I echo her `nd other noble Lords in each of you to to
:55:46. > :55:50.to miss enormously. Can I also take to miss enormously. Can I also take
:55:51. > :55:57.this opportunity to congrattlate my noble friend, Baroness Fall for an
:55:58. > :56:01.excellent maiden speech. My noble friend is going to be a gre`t
:56:02. > :56:04.addition to this house, and I greatly look forward to my noble
:56:05. > :56:11.friend's contributions in the future. Also let me thank all noble
:56:12. > :56:16.Lords for their contributions this evening. My Lords, we know there are
:56:17. > :56:22.people young and old who did from what are often referred to `s
:56:23. > :56:26.avoidable and premature deaths. Deaths, I feel, we would all agree
:56:27. > :56:33.safety and the way in which people safety and the way in which people
:56:34. > :56:35.are treated were consistently good across the whole health card system.
:56:36. > :56:40.My Lords, the government is clear that lives of people of all ages
:56:41. > :56:46.with learning disabilities latter. We are working with partner
:56:47. > :56:49.organisations, professionals, people with learning disabilities, and
:56:50. > :56:55.their families, to respond to issues that I'm porting to, and have a big
:56:56. > :56:59.impact on, people's lives. We know that people with learning
:57:00. > :57:03.disabilities, as the Baroness mentioned in her speech, experienced
:57:04. > :57:06.significantly worse outcomes than significantly worse outcomes than
:57:07. > :57:11.the rest of the population. Our activity therefore extends beyond
:57:12. > :57:16.health and care and must also encompass education of health care
:57:17. > :57:20.housing. To this end, NHS England housing. To this end, NHS England
:57:21. > :57:28.has a wide-ranging programmd of work on learning disability, deshgned to
:57:29. > :57:31.transform care and improve outcomes, driving up the quality of clinical
:57:32. > :57:40.and nursing care and reducing health inequalities. The NHS five-xear
:57:41. > :57:43.forward view highlighted thd need to improve learning disability
:57:44. > :57:47.services, with the NHS drivhng improvements in culture and
:57:48. > :57:53.learning disabilities. To this end, learning disabilities. To this end,
:57:54. > :57:57.the NHS published a shared planning guidance in September, improving
:57:58. > :58:03.learning disability services, including reducing prematurd
:58:04. > :58:11.mortality, one of only nine must dos in the guidance, and in March, as
:58:12. > :58:19.the Baroness also mentioned in a speech, the Clinical Commissioning
:58:20. > :58:22.Group Assessment Service was lodged, which Ofsted like service whll allow
:58:23. > :58:26.us to see which Clinical Commissioning Groups are performing
:58:27. > :58:32.in key areas. It provides tde key indicators on learning disability,
:58:33. > :58:34.specialist inpatient care, `nd the proportion of people in GB learning
:58:35. > :58:38.disability registers receivhng an annual health check. Lord Htnt,
:58:39. > :58:46.Baroness Tyler, all talked `bout the Baroness Tyler, all talked `bout the
:58:47. > :58:52.NHS Foundation Trust, and mx goodness, there is lessons to learn
:58:53. > :58:56.from that. We have asked whdther issues raised in the report might be
:58:57. > :59:01.found on other providers across the country. The Care Quality Commission
:59:02. > :59:06.'s review into the investig`tion of deaths includes a sample of all
:59:07. > :59:09.types of NHS Trust in different parts of the country, and whll
:59:10. > :59:17.assess whether opportunity for the prevention of death has been missed,
:59:18. > :59:21.for example, because of latd diagnosis of fiscal health care
:59:22. > :59:29.problems. We expect the Card Quality Commission to publish the fhndings
:59:30. > :59:33.in December. In answer to B`roness Hollings' question, and Baroness
:59:34. > :59:37.Tyler's, about what the govdrnment is doing to provide full information
:59:38. > :59:42.on an ongoing basis order that trends in the age and cause of death
:59:43. > :59:47.disabilities can be monitordd, the disabilities can be monitordd, the
:59:48. > :59:53.Department of Health is working with Public Health England and NHS
:59:54. > :59:57.Digital, to address the lack of reliable data which is so ilportant
:59:58. > :00:02.so that the right decisions can be made for those with learning
:00:03. > :00:04.disabilities, and the health care professionals treating them. A
:00:05. > :00:08.number of approaches are behng considered, but this has bedn
:00:09. > :00:12.frustrating, with a lack of frustrating, with a lack of
:00:13. > :00:16.progress. However, noble Lords will be aware of the wider issues
:00:17. > :00:24.surrounding safe and secure use of health and care in, and the work
:00:25. > :00:27.undertaken by the National Data Guardian For Health Care, to insure
:00:28. > :00:33.that the public and make choices about how their data is used. The
:00:34. > :00:37.Department of Health run a public consultation on those proposals and
:00:38. > :00:42.is currently analysing responses received. In addition, the
:00:43. > :00:45.Department of Health sponsored a study in this area, undertaken by
:00:46. > :00:49.Public Health England, and the findings were published by The
:00:50. > :00:53.Journal Of The Stability Of Intellectual Research in July, and
:00:54. > :00:59.they indicate the extent of premature mortality and its causes.
:01:00. > :01:02.As the noble Lords have mentioned, people with learning disabilities
:01:03. > :01:06.have a life expectancy an average of approximately 20 years less than
:01:07. > :01:09.other people. Public Health England also publishes a digester the most
:01:10. > :01:17.up-to-date mortality statistics in the publication People With Learning
:01:18. > :01:24.Disabilities In England be 2016 edition of this will appear later
:01:25. > :01:28.this year. Baroness Hollings and Baroness Rawlings asked if ht is
:01:29. > :01:30.time to mandate reviews into the guessable people with learnhng
:01:31. > :01:39.disabilities, and actually, several noble Lords also mentioned this In
:01:40. > :01:43.the Learning Disability Mortality the Learning Disability Mortality
:01:44. > :01:50.Review Programme, which aims to support local and regional `reas,
:01:51. > :01:54.with learning disabilities, and with learning disabilities, and
:01:55. > :02:00.implement any recommendations of plans of action. Every NHS region is
:02:01. > :02:02.testing the review process, and by March 2019, we expect every area to
:02:03. > :02:07.establish a mortality review process.
:02:08. > :02:16.Moving on to drugs such as `n important point. Excessive tse of
:02:17. > :02:20.medication is known to be a factor in premature death of peopld with
:02:21. > :02:27.learning disabilities. Several royal colleges has signed a pledgd to stop
:02:28. > :02:33.overprescribing and are issting guidance for nurses and
:02:34. > :02:36.psychiatrists, providing accessible information on medication for people
:02:37. > :02:42.and their families and publhshing advice for prescribers. NHS England
:02:43. > :02:47.will look it primary care and the prescription of drugs to monitor
:02:48. > :02:53.progress nationally. As I mdntioned earlier, the NHS mandate includes
:02:54. > :03:00.the requirement to reduce hdalth inequalities for people with
:03:01. > :03:07.learning disabilities. The baroness is mentioned annual health checks. A
:03:08. > :03:11.key objective of this work hs to increase the number of people on
:03:12. > :03:17.primary care registers and to ensure as many of them as possible get an
:03:18. > :03:22.annual health check. The ambition is for 75% of people on GP reghsters to
:03:23. > :03:28.receive an annual health chdck by 2020. This includes standardised
:03:29. > :03:34.letters to improve advice and guidance given to people, pre-help
:03:35. > :03:40.check questionnaires, health check templates linked to people's care
:03:41. > :03:48.records, and health action planning, including a focus on key issues that
:03:49. > :03:54.require following up. NHS England is trying to improve care pathways for
:03:55. > :04:00.health conditions affecting people with a learning disability, such as
:04:01. > :04:08.diabetes, epilepsy and heart problems. Improving experience of
:04:09. > :04:12.outcomes and reducing variation in the quality and making reasonable
:04:13. > :04:18.adjustments for services. Education is hugely important, as has been
:04:19. > :04:24.mentioned by nearly every Noble Lord spoken tonight. We have recognised
:04:25. > :04:28.that there needs to be a significant improvement in the education of
:04:29. > :04:34.health care professionals, so health care education England together with
:04:35. > :04:39.skills for health and skills for care, learning disabilities core
:04:40. > :04:44.frame and training as have `lready been mentioned, this framework
:04:45. > :04:51.provides the knowledge and skills for those delivering training to
:04:52. > :04:57.Helsinki professionals. Lord Addington and Baroness menthoned the
:04:58. > :05:05.difficulties in communicating and some universities, such as Saint
:05:06. > :05:08.Georges, lead the way here. Sheer students receive training bx
:05:09. > :05:17.training advisers who themsdlves have learning disabilities. We are
:05:18. > :05:22.also taking steps to help pdople understand and access the rhght care
:05:23. > :05:28.and support, including by trialling the idea of named social workers and
:05:29. > :05:32.as part of the transforming care programme establishing the role of
:05:33. > :05:37.care and support navigators. They will support the aims of
:05:38. > :05:42.personalised care. The provhsion of accessible information and hnability
:05:43. > :05:50.to communicate with staff whll impact on their care experidnces and
:05:51. > :05:54.outcomes. In July 2015 be ptblished a standard for NHS social c`re
:05:55. > :06:05.services to help services identify and and deal with people's needs. As
:06:06. > :06:11.has already been mentioned, last Thursday about libraries, the
:06:12. > :06:15.provision of books beyond words for those who have visual learnhng but
:06:16. > :06:19.have difficulty with words can make a real difference and it is so
:06:20. > :06:25.important that every possible health care professional gets this so that
:06:26. > :06:30.they have it to their side when they are dealing with people that have
:06:31. > :06:36.learning disabilities. I want to finish by making sure that H have
:06:37. > :06:41.covered all the questions bdcause as always I'm running out of thme.
:06:42. > :06:45.Baroness Hollins did mention what is the Government doing to improve our
:06:46. > :06:52.knowledge and understanding about this vulnerable group. GPs tnder the
:06:53. > :06:57.framework have to maintain ` register of their patients that have
:06:58. > :07:03.learning disabilities and a new care quality expections for hosphtals
:07:04. > :07:07.will examine how patients whth particular needs such as le`rning
:07:08. > :07:14.disabilities or dementia ard identified. She also mentions that
:07:15. > :07:19.the Government will inform Parliament of the progress that has
:07:20. > :07:29.been made and I think anothdr person mentioned this. The Observatory team
:07:30. > :07:34.reviewed each year and it is covered in joint should teach needs
:07:35. > :07:39.assessments. This team will continue and funding will continue for this
:07:40. > :07:41.team. The Secretary of Statd for Health reports annually to
:07:42. > :07:52.Parliament his assessment of his progress. They also wanted to know
:07:53. > :07:55.whether the Government can give a clear message to local authorities
:07:56. > :08:01.and special care agencies about their expectations that staff will
:08:02. > :08:10.be released to contribute to these reviews. We agreed it should be
:08:11. > :08:17.possible to carry out reviews, but we have no plants to legisl`te to
:08:18. > :08:21.make participation a statutory duty. There is already a strong
:08:22. > :08:27.expectation that providers will participate in relevant clinical
:08:28. > :08:40.audits. Participation in NHS England review programme, which the
:08:41. > :08:50.mortality programme is carrxing on. I think Lord Hunt I will have two
:08:51. > :08:59.rides on the 18 recommendathons I hope that is all right. Perhaps also
:09:00. > :09:03.on funding attitudes as well. So, my Lords, there is work in progress
:09:04. > :09:12.which in time for have a positive impact on safety and qualitx of
:09:13. > :09:18.care. Could she also replied to my question about learning dis`bility
:09:19. > :09:28.nurses. And so sorry. I will make sure I get back to you. -- H am so
:09:29. > :09:32.sorry. It is thanks to the baroness that this vulnerable group keep
:09:33. > :09:36.having their barriers pushed as far as the Government is concerned we
:09:37. > :09:40.are focused on making changds happen and stopping variation in c`re and
:09:41. > :09:44.championed those with learnhng difficulties to be able to live full
:09:45. > :09:49.and happy lives knowing support is there when needed. I thank `ll the
:09:50. > :09:53.noble Lords for taking part tonight and I am so sorry that I have not
:09:54. > :10:00.had time to answer all the questions. I will make sure that
:10:01. > :10:03.letters get you. I beg to move that the host is now adjourned. The House
:10:04. > :10:10.will now adjourned.