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Learning Disability: NHS Healthcare

Volume 690: debated on Wednesday 14 March 2007

asked Her Majesty’s Government:

What is their response to the report by Mencap, Death by Indifference, on the premature deaths of six people with learning disabilities while in National Health Service care.

My Lords, the Government are shocked and saddened to read of the deaths of the six individuals highlighted in the Mencap report. Every person with a learning disability should be treated with care, dignity and respect. In response to the publication of the report, the Secretary of State for Health has confirmed that there will be an independent inquiry in order to learn lessons and ensure that change happens.

My Lords, I thank the Minister for that response. However, does he recall that the 2001 White Paper, Valuing People, promised to explore the feasibility of a confidential inquiry into mortality among learning-disabled people? A report on that has never been made. Am I to take it that the Secretary of State’s promised inquiry, which, according to the Independent, would examine the six cases and look at any potential implications for care practice nationally, will do as thorough a job as the one that we were vaguely promised all of six years ago?

My Lords, the exact terms of reference of the inquiry have yet to be decided and will be announced in due course. I would expect that, in addition to looking at the tragic events identified by Mencap, the inquiry will want to examine lessons for local government and the NHS as a whole. Clearly, as part of that, identification of the scale of the problem would be very important.

My Lords, any response from the Government to the report needs to be strong, positive and imbued with a sense of urgency. If the people referred to in the Mencap report are receiving the worst healthcare, even though they have the worst health, that is a totally unacceptable situation, which we cannot allow to go on. Frankly, we do not need an inquiry. The facts are known. Why are the Government messing about like this? They should get on with it and prevent discrimination against these people. This is really shocking.

My Lords, it is important to hold an inquiry to get to the bottom of the tragic and disturbing cases identified by Mencap. I agree with my noble friend that that should not be a reason for inhibiting the necessary development of better training, better provision of services and better understanding of the issues raised. I can assure him that the actions that are being taken—an audit of current learning disability services in the statutory sector, focusing on the development, training and understanding of staff—will go on and will not wait for the inquiry.

My Lords, do the Government still agree that village communities are extremely cost and care effective for people with intellectual impairment or learning disabilities and are very much wanted by their families? If the Government still agree with that, will they in future encourage such communities, in which this kind of tragedy does not occur, instead of continuing to allow local authorities to phase them out?

My Lords, those are matters for local decision. I understand the point made by the noble Lord; I have debated it with him. I know the value that many people with learning disabilities and their relatives place on those centres. The inquiry report relates to healthcare given to people with learning disabilities in NHS hospitals. It has identified a major problem with the diagnosis and the lack of treatment. It is very important that we focus on that problem.

My Lords, does the Minister accept that there is ignorance among many healthcare professionals of learning disability, which leads to their failure to involve patients’ families and carers? Is that an issue that needs to be addressed if the healthcare of people with learning disabilities is to improve?

Yes, my Lords, that is a clear message from the work that Mencap has done and from the published report, as well as from survey work and work by the Disability Rights Commission. There is no doubt that we need to give much more education and training to NHS staff. However, there are pockets of good practice; for example, some primary care trusts have appointed liaison nurses to work in hospitals as specialists in learning disability. That is an excellent way in which to inform and to encourage staff to give people with learning disabilities the healthcare treatment that they need and deserve.

My Lords, I am sure that the Minister is aware of the Joseph Rowntree Foundation report, Responding to the Pain Experiences of People with a Learning Difficulty and Dementia, which came out last year. It highlighted a generalised but concerning belief that people with a learning disability have a high pain threshold. Given the debates that have taken place in your Lordships’ House in the past month, what can the Government do as regards guidance about pain issues, particularly in palliative care, for people with learning disabilities?

My Lords, that is a very interesting point. I certainly agree with the noble Baroness that, if that were the case, it would be shocking and completely unjustified. She will know that an end-of-life strategy is being developed. I shall ensure that her comment is referred to the people developing that strategy.

My Lords, does the Minister agree that the problem is wider than just these tragic cases that we have heard about? Many people are just inarticulate and are not understood or treated properly by the health service. Will the inquiry look into the whole width of the thing, and not just be limited to this very small number of identified tragic cases?

My Lords, I certainly agree with the noble Baroness that communication problems are one of the main sources of complaints made against the NHS and other healthcare providers. Clearly, the concern about improving communication skills and understanding relates to all staff in the NHS. The NHS has made considerable progress in recent years in developing advocacy and in encouraging staff to understand the needs of their patients, but clearly we must do more in the future.