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Care Services: Older Adults and Disabled People

My Lords, I, too, congratulate the noble Baroness, Lady Fookes, on instituting this debate, and apologise for the fact that, as I am 16 years above the average age of Members of this House, I am afraid that I do not have the facility of being able to speak so freely without notes. Last Friday, there was the Second Reading of the Disabled Persons (Independent Living) Bill, which the Government are apparently not minded to support. Earlier last week, my noble friend Lady Boothroyd asked an Oral Question about learning disability and NHS accommodation. In the light of those two recent interventions and the fact that I am president of Mencap, I am sure that your Lordships will understand if I personalise a quote from Sir Joshua Reynolds: I will be obliged to imitate myself and repeat what I have before often repeated. The Government quite rightly set themselves the target of closing old NHS campuses by 2010 so that all people with a learning disability could be supported to live in the community rather than be treated as patients with a medical condition. This transition has been absolutely welcome given the undignified conditions and low standards of care that existed in the majority of those campuses. However, for some of those people with complex needs, being transferred to an underresourced system could prove to be disastrous. Some of those remaining in NHS accommodation have received round-the-clock support of a decent standard. They may now be expected to perform totally unfamiliar daily tasks as local authorities become responsible for them but while new funds intended for those with complex needs are diverted to other areas of the underfunded social care system. Rather than promoting independence and inclusion, the transition can lead to an even more restricted and difficult lifestyle, or simply a transfer of dependence on to parents, who must become full-time carers. As I said, my noble friend Lady Boothroyd raised this important point in her Oral Question last week. She highlighted the lack of any statutory duty on local authorities to provide 24-hour care. Even if it does not introduce such a duty, the Department of Health should at least play a far stronger role in overseeing this transfer. Sudden adjustments should not be made to people's care without inappropriate planning and support in place. In the same vein, responsibility to provide social care for disabled people in supported living is shifting from primary care trusts to local authorities. Again, that is a welcome policy, but the Department of Health must show stronger leadership to ensure that change is not too hasty and support is not reduced. It must cover the extra costs that arise. Otherwise, this well-meaning policy will continue to diminish quality of life for many of those who are supposed to benefit. All this is against the backdrop of the Government's vision of equal citizenship for disabled people by 2025. The reality at present is not matching up to that vision. Likewise, I remain deeply concerned that government commitments in Valuing People Now will not be realised unless the funding is there. From day one, families feel that they must fight with their local authority to get even minimal support. Too often, support is limited and inconsistent, the processes to get that support are time-consuming and tiring, and information is inaccessible. In turn, local authorities explain that they simply do not have the budget to meet demands. It should be made clear in statute that entitlement to care must apply equally to all people who need support, whether due to impairments resulting from age, or whether due to a lifelong physical, sensory or learning disability. Entitlement should be based on an understanding of human rights that belongs to us all. We should be deeply ashamed that the Joint Committee on Human Rights reported that: ""For many adults with learning disabilities, the violation of their human rights is seen as a normal part of their everyday lives"." Support is growing for a national resource allocation system, which would operate with human rights as its basis, assessing each individual's needs in order to realise their rights and work out their entitlement accordingly, whether in the form of direct care provision or an individual budget which truly empowers that person. Such a system would avoid the current postcode lottery which penalises, for example, someone with a mild or moderate learning disability who unfortunately lives in one of the three-quarters of local authority areas where services are provided only for those with substantial or critical needs. The consequences of failure to assess and keep up with demand are already being felt across the country. People who need support with most or even all aspects of daily life have seen their care reduced. Those requiring less care have seen it taken away altogether amid tightening eligibility criteria. Furthermore, if you need social care, some local authorities have started charging for services that were previously free. Until the Education (Handicapped Children) Act 1970, children and adults with a learning disability were more or less excluded from society. Since that time, and especially in the past 15 years, a plethora of Acts, White Papers, Green Papers, regulations, targets, codes of practice and guidelines have poured forth from successive Governments applying to all disabled people, with spillage affecting the old and infirm. Some of this well-meaning legislation has indeed been efficacious, but much of it has struggled to have the desired effect through lack of resources and through myriad loopholes though which government, local government, social services and health authorities can sidestep their obligations. How often do we hear that pathetic excuse "lessons have been learned"? Were they learned by the carers in Cornwall who abused people with a learning disability? Were they learned by the health workers who allowed people with a learning disability to die as reported in Mencap's Death by Indifference, which will be the subject of an ombudsman’s report next week, and is it not too late for lessons to be learned by the Mid Staffordshire NHS Foundation Trust? ""‘That's the reason they're called lessons’, the Gryphon remarked: ‘because they lessen from day to day.’"" Unhappily they do not. Is it not time we closed the book on Alice in Wonderland and provided decent, dignified and discerning care for all older adults and all disabled people?