Health and Social Care Bill

My Lords, I begin by congratulating the noble Lord, Lord Rix, who has been such an outstanding champion of people with disabilities, alongside my noble friend Lord Morris of Manchester. The two of them have been in the vanguard of public policy-making and of informing and involving people in this crucial issue. The noble Lords, Lord Rix and Lord Newton, both implied that learning disability is something of an overlooked condition. The noble Lord, Lord Rix, referred to the degree of prejudice and ignorance surrounding learning disability, which sometimes leads to the rather disgraceful treatment of individuals who suffer from that complaint, as we read from time to time. It is therefore right that they should be included in this broad request for the Secretary of State to have a duty to promote the equality of and improvement in treatment for people with all kinds of disability. The noble Lord, Lord Rix, and to a degree the noble Baroness, Lady Hollins, questioned whether this might be rather too much of an issue for local commissioning groups to undertake. I am not so sure about that, and think that this area needs exploring. After all, the general practitioners, who will be a significant part of clinical commissioning groups locally, are the first line of service providers for people with a disability, and I am not clear that a commissioning body operating nationally would be the appropriate mechanism to promote such commissioning. Something like the shortly-to-disappear SHAs might have been, and it is not clear—at any rate, to me—the extent to which the national Commissioning Board will be operating at that sub-national level in the future. However, at all events, somebody has to assume an overarching responsibility, and local authority health scrutiny committees should certainly be ensuring that this group is not neglected in their statutory responsibility of reviewing the efficacy of local arrangements and local provision. The noble Lord referred to the important issue of data collection in Amendments 117 and 143 and of drawing on the experience of people with the condition. I think that he would probably accept my suggestion that both of the amendments would be slightly improved by reference to carers, as their experiences should also be shared and brought into the picture. The amendments suffer a slight defect which I believe the noble Baroness, Lady Hollins, implicitly touched on. The amendments relate very much to the clinical and medical side of the conditions with which the amendments are concerned, but, of course, there are other agencies and other services that are important and must play a part in improving life for people with any of the range of conditions covered by the amendments. The role of local authorities can and should be very important in this respect. There will be a locus for involvement through the health and well-being boards in the preparation of joint strategic needs assessments which would, of course, cover this group. However, there is a range of local authority services—not least housing, a service carried out by district councils in two-tier areas—which will not necessarily be included in the commissioning groups, a matter to which we might revert later. There is also the question of the provision of aids and adaptations, leisure, educational services, transport, community safety and possibly, pending the introduction of a new structure for welfare reform, access to benefits through the support of welfare rights services. Clearly, all those matters can influence outcomes and the quality of life of a significant number of those whose needs the amendments seek to address. It will be interesting to hear the Minister's replies to the observations made by noble Lords in proposing and supporting the amendments. It is important that there should be a reference to this group in the Bill, as that would send precisely the right signal to them, to their carers, to society at large and to decision-makers at all levels. If the Minister cannot accede to the amendment today, I hope that he will agree to take it away and come back on Report with something that would satisfy that particular need.