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Learning Disability: Adult Social Care

My Lords, I start by paying tribute to the noble Lord, Lord Rix, and by saying how much I admire his dedication and work in support of people with learning disabilities. As I am learning in my job, in which now I am not so new, many noble Lords have huge expertise in these areas, some of whom are represented here today. Social care is a vital part of the lives of many disabled people, including people with learning disabilities. In 2005-06, a total of £5 billion was spent on social care for 18 to 64 year-olds, of which 56 per cent was spent on people with learning disabilities. That indicates the scale of the issue that needs to be addressed when we consider the future. While we have become better at identifying and supporting people with learning disabilities, there are now many more people with learning disabilities that survive into adulthood and older age and require continuing care. We have a responsibility to ensure that people can access that support. We recognise that the voices of people with learning disabilities and their carers have not always been heard in the debate on social care. Now, as we face fundamental reform of social care, it is of great importance to the Government to consider the needs of people with learning disabilities in the whole debate around social care. Demand for social care has increased in recent years and is set to rise even further in future. The main reasons for this is down to the major changes happening in our society, which have serious implications for the care system: an ageing population; people with learning disabilities living longer and fuller lives; higher expectations about what services should deliver; and technological changes. All this is excellent news, and a tribute to the advances in medicine and in care over recent decades, as well as the effectiveness of organisations such as Mencap under the leadership of the noble Lord, Lord Rix. But we cannot underestimate the challenge that this represents to social care services. A recent report produced by the King’s Fund estimated that the cost of providing the current levels of social care for those over 65 will increase from £10 billion per year in 2002, to £24 billion per year in 2026. We also know that by 2021, there will be over 1 million people aged 15 and above with learning disabilities in England, and the number of adults with learning disabilities aged over 60 is predicted to increase by 36 per cent between 2001 and 2021. Although it is clear that continuing research will be needed to underpin the developing policy, we already know that there is a huge challenge before us. It is the shared ambition across government to put people first, including people with learning disabilities, through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity. That is why in December last year we published a cross-sector concordat, Putting People First, which establishes collaborative framework between central and local government, the sector’s professional leadership, care providers and the social care regulator. It sets out the shared aims and values, which will work across agendas with users and carers to transform people’s experience of care and support services. The challenges to delivering the ambitions set out in Putting People First are significant. In recognition of this, we are providing councils with £520 million over the next three years to support them to make the system changes and, more importantly, the cultural changes required to empower citizens to shape their own lives through the support that they need. However, the noble Lord is right to seek clarity about how we will meet the needs of those with learning disabilities through these reforms. For far too long the needs of people with learning disabilities have not had the prominence they have deserved and needed in the debate on social care. We are committed to listening to the views of people with learning disabilities and their carers, and that is why we are currently consulting on Valuing People Now: From Progress to Transformation. This sets out the priorities for the provision of services for people with learning disabilities for the next three years. Valuing People Now sets out how we are working towards transforming people’s lives—for example, through prioritising jobs and housing for people with learning disabilities—through the public service agreements on socially excluded adults. Through Valuing People Now we are setting out the Government’s strategy to tackle a number of serious concerns raised around how health services are meeting the needs of people with learning disabilities. In May 2007, the Secretary of State established an independent inquiry into the healthcare of people with learning disabilities. This was in response, of course, to Mencap’s report Death by Indifference, which highlighted the tragic deaths of six people with learning disabilities who were under the care of the NHS. Sir Jonathan Michael is chairing the inquiry and we await his report to the Secretary of State early this summer. We are committed to considering the feedback from people with learning disabilities and their carers. We shall look with interest at the views of groups such as the National Forum, the Task Force and the Learning Disability Coalition and will look to publish the final document in the summer. Valuing people now, which was referred to by the noble Baroness, Lady Hanham, and others, and Putting People First are vital to achieving our aspirations for supporting people to live independently through choice and control. However, the challenges of an ageing population and the facts that disabled people are living longer and that higher expectations remain mean that a radical rethink is required of the care and support system to meet these long-term pressures. The Green Paper mentioned by noble Lords will push forward the commitments made in Putting People First and address the long-term outstanding issues around funding, a point mentioned by my noble friend Lady Wilkins, the noble Baroness, Lady Hanham, and others. Over the next 10 years the Government want to create a new care and support system suitable for those with learning disabilities and their families. This is why the Government announced in the Pre-Budget Report last year that they would be producing a Green Paper on the reform of the care and support system. The Green Paper will look at options for developing a sustainable care and support system and whether it will be possible to develop a new system for all adults, not only for people over the age of 65. This is important for those with learning difficulties as a large proportion of them are of working age rather than pension age. The issue of ageing parents, a point raised by several noble Lords, is clearly part of the consideration of the Green Paper. At this stage, the Government remain open-minded about the solutions and are keen to work closely with a number of learning disability interest groups throughout this process. These groups will play a vital role in shaping the success of the reform and the support system. My honourable friend Ivan Lewis announced on 6 February that the Department of Health will commence a public engagement process in the spring which will engage with people of all ages about the problems facing the care and support system. In order to capture the views of people with learning disabilities, the Government will ensure that the public engagement process and associated literature are accessible, available in a wide range of formats and appropriately publicised. Turning now to specific questions raised by the Committee, the noble Lords, Lord Rix and Lord Addington, and the noble Baronesses, Lady Wilkins and Lady Hanham, particularly mentioned the issue of the eligibility criteria—one of the themes with which the noble Lord, Lord Addington, said I would become familiar. The Government have asked CSCI to carry out a review of the criteria for fair access to care services, their application by councils with social services responsibilities and their impact on people, and to address the issues, particularly for those with mild or moderate disabilities. We will receive a full report from CSCI in the autumn. This will assist in providing evidence to inform the Green Paper—which addresses one of the points raised by noble Lords—and we will use its findings to look at the right models to promote best practice in prevention and enablement, alongside good access and information about social care services where they are required. The noble Baroness, Lady Wilkins, raised the issue of people with low and medium-term needs. The range of ways in which local authorities support people with low and moderate disabilities has to be addressed, including support for housing and leisure programmes. The noble Lords, Lord Rix and Lord Addington, asked about carers. From our outset in 1997, the Government have recognised the value of carers, and since 1999 we have had a policy for carers, which is now being reviewed. We are increasing the amount of money that councils can use to support carers to £185 million this year, and we have made £25 million available to councils to help them support carers who are in a crisis situation. The noble Baroness, Lady Wilkins, and the noble Lord, Lord Rix, also raised the issues of research and how to look at unmet need when planning the Green Paper. Research underpins the reason why the Green Paper is being written. It is, by definition, difficult to identify how much unmet need there is out there. The research that has taken place looked at the overall level of demand and modelled the forward trends. The Green Paper has not been planned on specific research but has been planned and led by the Treasury. The noble Lord, Lord Rix, asked what the Government are doing about modernising day services. We want people with learning disabilities to be more independent. Valuing People Now has been published, and one of its priorities is what people do during the day, at weekends and in the evening. The deadline for responses is tomorrow. The noble Baroness, Lady Wilkins, asked what the Government are doing to ensure that people with learning disabilities are not socially marginalised and have access to housing. We have committed to a public service agreement to prioritise support into employment and to enable people with learning disabilities to have security in housing. I shall turn briefly to the issue raised by the noble Viscount, Lord Tenby, about when the Government are transferring funding from learning disability into the NHS and local government. In response to the investigation of learning disabilities in Cornwall, the Government’s commitment was to strengthen the commissioning of learning disability services, including giving consideration to a stronger role for local authorities. The current Valuing People Now consultation is seeking views on a proposal to transfer funding of commissioning responsibility for the social care elements of learning disabilities from PCTs to local authorities. I am not answering the question of ““when”” because my brief does not tell me, but I will find out and write to the noble Viscount. I think that I have nearly run out of time, but I want to address all the other issues raised by noble Lords. I shall make two more points. The noble Lord, Lord Addington, quite rightly raises the issue of joining up on every occasion. The concordat Putting People First was signed by six departments. The review for the Green Paper is similarly cross-governmental and is being led by Her Majesty’s Treasury. I hope that we are making progress. The noble Lord always recognises when we are. The Green Paper needs to have practical solutions. The options put forward by the Joseph Rowntree Foundation and Sir Derek Wanless are being considered. They will provide a menu of options that will need to be considered when the Green Paper is published. The needs of those with learning disabilities are a central policy issue that is being considered in a number of high-profile government agendas. The Green Paper on the reform of care and support systems is a unique opportunity for the Government to consider the needs of large numbers of people with learning disabilities who are living fuller and longer lives. It offers those with learning disabilities an opportunity to create a new system aimed at fulfilling the roles and responsibilities of citizenship by enabling them to have choice of and control over the support they need to live their everyday lives. I thank the noble Lord, Lord Rix, and other noble Lords. I will answer in writing those questions I have not directly addressed. [The Sitting was suspended from 2.53 to 3 pm.]