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Care Services: Older Adults and Disabled People

My Lords, I thank the noble Baroness for introducing a debate of such great importance and for doing so in a speech of such fluency and interest. I will confine myself to speaking about those with long-term learning disabilities and, in doing so, declare my interests as a parent of a daughter with that condition and chairman of the trustees of a residential home for women with learning disabilities in Hampshire. The Government are to be congratulated on recently producing the publication Valuing People Now and the proposals contained in it. It sets out ambitious plans for ensuring the quality and enrichment of life for all those with a learning disability and provides structured steps to achieve these objectives over the next few years. I welcome this commitment. At this stage, I make only two comments. First, achieving those objectives depends a great deal on successful interaction between a whole range of bodies, from regional offices and local authorities to strategic health authorities and PCTs, and such interaction in recent times and in other fields has not always proved to be—how can I put it?—entirely fruitful. Secondly, there is in the proposals a welcome commitment to the production of checks such as those provided by annual reports and other publications. However, these are of course only worth while as long as effective remedial action is taken in respect of weaknesses in the system identified by such publications. Before leaving this point, I ask the Minister when the national learning disability board, from which basically everything will flow, is to be set up. There was an indication in Valuing People Now that the national director would be appointed in February. Has this in fact happened and, if not, when is it anticipated that the director and board will be in place? Much needs to be done in this important area at a time when, as the noble Lord, Lord Lipsey, mentioned, there is likely to be financial famine. Although the Government are investing hundreds of millions of pounds in transforming commissioning, nothing, so far as I am aware, has been set aside to transform provision that has correctly been identified as inefficient and out of date. Perhaps the House will allow me to divert from the general to the particular for a moment. The home with which I am associated fits the aforementioned description. We are accordingly seeking to create a modern facility to meet the new standards while promoting the independence of our residents and enriching their lives. Although redevelopment may be viewed as costly, in many cases inefficiency is more so. Yet this dilemma is frequently ignored because it is a big theme with long-distance implications, which requires vision, co-operation and boldness in its solution. If the problem is not dealt with, however, and sooner rather than later, there will eventually be a mismatch between commissioner and provider, with all the heartache and frustration that that entails. On the more general front of financial provision, the Centre for Disability Research has estimated that the annual increase in new learning disability clients will be between 3.2 and 5.5 per cent, against the Department of Health’s assumption of a rise of only 1 per cent. The greater increase is due to a number of factors, ranging from greater longevity for those with profound learning disability to an increase in the number of babies born with Down’s syndrome due to a growing number of older mothers. However, such a discrepancy in the estimates surely calls for urgent government research and for the true state of play to be established. Can the Minister give an assurance that such a study will be undertaken as a matter of urgency? The fact is that there is currently a substantial gap between demand and what is available; again, this will become even more pronounced in the months and years ahead. Day services are being cut, as I know through personal experience. Even more alarmingly, 73 per cent of councils now offer support only to those deemed to have substantial needs. This, of course, stems from councils currently being under extreme financial pressure. It has been estimated that, even with less expenditure and reduced support, three-quarters had overspent their learning disability budget by 2.7 per cent in 2006-07—that was the situation then, let alone now. The previous national director for learning disability has stated that an additional £1 million for each English local authority would be needed every year for the next 10 years to provide good-quality social care, adding up to a whopping £1.5 billion over current expenditure levels. The mind boggles. I applaud the work of CSCI and many local authorities, particularly my own. I also give three cheers for the departure from the uniformity of old. Let us rejoice at self-advocacy and people-centred planning and at stretching the horizons and quality of life for all those in social care. Amidst all the justifiable enthusiasm for independence and self-enhancement, however, one must never forget that there are many who, sadly, may be unable to look after themselves completely—a fact of life of which the parents and carers are only too well aware. This experience and knowledge must never be ignored or dismissed lightly by the authorities. In giving thanks, I reserve my special tribute to the many hundreds of dedicated social workers who labour with love and energy to make life better for those in need. They really deserve such a tribute. Whatever financial stringencies confront us in the years ahead, let it never be said that we neglected by one iota the well-being and human rights of our vulnerable communities.