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Learning Disabilities: Transforming Care

Volume 773: debated on Thursday 9 June 2016


Asked by

To ask Her Majesty’s Government what progress has been made by the Transforming Care programme in supporting people with learning disabilities to leave in-patient settings and live with enhanced support in the community.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and to draw attention to my interests in the register.

My Lords, the data show a small but sustained reduction in in-patient numbers over the last year. Some 2,565 patients were recorded in hospital at the end of April 2016, compared with 2,800 at the end of March 2015. Forty-eight local transforming care partnerships have mobilised to deliver the three-year service transformation detailed in Building the Right Support, which was published in October 2015, with a national ambition of closing 35% to 50% of in-patient capacity and building community-based support.

My Lords, I thank the Minister for his reply. Does he agree that this programme will succeed only if robust community support helps people to live in their own homes and prevents new admissions? Is the Minister confident that enough money is being provided to local areas to develop and commission the right support and services, as outlined in the NHS England service model, in particular to develop a trained and supervised social care workforce, which is currently seriously underdeveloped?

My Lords, progress since the horrendous events at Winterbourne View some five years ago has not been as fast as we would like. Under the Building the Right Support programme, NHS England is putting in an extra £30 million, which will be match-funded by CCGs, and another £20 million for capital investment. That is a very significant commitment of extra resource, but the proof will be in the eating.

My Lords, as the noble Lord said, it is five years since “Panorama” exposed the scandals in Winterbourne View. Ministers’ responses at the time and since have been admirable in their expressions of concern and the action they require in the NHS. The problem is that very little has happened. Is the Minister satisfied that NHS England, which has been consistently charged with implementing the changes, understands what it is required to do by Ministers? So far there is very little evidence that it does.

It is very clear in the NHS mandate that it knows exactly what it has to do. It was NHS England that produced Building the Right Support. There is a lot more governance around the programme now. Every month we will see the numbers of patients in in-patient care settings. The noble Lord will be interested to know that over the last year 185 people who had been in hospital for more than five years have now left hospital and gone into the community. There are signs that things are happening, but I would advise the noble Lord that what is needed is constant scrutiny.

My Lords, I thank the Minister for reminding us how many patients have been removed from hospital, but I declare an interest that goes back to the 1970s, when I was responsible for transferring 1,500 and then another 1,200 patients from hospital through a joint working party involving social services and the health service. It seems that we have discharged patients. The Royal College of Nursing demonstrated in a recent report that, from the nursing point of view, never have so few nurses been trained in mental handicaps. People with learning disabilities have physical and mental requirements, as well as environmental ones. Safe staffing is the issue here. Following on from what the noble Lord, Lord Hunt, said, will the Minister please consider getting out an edict on the importance of looking not just at hospital staff but at community staff?

The noble Baroness raises a very important point. It is worth saying that an assurance board monitors the national transformation plan on a monthly basis and comprises local authorities as well as CCGs and others. On the workforce front, which is obviously crucial, it is no good putting money into a system if you do not have the right people to deliver the care. We expect the number of whole-time learning-difficulty nurses to increase from around 3,000 to more than 5,000 over the next five years, so there should be more resource going into this very important area.

My Lords, I declare my interest as chair of Hft, a learning disability charity delivering such services across England. It is really very difficult to plan at the moment. We anticipate an element of growth, but we are not sure where or when that will come. The Minister outlined issues such as that. Could the NHS learn from some local authorities that are charged with managing their markets so that when they are ready to discharge such patients they have already established settings for them?

All the transforming care partnerships will comprise both CCGs and local authorities, so all the experiences learned by local authorities should be paid into the process.

My Lords, does the Minister agree that when such in-patients leave in-patient care, much of the responsibility for looking after them actually lies with their families? As this is Carers Week, would the Minister update the House on the Government’s attitude to this with the revision of the carers’ strategy?

I think we have a direct Question on carers next week. We are absolutely committed to supporting carers. Where people who have been in hospital for more than five years are discharged back into the community, as it were, the CCGs will provide them with a dowry to cover their costs. It will be very clear that the funding of those patients will stay with the CCGs.

My Lords, will the Government encourage village and intentional communities, which have proved so successful for those covered by this Question and are in great demand by their families, a demand that cannot be met at the moment? I declare an interest, as my daughter lives in such a community.

Yes, I am very happy to do that. There are some concerns about changes in social housing and rent caps, which might have the unintentional consequence of making it more difficult to build new houses that can accommodate these kinds of people. That is very much under review by the Government. We absolutely support what the noble Lord says.

My Lords, is the Minister aware that some of the establishments of the type just described by the noble Lord, Lord Pearson, are closing? The Camphill communities are an example of that. I was disturbed to see that, because we cannot afford to lose those facilities. Is he aware of that, and can anything be done to help?

I am not aware of the specific case of the Camphill communities, although I know about Camphill. Certainly, the preference is to have an environment where there are not too many people, with houses containing between, say, five, 10 or 15 people, rather than large organisations with sometimes many hundreds of people. I believe that Calderstones Hospital in the north-west, for example, has 223 in-patient beds. The intention is to close that and reprovide those facilities in the community. The key thing that we should always bear in mind is the best interests of the individual.

My Lords, the Camphill Village Trust is an excellent organisation that provides small family units. May I ask the Minister to visit the excellent Camphill Village Trust in the Forest of Dean?

My Lords, Sir Stephen Bubb’s update report also said that the review was going forward very slowly. The Minister has also referred to this. What is the new timetable for the full implementation of the Bubb report?

It is a three-year timetable. The intention is to reduce the number of in-patient hospital beds by between 35% and 50%, as I said. There will be a review at the end of the three years to see whether that can be taken further. The truth is that progress seems painfully slow until you look back to where we have come from. We have come a long way over the last 20 years, but nothing like far enough or fast enough. An old Chinese proverb says that it is better to light one candle than curse the darkness. We are making progress, but it could be quicker.