17/10/2016 House of Lords


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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.


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