Health and Social Care Bill

Thank you. Five of the six amendments that I have tabled to the Bill have been grouped together. I welcome the opportunity to raise some specific concerns about the Government’s health reforms in relation to learning disability. I should also like to thank the Minister, who recently met the noble Lord, Lord Wigley, the noble Baroness, Lady Hollins, and me, along with representatives from the Royal Mencap Society, of which I am president, to discuss our concerns in more detail. As I made clear during my contribution at Second Reading, people with learning disabilities already have worse health outcomes than the rest of the general population. Mencap’s 2007 report, Death by Indifference, highlighted the neglect that was faced by six people who were treated in the NHS, leading to their deaths, which were entirely avoidable. Since then, many parents have approached Mencap to recount the indifference, prejudice and ignorance that is displayed towards people with a learning disability when being treated by the NHS. The purpose of the various amendments that I have tabled to the Bill is to address this problem. First, Amendment 13 would ensure that the Secretary of State for Health has a clear duty to improve the quality of services for people with a disability. This is a prerequisite if the health inequalities to which I have previously referred are to be reduced and entirely removed as soon as possible. We hear a great deal from the Government about the importance of local decision-making, empowering patients and more opportunities for clinicians to make their input. In principle, I do not object to these intentions but they must not be at the cost of removing the accountability of the Secretary of State. By placing a duty on the Secretary of State to improve the quality of services for disabled people, I hope greater priority will be given in government to making this happen and seeing improvements on the ground. My second amendment, Amendment 81, aims to ensure that health services for those with the most complex needs are commissioned by the NHS Commissioning Board. I am concerned that, since the numbers of those with the most complex needs, particularly those with profound and multiple learning disabilities, are likely to be relatively small, clinical commissioning groups may not commission those services that are deemed to be insignificant. We already know that the commissioning of services for people with complex needs by primary care trusts has been patchy. It is questionable whether commissioning led by clinical commissioning groups alone will lead to any great improvement on this issue. My amendment would ensure that the NHS Commissioning Board has oversight in this area, including the co-ordination and commissioning of services and facilities for this very specialist group of disabled people. The third amendment tabled in my name, Amendment 117, concerns the importance of collecting data on the experiences and outcomes of all patients in the NHS. Where a patient has a disability, it would also ensure a breakdown of disability by impairment type. This will provide a bank of information that could be disseminated and used to inform future NHS decision-making to ensure that it accurately reflects the expectations of those it seeks to serve. It would also help to ensure that clinical commissioning groups, the NHS Commissioning Board and the Secretary of State are more accountable for their decisions and better placed to improve such decisions. Without the collection of this data, including the impairment type for disability, it will be difficult accurately to assess what is happening to people with a learning disability and other disabled people within NHS treatment. The penultimate amendment in my name in this group, Amendment 143, relates to accessibility in relation to public involvement and consultation by the NHS Commissioning Board. I welcome the direction of Clause 20, to which my amendment relates, because it is essential that the board is accountable to the public to ensure that its functions and decisions are subject to the correct level of public scrutiny, openness and transparency. However, I am concerned that this accountability would be limited if the means by which it achieved draws only on the views of a narrow cross-section of society. I am specifically referring to the need to include people with a learning disability, people with communication difficulties, the elderly, people with visual impairments—which, I regret, I have at this precise moment—and those with hearing difficulties who might require alternative formats or means of communication such as Braille or Easyread in order to influence decisions taken by the board. Such individuals are disproportionately more likely to be more frequent users of the NHS, and therefore have a particular justification in wanting to have their say in the commissioning arrangements. I am seeking assurances that steps will be put in place to ensure that reasonable adjustments are made by the Commissioning Board to ensure that this participation is proactively addressed. The final amendment in this group, Amendment 245, tabled in my name, will place a duty on the Secretary of State to ensure that his or her annual report to Parliament on the performance of health services in England includes progress in tackling health inequalities for people with a disability. For example, there has been some progress in improving healthcare outcomes for people with a learning disability, but that progress remains inconsistent and disparate, with variances in equality of health outcomes continuing to exist for many disabled people. More needs to be done if the NHS is to improve its record in this area. The need to tackle this issue has been acknowledged by the Secretary of State for Health—hence his recent announcement that he plans to provide GPs and the new clinical commissioning groups with the practical support necessary to improve their understanding of the needs of particularly vulnerable groups. This work is to be led by the Royal College of General Practitioners, which is recognition of the importance of trying to provide better healthcare for all. The existence of a statutory duty on the Secretary of State to report on progress made in the NHS in tackling health inequalities would act as an important driver in improving healthcare for all. In light of the various amendments tabled in my name and those of my noble friend Lady Hollins and the noble Lord, Lord Wigley, I look forward to hearing the Minister’s response to the issues that I have raised. I beg to move.