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Learning Disability: Adult Social Care

First, I congratulate the noble Lord, Lord Rix, on initiating this timely debate, focusing attention on the needs of one of the most significant groups in adult social care. I fear that I shall repeat many of the points that he has made but, such is the importance of this debate, I have no doubt that many of us will do so. To date, as he said, the debate surrounding the forthcoming Green Paper has been focused almost solely on the funding of long-term care for elderly people. The value of this debate is in pointing out how some of the potential solutions voiced in that area will not meet the needs of adults with learning disabilities. As the noble Lord pointed out, social care packages for people with learning difficulties are for life, not just old age. While elderly people may be able to contribute to the cost of their social care, it is unlikely that people with learning difficulties will be able to gain the resources to do so. Moreover, the social care packages for people with learning difficulties accommodate much more than just personal care. They need to involve multi-disciplinary teams covering most aspects of that person's life, including housing, domiciliary support, employment, further education, health and leisure activities. First, I congratulate the Government on their decision to publish a Green Paper on adult social care, which has been warmly welcomed. It is extremely heartening that adult social care is at last gaining prominence on the political agenda. The Government strategy unit's report Improving the Life Chances of Disabled People was widely applauded, with its target date to achieve equality for disabled people by 2025. However, if that is to be realised, this Green Paper must address the sensitive and complex needs of people with learning disabilities. It needs to grapple with two stark facts: first, the extent of need which is not currently met and, secondly, the future growth in demand that will result from social trends and demographic changes. Mencap's report, Breaking Point, put in sharp relief the significant amount of unmet need that currently exists, especially relating to respite care. It found that seven of out of 10 families have never been offered a choice of short-break services and six out of 10 do not get a short break that fully meets their needs. One in three families had experienced a cut in their short-break services last year and six out of 10 family carers who are in poor physical health say that it is because the amount of care they provide. As this shows, local authorities are struggling to meet even current need. The Local Government Association has found that in 2005-06 three-quarters of councils experienced significant cost pressures for their learning disability services. As a result, local authorities have tightened their eligibility criteria for care services to a shocking degree. According to the state of the nation report from the Commission for Social Care Inspection, by the end of the current financial year 73 per cent of local councils will support people with learning disabilities only when they have substantial or critical needs. What does this mean for all those people with learning disabilities who have very real needs that are not so severe? It means that they will live poverty-stricken lives of isolation and restriction, in which they are given no chance to fulfil their potential in employment, training or any meaningful social activity. They have no hope of getting even a small amount of support to live the fulfilling lives which admirable government policies have spelled out for them. The gap between the vision of government policy and reality is stark. While central government may be committed to establishing a support organisation of disabled people in every social service authority, those organisations are the first to be cut when council funding is short. Currently, Liverpool People First, in common with many other such organisations, is in danger of losing all its core funding. Core funding is the essential element that enables these organisations to survive, yet trusts and funding organisations are loath to fund them. As People First points out, local councils’ duty to consult disabled people is severely impaired if local organisations of disabled people do not exist. As a result, local councils’ commissioning of services to meet need is bound to be faulty and inadequate. People First calls on the Government to set a baseline for funding those local disabled people’s organisations that councils are unable to fall below without financial penalty. As the Learning Disability Coalition points out, the current lack of funding for adult services lies at the heart of the widespread human rights abuse that was detailed in the Joint Committee on Human Rights report A Life Like Any Other, which was published earlier this month. The report found that the human rights of people with learning disabilities were being violated by public authorities, local councils and NHS trusts in an alarming number of areas and concluded that: "““For many adults with learning disabilities, the violation of their human rights is seen as a normal part of their everyday lives””." If that is the current picture, what is the prospect for the future? There are a number of demographic changes and social trends that mean that the pressure on services will only get worse unless they are properly addressed by the Green Paper. For one thing, improvements in neo-natal care have resulted in an increasing number of babies surviving with profound and multiple learning disabilities. There is the rise in single-parent households and the consequent pressure, mostly on mothers, which can lead them to breaking point. The tightening of local authority eligibility criteria means that many more people with learning disabilities are forced to stay at home as day activities are cut, which increases the pressure on families. Moreover medical improvements mean that people with learning disabilities are living longer, but that means that they are outliving the ability of their families to help care for them. It is estimated that 60 per cent of those with a severe or profound learning disability in England live with a family carer, so provision needs to be made for the time when that family carer is too old or frail to continue. Yet Mencap’s report The Housing Time Bomb found that only two in four local authorities was even aware of the number of people this affected and only one in four had planned alternative housing for people with learning disabilities who were living with parents aged over 70. The Learning Disability Coalition is keen to hear from the Government how they will use the Green Paper to ensure that there will be sufficient funding to provide adequate support for people with learning disabilities when they leave their family home. It is this lack of awareness of the extent of need and the conflicting predictions by social care statisticians of future demand that the Learning Disability Coalition calls on the Government to address urgently. Can the Minister assure me that an up-to-date assessment of the future demand for social care for people with learning disabilities will be carried out before the Green Paper is published? Unless the provisions proposed in the forthcoming Green Paper are based on an accurate forecast, it has no hope of closing the yawning gap between the Government's admirable policies for people with learning disabilities and the reality of their needs.