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Mental Health and Learning Disability: Health Inequalities

Volume 692: debated on Wednesday 6 June 2007

asked Her Majesty’s Government:

What progress they have made in developing a national monitoring system of critical health outcomes for people with a mental health condition or learning disability following the reports by the Disability Rights Commission and Mencap.

My Lords, these reports highlighted a completely unacceptable situation. A number of actions are in hand to address the range of issues raised in both reports. On 31 May, we published a new strategy for public health intelligence, emphasising the need for information that monitors inequalities in health, including those caused by disability.

My Lords, I thank the Minister for that reply and am grateful for the Government’s efforts in this respect, but does he not agree that some of the facts are quite shocking? Mental health patients and those with learning disabilities have more than twice the average rate of heart attacks and strokes under the age of 55. Only 20 per cent of women with learning disabilities are offered breast screening compared with 80 per cent of women generally. People with schizophrenia have twice the average rate of bowel cancer. Does that not suggest that primary care trusts have no mechanisms for monitoring these inequalities or any real processes in play for monitoring the outcomes of inequalities in a whole range of groups of vulnerable people?

My Lords, the noble Baroness is right to draw our attention to the seriousness of the reports and, indeed, to the poor health outcomes for many people with mental health conditions or learning disabilities. The public health information to which I referred will enable PCTs to have a much better idea of the problem and, therefore, to take action. Commissioning advice for mental health patients was given last year to the health service, and more advice on this very issue is being prepared on those with learning disabilities.

My Lords, given that the disability equality duty is one of the most powerful mechanisms that the Government have put in place to promote equality of disabled people, are the Government satisfied with the response by PCTs to fulfil this duty? How many PCTs have produced the required disability equality scheme, and are the Government satisfied with the quality of those schemes?

My Lords, that goes rather wider. I expect that PCTs will have done what is required under the law, but we will be monitoring the situation. I pay tribute to the DRC for its extraordinarily valuable work. We have already responded to this specific DRC report once, and we are due to go back to the commission in the autumn with an account of our actions. I can assure the noble Baroness that we will be working closely with it on this matter.

My Lords, the Government’s White Paper Our Health, Our Care, Our Say: A New Direction for Community Services acknowledged that, historically, the NHS has not served people with learning disabilities well. However, all it actually says is that it will explore way s of delivering on an earlier commitment to introduce regular health checks for that group. It does not give a time-scale. Can the Minister give us a time-scale today?

My Lords, health checks are very important for people with learning disabilities. I assure the noble Baroness that we are working very hard on this. I hope very much that the commissioning guidance that will go out to primary care trusts fairly shortly will cover this issue.

My Lords, is the Minister aware of the very serious problem of people with a dual diagnosis of mental illness and drug and alcohol addiction? Will he assure us that they will not fall through the net of different agencies?

My Lords, I am very much aware of that. It is why we want agencies to work very closely together. The noble Baroness identifies an issue known as diagnostic overshadowing. The DRC report makes it clear that often the problem is that health professionals do not recognise that people with mental health issues or learning disabilities may have physical health issues as well. The outcome of the work that we are doing with the DRC is to get this matter much more widely recognised by health professionals.

My Lords, following the question of the noble Baroness, Lady Neuberger, does the Minister share my concern that only 20 per cent of women with a learning disability are screened for cervical and breast cancer compared with 80 per cent of the female population as a whole? How do the Government intend to ensure that these services better reach women with learning disabilities?

My Lords, we are very concerned about that. The noble Earl might also have mentioned that the DRC report referred to bowel cancer, which seems to have a much higher incidence in people with schizophrenia. We are looking at all those issues to ensure that the appropriate programmes are in place. As regards bowel cancer, we are setting up a bowel screening advisory committee which we hope will consider the screening of high-risk groups such as those with schizophrenia.

My Lords, housing, education and other services directly affect the health of people with learning disabilities and mental health conditions. Therefore, what are the Government doing to ensure that they have joined-up government in response to this report?

My Lords, the noble Baroness raises a very important matter. We encourage the closest working between local agencies. I commend to her local area agreements as a way of tackling this matter. The local government Bill, which will shortly come to this House, very much strengthens the requirement for partnership between the health service, local government and other statutory agencies.

My Lords, also following the question on health checks, given that annual health checks for people with learning disabilities are not part of the GP contract, will the Minister encourage PCTs to use enhanced service agreements to commission annual health checks for people with a learning disability, as some health boards are already doing in Wales?

My Lords, I shall be glad to consider that interesting suggestion. As I said, we very much want to see GPs undertake these health checks. We are preparing commissioning advice for primary care trusts. We shall want to address the matter in future contractual negotiations with GPs.