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Learning Disability: Adult Social Care

I, too, thank the noble Lord, Lord Rix, for raising this matter. By doing so, he has put a challenge to the Minister and to the Government which I am sure the Minister will be able to rise to today. The whole question of support for vulnerable adults is mired in controversy, and it should not be. It is to be hoped that the Green Paper will bring common-sense solutions to the fraught question of who pays for what. There is a crying need, too, for coherence in relation to the question of how responsibility can be borne or shared for those who need care, either because they cannot provide it for themselves, or because they have no one to provide it for them, or because their requirements, either practical or financial, are beyond committed families to provide. It is well recognised that for our older population, irrespective of their financial means, there is a need for sensitive, practical care, either to help keep people in their own homes or in supported housing. Those who are most at risk of not finding such care are those who fall outside the criteria for the limited social care support, about which we have heard a great deal today, but where paying for their own care is beyond their means. Currently local authorities—I declare an interest as an elected member of one in London—which either give support themselves or commission it from private providers, are able to do so only for the most needy, a point raised by the noble Baroness, Lady Wilcox, very specifically. For the rest, what can be given is either extremely limited or non-existent. In many cases, local authorities are not even providing advice or practical assistance to anyone who does not meet their criteria. That seems to be as true for those with learning difficulties as for elderly people who need help. No one who has listened to the noble Lord, Lord Rix, today, or has read the briefing provided by the Learning Disability Coalition, can have failed to be moved by what both have said. Of course, as with other people who are vulnerable, there are gradations of need. Many of those with learning disabilities can, given a modicum of help and the support and drive of their families and teachers, achieve virtually normal lives, a point made by the noble Lord, Lord Addington, and the noble Viscount, Lord Tenby. They can maintain jobs applicable to their own capacity and an independent existence. However, others are almost totally reliant for the whole of their lives on social or healthcare support. We have already noted that medical improvements ensure that those with learning disabilities live longer than in the past and, in many cases, may outlive their parents. They either then become the responsibility of their siblings—if they have any—who may find assuming responsibility for them too onerous or too intrusive on their own lives, or they may require help from the social or health services. Regrettably—again, as we have heard—a recent audit by the Healthcare Commission found that, where health services are provided, insufficient attention is paid to safeguarding those who are most vulnerable, they are poorly planned, and residential care provided by health services is largely in institutionalised settings. I recognise, as the noble Viscount, Lord Tenby, said, that there are private organisations which provide this care, but the report related specifically to services provided by the state. As I said, they were found to be institutionalised, but is that still the case? Institutionalised settings should have gone out years ago. The commission concluded that it had concerns about the quality of care overall in most establishments. The noble Viscount, Lord Tenby, raised a very important point in referring to one particular home. Many homes for the elderly—and, now, for those who are vulnerable in other senses—are being driven out of existence by care standards. In my own borough, I know of two large private homes for the elderly that gave up simply because they could not meet the very exacting physical standards demanded of them. I just hope that that will not happen across the board. No one wants establishments that do not have proper facilities or are unable to provide nice surroundings but, equally, do we want some of these excellent places forced out of existence simply because they cannot practically provide a room with an en suite bathroom? As other noble Lords have pointed out, help from social services is not necessarily an option either. As the social care inspectorate found, by the end of 2008, 73 per cent of local councils’ finances will support only those who have substantial or critical needs. Local authorities will tell you that there is enormous pressure on their social care budgets, but being able to provide only a proportion of what is required, and then only for the most seriously affected, will leave many questions still to be answered. As with the whole question of adult social care, for years solutions have been sought to the unequal conundrum of who pays, who receives and who loses out. The report, Valuing People, which was published in 2001 and has been referred to already, set out the Government’s commitment to improving life chances for people with a learning disability. Valuing People Now went further into how the principles outlined in the former report could be extended. However, fine words cannot deliver the goods if there is insufficient money in the system to enable that to happen. There is a not unreasonable expectation that, where they can, people should self-fund at least a proportion of their care, and it is anticipated that this will be promulgated again in the Green Paper. However, this concept—I think it was the noble Viscount, Lord Tenby, who raised it—does not readily lend itself to those with learning difficulties, who are unlikely to earn sufficient to make any contribution to their present or future needs and who, in many instances, have been maintained by their parents, often at enormous personal cost. The aim of the Green Paper is to ensure that care funding is, "““a sustainable system that targets resources effectively””." That seems to be as relevant to the concerns about those with learning difficulties, who in adulthood become increasingly vulnerable, as it is to those who are elderly. The problems relating to both are not going to go away. Demography tells us that, if nothing else does. The distribution or sharing of resources, standards of care and responsible authorities are germane to both. I look forward to the Minister’s response to the case which I believe has been made out by noble Lords that this widely anticipated Green Paper should not address itself to adult social care alone but should include those with learning difficulties.