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Learning Disability: Adult Social Care

I am grateful to my noble friend Lord Rix for raising this important subject in a Question for Short Debate, even though he has skilfully and clinically dispatched some of my birds. On quoting his phrase, ““the usual suspects being here””, I can honestly claim to be not guilty on that score, strangely enough. However, I must declare an interest in these matters, as chairman of a small residential home for women with physical and learning disabilities in Hampshire and as the honourable vice-president of MCCH, an organisation which provides services for those with mental illness, learning disability and autism in London and the south-east. The debate is timely because earlier I had the honour of hosting a launch in this House for the Mental Health Helplines Partnership, a much-needed and exciting initiative by the Department of Health, NHS Direct and a media company. It is entirely right that, ahead of publication of the Green Paper, we should be singling out one critical aspect of adult social care—the needs of those with a learning disability. These needs are inevitably more complex and diverse than those in other categories of social care, acute though they may be; that includes issues such as housing, employment, further education, home support, health, life enhancement—I could go on with such a list. I believe that the strain on funding, and therefore on services, has never been greater, at least in my time, which is quite long. Whether it is the threat to day services and what they are able to offer clients, or to respite care facilities, the danger of cuts is evident on every side. The critical factor is surely the evident dysfunction which exists between the entirely understandable and laudable aims of the various agencies in this field and the financial resources which are likely to be available for these purposes. You could argue that this is—indeed it is—an age-old problem, but I believe that it has never been so acute and as apparent as it is now. Speaking in general terms and non-technically, I have become increasingly puzzled by the rationale which allows two systems to run in parallel—care provided by the NHS and care provided through the social services departments of local authorities. Perhaps a short personal example will illustrate the point. The home with which I am associated is in a serviceable building, is quite modern and is capable of accommodating 20 clients. On national criteria, however, that is 10 too many. So, until we rebuild, we will get no further referrals. Without these our income drops until ultimately we implode. Contrast that with the recent case—admittedly exceptional—of Orchard Hill in Sutton, run by the NHS with, so far as I can recall, over 100 residents and the subject of a damning report 18 months ago. Are they down to 10 yet—I wonder? The phrase ““level playing fields”” comes to mind. My first question to the Minister is: there has been much speculation about the transfer of learning disability from the NHS to local authorities. When is that going to take place? Secondly, will wholly adequate resources be made available to fund the transfer so that those affected will not be disadvantaged in any way? Furthermore, there is a general move away from the commissioning of block contracts to spot purchasing. Will provider organisations be allowed the time to make new arrangements? Will there be guidance in the Green Paper on how commissioners can move from one system to the other without serious disruption? We know how common a disease serious disruption has been in this country in recent years. When local authority budgets are under severe strain—18 months ago it was estimated that three-quarters were in the red—and in view of the parlous financial situation for the foreseeable future, it will be essential that the Green Paper deals with today’s realities, among which are, as we have heard, carers getting older and being unable to cope. I do not apologise for repeating that 60 per cent of those with learning disabilities live at home. People with learning disabilities are living longer. Last but not least are the alarming findings of the report from the Joint Committee on Human Rights, which states that, for many adults with a learning difficulty, "““the violation of their human rights is seen as a normal part of their everyday lives””." I echo calls for the Government to undertake a thorough evaluation before the appearance of the Green Paper of the likely demands on special care from those with learning difficulties—that is essential. The heart of this and previous Governments has been in the right place in valuing people policies. No one doubts that for a moment—certainly not this speaker. But, since the demand for resources to back these policies up has never been greater, we are rapidly approaching a last-chance saloon in providing a satisfactory framework for the needs of our most disadvantaged citizens. If the forthcoming Green Paper does not meet these concerns head on and offer practical—I stress that—solutions, a great opportunity will have been lost. I am confident that the Minister will have regard to those anxieties when she replies.