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Learning Disability: Adult Social Care

When the noble Lord, Lord Rix, talked about the usual suspects, I could not but help feeling guilty as charged. This is an interesting debate not because anything new has come up, but because the Question has been asked as the policy paper is being commissioned. We are starting to co-ordinate a response to government, because, as has been said, they seem to be making the right noises and commitments. But the question is how parts of government tie together. That we should get bits of government to co-ordinate is one of my usual cries. We should take it as read that Chinese walls exist in Whitehall, but how do many of the problems that have been spoken about today—for instance, the fact that social care needs are not being met—impinge on other government policies? The noble Baroness, Lady Pitkeathley, should be here to talk about carers, as they probably underpin the whole approach. If carers are let down and they ultimately fail and say, ““We cannot cope any more””, one’s entire strategy is torn apart. Those with mild and moderate learning disabilities will suddenly have acute problems, because local provision for those acute problems will suddenly disintegrate as a result of the maths not balancing out. The problems will get worse without the carers and the support workers at home who are part of the demographic process which the Green Paper addresses. To make the thrust of the Green Paper work, one must have a strategy that addresses what happens to those groups; otherwise, everything will break down. How does one tie in adult social care with other groups? When discussing the previous welfare reform package of legislation, we spoke about welfare to work and getting people involved. How do social care budgets tie in with that? The question does not apply if one is talking about those who require care predominantly for reasons of age; it does apply if one is to try to get those with mild and moderate learning difficulties into work to provide themselves with some social support and outside stimuli. That the Government have said that they will enable people to gain qualifications will mean that the day courses in colleges which have already been referred to face acute problems as well, because one is accentuating problems arising from people being at home for too long. How this is co-ordinated is the big question for government. As the noble Viscount, Lord Tenby, said, it is not that the Government—indeed, all who are involved with government: we all must take some responsibility here; it is anybody who deals with Whitehall, either as direct lobbyer or organiser of the system—lack good intentions. But how will they make the parts come together? There are two ways of doing it: either one tries for joined-up government, or one says, ““We can’t do it”” and goes for a silo defence of one’s budget. We must hear from the Minister which one of these is favoured. Will she simply say that a criterion will look after this problem within these strategies, which is often the way we go forward and have to deal with it? How do mild and moderate learning disabilities fit into the thinking? Another of my clichés is that we have reverse battlefield medicine here. In battlefield medicine, you patch up very quickly those you can get back out to be shot at again, but the state tends to deal first with those with the most severe problems. This means that those who are the least easy to spot, or who are muddling through and achieving at the moment, are ignored. Then, when they are pushed over the edge, they suddenly become a new problem. How the Government intend to deal with that and work such people into the system is an interesting question. Although the Minister has taken on her responsibilities only comparatively recently, I am sure she has already noticed the similarities across many of these debates. She nods her head. The fact is that if you have a middle group that is undiagnosed, unhelped and unsupported, it can become a much bigger cost later on. Can we please have some indication of how the Government are starting to work this group into the system? Will the Government continue to try to get government and parts of Whitehall working together, or are they going to make sure that there is an understanding and commitment, with something written up front, that all new policies will include this group? I am sadly coming to the conclusion that that may be the only practical way forward.