My Lords, the report identifies significant variation in the recognition and treatment of acute illness among people with learning disabilities. The Minister talked about guidance, but could she be more specific? What specific help does her department aim to give to those areas, trusts or ICBs deemed to be underperforming? Given the new Prime Minister’s pledge on further devolution, how will the department resolve that tension between local decision-making and central government intervention, especially in underperforming areas?

I hope that I have already agreed with the noble Lord and others about the progress that needs to be made in this area. I have certainly not said that it is acceptable—it is far from acceptable—and the questions have been very helpful in identifying that. The learning disability improvement standards support NHS trusts to measure the quality of care that they provide. All the areas that I have suggested and more are taking us forward. I gave the commitment —and I mean it—to keep these things under review and to seek to improve wherever we can. We look forward to working with the noble Lord in doing so.

My Lords, every question that has been asked has shown that the system is failing: people are still dying. The key point is that the accountability mechanism is missing or is too diluted to work. Why do the Government allow this system, which kills people early, to continue? What has the Minister not heard in this debate that assures her that the system is working and that it will somehow change for the better? Evidence and history tell us that the system is broken.

My Lords, we welcome the National Confidential Enquiry into Patient Outcome and Death’s report and its recommendations. NHS England has circulated learning from the report across the health and care system for regional teams to share it with integrated care boards. NHS accountability arrangements are in place, and immediate improvement actions are under way, including the reasonable adjustment digital flag. The Government are committed to high-quality care for people with a learning disability.

Through our impact evaluation of the pilot, we will be exploring, where possible, whether there are differential outcomes by primary disabling condition. We do not anticipate being able to identify impacts specifically on claimants with learning disabilities due to the small scale of the trial and low volume of these cases involved.

In addition to the impact evaluation, we are undertaking research with provider and DWP staff. This is to understand their experiences of undertaking assessments and making decisions under the changed approach. Our qualitative evaluation methods will include observations and interviews. We are not undertaking any specific qualitative evaluation activity with claimants with learning disabilities during this trial. We will continue to monitor decision making quality throughout the trial through established quality assurance processes.

The Department is committed to ensuring Jobcentre Plus work coaches are equipped to support disabled customers, including people with learning disabilities. Through the Strategic Relationship Team Learning Disability Project, DWP has developed new learning products to improve understanding of learning disability and support effective service delivery. These have been co-designed with national learning disability organisations, including BASE and Mencap amongst others, and peer reviewed by people with a learning disability.

This specialist learning is currently being rolled out, and we are exploring ways to ensure it becomes embedded within relevant learning pathways. Due to this we do not currently hold uptake data at work coach level and are therefore unable to provide the number of work coaches who have completed this training, or the percentage of the total work coach workforce this represents.

Integrated care boards are responsible for assessing local need and commissioning services to best meet the needs of their local population, including determining how services are delivered locally to reduce the health inequalities. Therefore, staffing models may differ between areas to reflect local needs and existing provision. All staff within health and social care must have learning disability and autism training specific to their role as set out in the Health and Care Act 2022, which means that staff who see patients should be better able to meet the needs of people who have a learning disability.

We are committed to ensuring that, under the Reasonable Adjustment Digital Flag Information Standard 2025, all publicly funded health and social care service providers are able to share, read, and write reasonable adjustment data by 30 September 2026. The Information Standard is mandated across all publicly funded health and social care providers, commissioners, and IT suppliers. Should issues of non-compliance arise, commissioners of health and publicly funded social care services will be able to enact contractual sanctions at their discretion.

The Government continues to recognise the value of involving patients and family carers in decisions about the care of people with a learning disability. The Health and Care Act 2022 sets duties for involving carers in healthcare. Acute trusts are responsible for determining how best to involve family carers in the delivery of care, taking account of the needs of their patients and local circumstances. There are currently no plans to establish independent or statutory audits to monitor whether acute trusts are consistently involving family carers from admission to discharge. The Friends and Family Test is an important feedback tool that supports the fundamental principle that people who use National Health Services should have the opportunity to provide feedback on their experience.

NHS England has previously published guidance to support primary care to identify people with a learning disability, titled Improving identification of people with a learning disability: guidance for general practice. This information can be shared with other health providers if a patient gives their permission. The Summary Care Record is a national database that holds electronic records of important patient information such as current medication, allergies, and details of any previous bad reactions to medicines, created from general practice medical records. It can be seen and used by authorised staff involved in the patient's direct care, including in other organisations such as an acute trust, with the patient’s consent. We expect acute hospitals to have appropriate arrangements in place to record learning disability information, including through the use of SNOMED codes, which are mandated for use across the NHS including in acute trusts.

Integrated care boards are responsible for assessing local need and commissioning services to best meet the needs of their local population, including determining how services are delivered locally to reduce the health inequalities. Therefore, staffing models may differ between areas to reflect local needs and existing provision. All staff within health and social care must have learning disability and autism training specific to their role as set out in the Health and Care Act 2022, which means that staff who see patients should be better able to meet the needs of people who have a learning disability.

We are committed to ensuring that, under the Reasonable Adjustment Digital Flag Information Standard 2025, all publicly funded health and social care service providers are able to share, read, and write reasonable adjustment data by 30 September 2026. The Information Standard is mandated across all publicly funded health and social care providers, commissioners, and IT suppliers. Should issues of non-compliance arise, commissioners of health and publicly funded social care services will be able to enact contractual sanctions at their discretion.

The Government continues to recognise the value of involving patients and family carers in decisions about the care of people with a learning disability. The Health and Care Act 2022 sets duties for involving carers in healthcare. Acute trusts are responsible for determining how best to involve family carers in the delivery of care, taking account of the needs of their patients and local circumstances. There are currently no plans to establish independent or statutory audits to monitor whether acute trusts are consistently involving family carers from admission to discharge. The Friends and Family Test is an important feedback tool that supports the fundamental principle that people who use National Health Services should have the opportunity to provide feedback on their experience.

NHS England has previously published guidance to support primary care to identify people with a learning disability, titled Improving identification of people with a learning disability: guidance for general practice. This information can be shared with other health providers if a patient gives their permission. The Summary Care Record is a national database that holds electronic records of important patient information such as current medication, allergies, and details of any previous bad reactions to medicines, created from general practice medical records. It can be seen and used by authorised staff involved in the patient's direct care, including in other organisations such as an acute trust, with the patient’s consent. We expect acute hospitals to have appropriate arrangements in place to record learning disability information, including through the use of SNOMED codes, which are mandated for use across the NHS including in acute trusts.

Integrated care boards are responsible for assessing local need and commissioning services to best meet the needs of their local population, including determining how services are delivered locally to reduce the health inequalities. Therefore, staffing models may differ between areas to reflect local needs and existing provision. All staff within health and social care must have learning disability and autism training specific to their role as set out in the Health and Care Act 2022, which means that staff who see patients should be better able to meet the needs of people who have a learning disability.

We are committed to ensuring that, under the Reasonable Adjustment Digital Flag Information Standard 2025, all publicly funded health and social care service providers are able to share, read, and write reasonable adjustment data by 30 September 2026. The Information Standard is mandated across all publicly funded health and social care providers, commissioners, and IT suppliers. Should issues of non-compliance arise, commissioners of health and publicly funded social care services will be able to enact contractual sanctions at their discretion.

The Government continues to recognise the value of involving patients and family carers in decisions about the care of people with a learning disability. The Health and Care Act 2022 sets duties for involving carers in healthcare. Acute trusts are responsible for determining how best to involve family carers in the delivery of care, taking account of the needs of their patients and local circumstances. There are currently no plans to establish independent or statutory audits to monitor whether acute trusts are consistently involving family carers from admission to discharge. The Friends and Family Test is an important feedback tool that supports the fundamental principle that people who use National Health Services should have the opportunity to provide feedback on their experience.

NHS England has previously published guidance to support primary care to identify people with a learning disability, titled Improving identification of people with a learning disability: guidance for general practice. This information can be shared with other health providers if a patient gives their permission. The Summary Care Record is a national database that holds electronic records of important patient information such as current medication, allergies, and details of any previous bad reactions to medicines, created from general practice medical records. It can be seen and used by authorised staff involved in the patient's direct care, including in other organisations such as an acute trust, with the patient’s consent. We expect acute hospitals to have appropriate arrangements in place to record learning disability information, including through the use of SNOMED codes, which are mandated for use across the NHS including in acute trusts.

The Government has prioritised introducing these reforms through the Mental Health Act 2025, and is committed to implementing this legislation so that people with serious mental illness and people with a learning disability and autistic people see real improvements in their care and outcomes as soon as possible.

We are working to develop the revised Code of Practice to enable the commencement of the first major set of reforms, phase 1, in 2028/29. We will be engaging extensively on this and particularly we are keen to ensure that we reflect the views of clinicians and other professionals, as well as those with lived experience, their families and carers, and other organisations, including organisations advocating for people with a learning disability and autistic people.

To support this work, we are running an open tender process for an external organisation to lead engagement with people with lived experience, including people with a learning disability, autistic people, and their families and carers to ensure their perspectives are informing the development of the updated statutory guidance. As part of our governance structures to support drafting of the Code of Practice, we have established an Expert Reference Group which includes representatives from Mencap and the National Autistic Society.

We intend to go to public consultation on the revised Code of Practice in the first half of 2027. We will then need to train the workforce on the reforms and the new Code of Practice, ahead of the code being laid before Parliament. We intend for the new code to come into force in parallel with phase 1 reforms.