§ Motion made, and Question proposed, That this House do now adjourn. —[Mr. Woolas.]9.33 am
§ The Minister of State, Department of Health (Jacqui Smith)
I welcome this opportunity to describe and debate progress made in implementing the proposals in "Valuing People: A New Strategy for Learning Disability for the 21st Century", which was published in March last year.
We estimate that there are around 210,000 people with severe and profound learning disabilities. About 25 people per 1,000 of the population are thought to have mild to moderate learning disabilities. So the total learning-disabled population in England is about 1.2 million. Learning-disabled people can be among the most disadvantaged of an already disadvantaged group. Before we look at developments and the implementation of the proposals in "Valuing People", it is worth remembering why there was a need for a new strategy on learning disability services. What were the problems that people with learning disabilities faced?
The problems fall into three main categories. First, there is the category of social exclusion. As I have said, learning-disabled people can be among the most isolated and disadvantaged groups in our society. Too often, they have faced poor housing, difficulties in being able to work and in using transport and poor advocacy services, and they have had too little ability to make and exercise choices over the care and support that they receive.
Secondly, there has been too much inconsistency in service provision. People are receiving different services in different parts of the country, there are very great differences in the proportion of spending by both local authorities and health authorities throughout the country, and there has not been a sufficiently consistently high level of services, such as day services, for users.
Thirdly, the management of services has too often been dependent on administrative and bureaucratic boundaries, and too little focused on the users' needs. There has been too little co-ordination between social and health services, never mind other statutory authorities. There have been problems with the transition from children's services to those for adults; services have not properly been designed around individuals' needs; and there have been unqualified staff and poor training.
Often, learning-disabled people live isolated lives, knowing only their family and other people with learning disabilities. Research published in 1999 found that only 30 per cent. had a friend who was not learning-disabled, part of their family or paid to care for them. So, more 536 than two thirds of people with learning disabilities have no outside friends—no ability in either their social or community life to enjoy the sorts of opportunities that many of us take for granted.
The Prime Minister made that point very clearly in his foreword to "Valuing People":People with learning disabilities can lead full and rewarding lives, as many already do. But others find themselves pushed to the margins of our society. And almost all encounter prejudice, bullying, insensitive treatment and discrimination at some time in their lives. Such prejudice and discrimination—no less hurtful for often being unintentional—has a very damaging impact. It leads to your world becoming smaller, opportunities more limited, a withdrawal from wider society so time is spent only with family, carers, or other people with learning disabilities.So those were the problems that we needed to tackle, and "Valuing People", the first White Paper on learning disability services for 30 years, sets out a programme to tackle them.
Published in March last year, the programme is based on four key principles—of rights, independence, choice and inclusion—and lays down a wide-ranging programme of action. The programme includes developing an integrated approach by health, education and social care to services for disabled children and their families; more choice and control through the development of advocacy; enabling more people to receive direct payments; a national information centre; plans to move the 1,500 people living in long-stay hospitals to more appropriate accommodation in the community by April 2004; access to a specialist health facilitator and a health action plan for every learning-disabled person; more choice in housing; a five-year programme for modernising day services; increased employment opportunities; the development of person-centred planning; and stronger partnership working locally.
I shall return to those things later, when I will describe progress in their delivery, but I shall now make some points about the way in which the development and implementation of the strategy has involved learning-disabled people themselves. If we are serious about putting learning-disabled people at the centre of services and designing services around them, it is right—in fact, it is essential—that they are involved in the policy discussions and debates that determine those services.
That theme was summed up in the title of one of the reports published with the White Paper. The report from the national service user group, which worked with us in developing "Valuing People" is called "Nothing about us without us". Work on "Valuing People" began in December 1999, and service users and carers were at the launch seminar; what they said directly affected the way in which we took the work forward. Service users and carers were also members of the learning disability advisory group, which oversaw the whole process. "Valuing People" is the first White Paper to be published both in conventional form and in more straightforward, accessible forms, including tape and CD, so that people with learning disabilities can see for themselves what the Government are proposing. Service user involvement continues as we develop and implement the policy, for example, in the selection of the director of learning disability implementation and members of the support team—candidates were interviewed by people with learning disabilities; the development of a national forum for people with learning disabilities; membership, 537 including co-chairmanship, of the learning disability taskforce; and membership of local learning disability partnership boards.
I should like to turn to developments since March in implementing principles in the White Paper. "Valuing People" set out in broad terms our proposals for improving learning disability services. Guidance which we issued in August last year gives more detail, and stresses that "Valuing People" is for all children, young people, adults and older people with learning disabilities and their families; people with severe and profound learning disabilities, through to people with mild or moderate learning disabilities; and people with learning disabilities in the autistic spectrum. I know that concern has been expressed, by the hon. Member for Daventry (Mr. Boswell) among others, about the position of adults with Asperger's syndrome or higher-functioning autism. As we made clear in the guidance, and as I have previously made clear in the House, adults with Asperger's syndrome or higher-functioning autism are not precluded from using learning disability services.
I have already referred to the learning disability advisory group, which oversaw the development of "Valuing People"; we are grateful to its members for their contribution to that work. The advisory group was superseded by the learning disability taskforce, which has the role of monitoring and supporting the implementation of "Valuing People" nationally. It also advises the Government on the continuing development of learning disability policy. The taskforce met for the first time in December; its co-chairs are Chris Davies, director of social services of Somerset county council and Michelle Chinery from the self-advocacy group London People First, who is a user of learning disability services. I am delighted that Chris and Michelle agreed to take on that role. Four other learning-disabled people take it in turn, two at a time, to attend the taskforce.
If we are to involve users in our discussions, it is important that we consider the way in which we organise, facilitate and prepare for those discussions. The taskforce has discussed how to ensure that learning-disabled members can participate fully in its work. That is not easy; we shall have to learn to adjust and adopt new procedures. I should like to tell the House the rules that the taskforce has agreed. It has agreed that people should raise their hand if they want to speak; speak clearly and slowly; look at the person to whom they are speaking; and avoid long words. It has also agreed that only one person should speak at a time; there should be no jargon; and that mobile phones should be switched off—[Hon. MEMBERS: "Hear, hear."] I thought that would get a response. I have to admit that when I recently addressed a conference on the implementation of the learning disability White Paper, I was a bit embarrassed because I was not sure that our procedures in the Chamber were up to the high standards that have clearly been set by the learning disability taskforce. We may well learn from the model that it has provided.
The learning disability taskforce operates at a national level. At a local level, where policy has to be implemented and fit the experience of users of learning disability services, learning disability partnership boards are responsible for overseeing and advising on implementation of the adult aspects of "Valuing People".
538 The boards are chaired by a senior local government officer or elected member, and the membership includes representatives of statutory sector interests, such as social services, housing, education, health bodies; people with learning disabilities and carers; independent providers; voluntary organisations; community groups; and local employers.
The boards were responsible for developing joint investment plans, which should have been returned to the Department of Health by yesterday, and will help to ensure that the £3 billion spent on learning disability makes the best and most appropriate impact; they will also target the extra £42.6 million available for development from this coming April. The taskforce operates nationally and the partnership boards have been set up locally. We must ensure that we provide support for implementation, which is why we have an implementation support team, reporting to the taskforce through its director Rob Greig.
The team is now largely in post and will be fully operational from this month. Its first priority is to establish links and contacts with partnership boards, looking particularly at the involvement of service users and families, offering advice and support as necessary; and to explore how far the boards have begun to include people from outside the traditional learning disability field. Its next priority is to work with boards on the implementation plans for person-centred planning, on which the Department has recently issued guidance. Another early priority is to establish contact with advocacy, and particularly self-advocacy, groups in each region. The support team will work with partnership boards whose joint investment plans, following the evaluation that will now begin, are found to be below an acceptable standard, to help them take remedial action and ensure that the transformation of local services is achieved. In terms of partnership with others, I am especially pleased that in December, we launched with Mencap a telephone helpline to overcome some of the issues identified in the White Paper in relation to the need for national information to be available to users, carers and those who work with people with learning disabilities. The line has responded to 674 inquiries in its first month.
Those are some of the structures that are already in place, but I also want to deal with two areas where independence, which is one of the key principles of "Valuing People", can be strengthened: advocacy and direct payments. Effective advocacy can make a real difference to the lives of people with learning disabilities. It allows them to express their wishes, make choices, put forward their own views and join in planning and designing their own services. With the right support, many people with learning disabilities can become effective self-advocates. Citizen advocacy can also make a vital contribution to ensuring that the voices of people with more complex disabilities are heard.
Some £1.3 million from the implementation support fund is being used this year to promote advocacy. That includes setting up a national citizen advocacy network. Furthermore, £900,000 of that money is for a scheme to support advocacy projects. I am very grateful for the work of two organisations that are working with us in that regard. The British Institute of Learning Disabilities and Values Into Action are helping to ensure that the money is distributed and support is given in a way that ensures that the most value is added in terms of the advocacy 539 work. Bids have been coming in for funding, and decisions will be made within the next few weeks about how we can support those advocacy groups.
I know that concerns have been expressed about funding for self-advocacy groups. We have been considering very closely the funding arrangements for next year. I am pleased to confirm that we have already identified an additional £140,000 that will be available from the implementation support fund from this April. The learning disability taskforce will be discussing funding for advocacy services at its future meetings. I shall want to listen carefully to its concerns and recommendations about how to develop this work. Of course, advocacy groups do not need to look only to central Government for funding. Local government and the NHS at a local level are possible sources, as are European funds and the national lottery. There is an important role to be played in supporting and facilitating advocacy groups in accessing those other forms of funding. Effective advocacy helps people to gain control over their lives.
Direct payments are another effective and popular way of giving people greater control and helping them to make their own decisions about how their care is delivered. I am pleased to say that the number of people with learning disabilities who are receiving direct payments has increased by more than 60 per cent. in the past year. That is good news. It is an indication that progress is being made and that direct payments are increasingly a real option for people with learning disabilities.
§ Mr. Tim Boswell (Daventry)
Does the Minister agree that the absolute figures, which she may want to share with the House, are disturbingly and pitifully small? Is not a very rapid and extended increase needed, if that is what the individuals want?
§ Jacqui Smith
I do not disagree with the hon. Gentleman. While the figures are moving in the right direction, they are still too low. I shall outline what the Government have done and will do to ensure that we can increase that opportunity for people across a wide spectrum of care. In today's debate, that means people with learning disabilities.
The Department of Health has produced and distributed almost 20,000 copies of the "Easy Guide" to direct payments, to help to get across the message that such payments can offer people with learning disabilities real choices and opportunities in their lives. A small number of councils such as Durham, Essex and Hampshire have made substantial progress in making direct payments accessible for people with learning disabilities, but those pockets of good practice are too isolated. Overall, the numbers are still far too small; there are fewer than 400 throughout the whole of England. We want to see significant improvements in those figures. We want direct payments to become a mainstream option for a much wider variety of people. That is one of the reasons why we are taking powers in the Health and Social Care Act 2001 to help us expand the take-up of direct payments by requiring councils to offer them to people who request them. Access to direct payments will no longer be a question of where people live. Councils will have a duty to offer them as part of the standard menu of services.
We are currently working on producing the policy and practice guidance to coincide with those changes. We will use that opportunity to strengthen the message to councils 540 about the need to make direct payments work for people with learning disabilities. A draft of the revised guidance will be issued shortly for consultation. The programme of work arising from "Valuing People" is also helping us to improve the situation for people with learning disabilities. Part of the role of the implementation team will be to promote the uptake of direct payments. Of course, advocacy services can provide significant help for people to access and manage direct payments.
I should like now to turn to some of the other ways in which we are improving and developing better services for people with learning disabilities. Most people with learning disabilities have greater health needs than the rest of the population. Although life expectancy is increasing, 50 per cent. of people with learning disabilities die before they reach 50, compared with only 17 per cent. of the population as a whole. People with learning disabilities are more likely to experience mental illness and are more prone to chronic health problems such as epilepsy and physical and sensory impairment. Poor oral health may lead to chronic dental disease. Although increasing life expectancy is welcome, it will also lead to more age-related diseases; strokes, heart disease, respiratory disease and cancer are all likely to be of concern. An increasing number of young people with severe and profound disabilities have complex health needs.
§ Mr. Boswell
I am grateful to the Minister for giving way again. Does she agree that it is a particular concern that, when people with learning disabilities are hospitalised, they should have access to adequate advocacy and explanation of their problems? They should also have access to medical staff who are very well trained and are aware that such patients may well not only have the specific medical problem for which they were admitted, but a series of related issues in respect of which they also need the most careful maintenance and support during their spell in hospital.
§ Jacqui Smith
Once again, the hon. Gentleman makes a very important point, which demonstrates why we need to develop our specialist learning disabilities services to ensure that those involved can work more closely with other professionals, become multi-skilled and recognise the complex range of health needs to which he refers. Furthermore, the changes being made by the Government in relation to advocacy—especially the development of patient advocacy liaison services for every trust—will also be a very important way of ensuring that people with learning disabilities, in contact with particular health trusts, can express their views and make complaints and be supported in doing so.
The NHS plan commitment to care for all was based on clinical need, shaping services around the needs of individual patients, families and carers and reducing health inequalities. Health improvement plans provide a means of addressing the health needs of people with learning disabilities so that they do not experience avoidable illness and premature death. To help us reduce the number of avoidable deaths we are exploring the feasibility of establishing a confidential inquiry into mortality among people with learning disabilities.
Other key actions on health will include ensuring that all people with a learning disability are registered with a GP by June 2004; getting the NHS to ensure that all mainstream hospital services are accessible to people with 541 learning disabilities; developing local specialist services for people with severe challenging behaviour—this will be a priority for the capital element of the learning disability development fund; and a new role, as I suggested earlier, for specialist learning disability services, making the most effective use of their expertise.
The Government expect all learning disability partnership boards to have agreed a framework for the introduction of health action plans for people with learning disabilities by June 2005, and to have ensured that they all have clearly identified health facilitators by June 2003.
I have spoken mainly about adults, but it is important to remember that the "Valuing People" programme is for learning-disabled people of all ages, and that learning disability partnership boards are responsible for its adult elements. I shall now say something specifically about children.
We consciously and deliberately gave "Valuing People" a lifelong perspective on learning disability. The chapter on children focused on the needs of learning-disabled children and their families, but it did so in a framework that applies equally to all disabled children. Many disabled children have more than one impairment, and a majority have a learning disability.
Where necessary, the Government have put in place the legislative framework for change—for example, the Special Educational Needs and Disability Act 2001. I have no doubt that the hon. Member for Daventry recognises what a fine piece of legislation that is, having spent some happy days in the Standing Committee that considered it last Session. The Act strengthens the right of children with special educational needs to be educated in mainstream schools, and from September 2002 protects them from discrimination on grounds of their disability in their access to education, including further and higher education.
The Carers and Disabled Children Act 2000 introduces direct payments, giving parents of disabled children and 16 and 17-year-old disabled young people greater choice and flexibility in the way in which they receive services. The Care Standards Act 2000 improves protection and raises standards through new regulations and inspection of care providers. The Children (Leaving Care) Act 2000 ensures continuity of support for all looked-after disabled children.
Furthermore, there are four cross-Government programmes to help tackle the social exclusion of children: sure start for the under-fives; the children fund for older children; Connexions for teenagers; and the "quality protects" programme for the most vulnerable across the whole age range, those in care and children in need. All must give priority to disabled children. As part of the "quality protects" programme, the Government set new national objectives for children's services which for the first time set out clear outcomes for children, and in some instances give precise targets which local authorities are expected to achieve.
Last year's "quality protects" management action plans show that authorities are beginning to improve the services that they provide to disabled children. Many are developing proposals in collaboration with partners from other agencies and sectors, such as the NHS and the 542 voluntary sector. More family support services were being provided, particularly home-based respite care and sitting services. Every management action plan included examples of services that increased the range and scale of provision of leisure, cultural and sporting activities.
That was supported by the last spending review, when the "quality protects" programme was extended from three years to five, with substantial additional funding being made available. Provision for disabled children has been made a priority in the programme. From 2001–02 to 2003–04, £60 million for the children's services special grant has been earmarked for services for disabled children and their families.
The new children's fund is also encouraging joint working between local authorities and the voluntary sector to benefit disabled children. We know, for example, that through the fund, new projects are under way in Birmingham, Bradford, Haringey, Greenwich, Bristol and many other places, where the fund is providing better after-school facilities for children with complex needs, providing sporting activities, addressing child care and transport issues, and working with special schools, mainstream schools, early-years and other settings.
As part of our programme to support children with special educational needs, the Government recently issued the revised SEN code of practice and a toolkit for key professionals with responsibility for implementation. That included sections for health professionals and social services staff. Developing an integrated approach to supporting disabled children is key to the development of the national service framework for children.
As I mentioned earlier, a particularly important issue for children with learning disabilities arises as they enter adulthood. Disabled young people and their families often find that transition stressful and difficult. There has too often been a lack of co-ordination between the relevant agencies. Some young people are not transferred from children's to adult services with adequate health and social care plans.
That is why we have asked all local partnership boards to have a member with responsibility for transition planning. It is also why we set a target by 2003 for local agencies to introduce person-centred planning for all disabled young people moving from children's to adult services. That will include not only council services such as social services and education, but a health action plan, setting out the services to be provided by the health service.
I said earlier that "Valuing People" involved several Government Departments. I have touched on work in education, but we are working across Government. For example, the Government's statutory advisers on transport-related disability matters—the Disabled Persons Transport Advisory Committee—includes among its membership a person with a learning disability, and is working with transport operators to help them understand the importance of information and training to give people with learning disabilities the confidence to travel.
With the Department for Transport, Local Government and the Regions, we are funding research leading to the publication of good practice advice on housing options and guidance on the range of housing options that should be provided for people with learning disabilities. We are working with the Department for Work and Pensions on a research project studying the links between day centres 543 and supported employment, as well as the ongoing work being taken forward by the workstep programme to provide employment opportunities for people with learning disabilities.
In conclusion, "Valuing People" sets out a programme of action that will make a real difference to the lives of people with learning disabilities, their families and their carers. Old long-stay hospitals will be closed and residents found more appropriate accommodation. Employment opportunities will improve. The transition from children's to adult services will be better. Accommodation choices will be wider, and access to health services will improve. In conjunction with other Government initiatives, educational opportunities will be available for all children regardless of their disability. People's control over their own lives will improve through better advocacy services and greater use of direct payments. People with learning disabilities will continue to work with us to achieve those improvements.
One of the learning-disabled people who worked on the White Paper was recognised in last year's birthday honours—Carol Lee, from London People First, who was awarded an MBE. She is quoted in one of the reports published with "Valuing People" as saying:I am proud to be in this group. It means a lot to work together with such a good team committed to supporting people with learning disabilities in their hard struggle to live independent lives.I hope that, today, we can reassure Carol and other learning-disabled people that that work will continue so that we can provide them with the opportunities that they fully deserve.
§ Mr. Tim Boswell (Daventry)
I am honoured and delighted to participate in this debate on the implementation of the Government's strategy for learning disability, as set out in the White Paper "Valuing People". It reflects a long history of action taken in this House to tackle disability issues.
So often, the distinctions are not so much between the parties, as we usually speak with the same voice, as between those who turn up and participate in such debates, and those who do not get round to it, and are not as closely focused on some of the problems. Often, we vie with each other in our enthusiasm for the topic, and I am happy to initiate an arms race on that today. The Minister has made a good start in setting out her case. However, we must approach this matter in the spirit—and with the historic record—that change and betterment in such sensitive areas are often progressive between successive Governments of widely differing political views.
I still remember my first visit to the House when I was a schoolboy. I believe that it was in 1959, when I was lucky enough to be at the school that had been attended by the then Clerk of the House, Sir Edward Fellowes. I was somewhat disconcerted when I came here as a Member in 1987 and found that he had joined the staff of the Clerk's Department in 1924. There is therefore a long history.
I mention that anecdote because I remember that the subject for debate, which was not well attended and did not leap off the page as a matter of high controversy, was the Report stage of the Mental Health (Scotland) Bill. Two points arise from that. First, the constitutional one 544 that that measure, or one like it, is unlikely to return here. Secondly, since 1959, we have drawn out and increasingly accommodated the important functional distinction, which was then much less well appreciated, between mental health and learning disability. There was a culture of institutionalisation that bridged both. Both relate to vulnerable people whose care requires careful and loving attention, but they are not the same people. From time to time, however, the frustrations of having difficulty with learning may spill over into mental health problems. If I were to make one criticism of the Minister's approach, it would be that she did not say much about the experience of being an adult with a learning difficulty, and the kinds of frustrations that arise.
At any event, the last major exercise, in the House, in overall provision for learning disability took place on a Conservative Government's watch, as a White Paper and legislation were introduced a generation ago in 1971. It is worth remarking that that White Paper was unashamedly called "Better Services for the Mentally Handicapped". Again, in the use of sensitivity and phraseology, we have collectively come a long way in a generation, in emphasising what people with learning difficulties can do, particularly if disabilities and difficulties can be relieved or released, rather than emphasising what they cannot do.
As the new White Paper, "Valuing People", acknowledges, apart from phraseology and terminology real progress has been made in the last generation in closing large institutions and developing services in the community. However, the new White Paper rightly adds that more needs to be done. We are considering the means of doing it, which is the tough part of government.
I am pleased to follow the Minister. As she mentioned, I have shadowed her for several years on educational matters, particularly in relation to special educational needs and the Special Educational Needs and Disability Act 2001. Even if I am not as ecstatic in my praise of it as she was, I readily concede that it represents an important advance, and, of course, feeds directly into this debate. With the way in which responsibilities have fallen, our paths have diverged—she has gone to the Department of Health, and I am an Opposition spokesman for Work and Pensions. That is an interesting development, as ministerial responsibilities in this area can look like a Venn diagram, in which health, work and pensions, education and several other important Government and local government departments and interests are all rightly engaged.
I hope that the Minister and I can claim a common commitment and a degree of mutual respect. Certainly, she has made a constructive and encouraging opening speech. I was particularly pleased that she picked up the point that many hon. Members have made, perhaps fuelled by the excellent campaign in The Times at Christmas, about the autistic spectrum. We are all learning much more about it. Many people with Asperger's syndrome are highly intelligent individuals who have social needs. If they are not catered for, they spill over into educational difficulties. I am glad that she is at least encouraging local authorities not to take a literal-minded view of the scope of her White Paper.
I am also pleased that the Minister talked about direct payments, which is a matter that needs working up. As she acknowledged, the numbers are still small. However, when people have the budget in their own hands, with the 545 support of their family or carers they can make their own choices. They are often better placed to do that than anyone making choices on their behalf.
In the general spirit of what I am sure will be a constructive debate, I should make it clear that the Opposition have no problems with the objectives of the White Paper. We support it and we want it to work. In particular, I like its title, "Valuing People". To use a modernism, it is a brilliant title. It is precisely the belief in the value of all people as ends in themselves and not as means that should drive us. None of us who has met a class or group of young individuals with various special educational needs, or seen an individual pupil properly and sensitively included in a mainstream setting, could have failed to notice the special buzz that can arise, the dedication of teachers, and the friendliness and interaction of the pupils. In this most cynical of places, that force can and should defy our cynicism.
Of course, in saying that, I do not wish to suggest that there are not problems with challenging behaviour from time to time. The Minister has already referred to them. People with learning difficulties can be very difficult, and it can be hard to deal with them and to get the appropriate administrative machinery together to do so. But there is something about them that we should remember and celebrate.
The Conservatives have no problems with the four cardinal principles set out in the White Paper: rights, independence, choice and inclusion. All that I would say, with some diffidence, to the hon. Lady is that they have not just arrived, freshly made, under new Labour. They are concepts that some of us have always thought important. Indeed, to my great personal pleasure, the previous Conservative Government laid the foundations with the Disability Discrimination Act 1995—not without difficulty, as I am sure that the hon. Member for North-East Derbyshire (Mr. Barnes) will remind us—and we are glad to embrace its subsequent extension and the establishment of the Disability Rights Commission, with which I have regular and positive exchanges.
Those four principles are interactive and are about the worth of individuals. My only possible reservation, which I state for completeness only, is that inclusion can be interpreted to subvert the free choice of individuals—for example, in relation to whether they should be at a special school or educated in a mainstream setting. Inclusion should be interpreted to offer new opportunities for choice between different educational or lifestyle approaches, but we will not spoil this morning by quibbling over definitions.
The White Paper is frank about what it describes as problems and challenges. Those of us who had the privilege of going to the parliamentary palace of varieties last night saw a rehearsal of the first episode of "Yes, Minister", which was very well executed by some of our colleagues. The great, mythical—and, in terms of the actor involved, sadly deceased—Sir Humphrey Appleby appeared in it. He was always a great believer in describing any ministerial policy, particularly those that included a modicum of initiative, as "challenging". This is a very challenging White Paper, but it is frank, and it is right that we should start, as the White Paper does, by flatly acknowledging the difficulties.
546 The difficulties that I have picked out would be the stuff of any constituency MP's experience: poor co-ordination of services; poor planning for transition; inadequate support for carers; poor, often discriminatory, health care; poor employment opportunities; and a general lack of choice. I can only say amen to that list; any constituency MP could, no doubt, add to it. How many times have we heard in our surgeries the line of argument: "We can cope with the disability of a member of our family, but it is the bureaucracy that gets us in the end"?
Only this week, I have been occupied with the case of a young constituent with multiple disabilities—both physical disabilities and learning difficulties—who now has the benefit, after the family has fought its way through a tribunal hearing, of a placement in a residential school operated by the Royal National Institute for the Blind. The problem now lies between social services and the local education authority, and centres on responsibility for the weekly transport to and from the school. Having recently studied a report published by the Joseph Rowntree Foundation on work carried out at the Norah Fry research centre at the university of Bristol into placements at residential schools, I believe that my constituent's experience would make an admirable object case for the foundation to consider.
I am sure that, with good will, that particular difficulty will be resolved—indeed, we are on the way to resolving it—but is has caused distress for the family and engendered suspicion among the parents that the tribunal's finding is in some way being subverted. It has also required the intervention of a Member of Parliament. Sometimes, I feel as though we function here as the front line of joined-up government, the people who actually put the bits together when there is a problem. To return to the White Paper, it is that element of effective partnership between health, social care and education that desperately needs improvement.
Nowhere is that cast into sharper or more disturbing policy perspective than in the recent Mencap report, "No Ordinary Life", which deals with the support needs of families caring for children with profound or multiple learning difficulties. No decent person could read that report without grave unease. Similarly, no one who is familiar with human rights legislation, and who is involved in government or local administration, could read it without some apprehension of ending up in court because of its findings. It is terrifying that many people set out with good will to put their bit of the jigsaw in place for people with these complex difficulties, but only one piece needs to be missing for the picture to be incomplete, and for the service to be inadequate. Those of us who have interviewed parents know how they feel when nearly everything is in place, but something is missing.
Although the Minister has not referred specifically to that report today, I was delighted that, when she responded on 23 January to my parliamentary questions, which were keyed around the report, she clearly saw the Government's response in terms of the White Paper and the learning disability taskforce that is to lead its implementation. I am also genuinely pleased to have her assurance that Ministers have actively involved Mencap and other leading non-governmental and voluntary organisations in the process.
547 I have long been a passionate supporter of the voluntary sector, and I believe that such organisations can add great value in two ways: by using their hands-on, objective experience of what it all means; and by communicating an element of what I would describe as passionate dissatisfaction to puncture any official complacency. I am sure that it will be the understatement of this speech to say that life for those directly caught up in learning disability, including families and carers, is very tough. It behoves us all to remember that and to take this agenda forward.
Before I concentrate on implementation, I shall touch on the main requirements for service users. Perhaps my comments will be the other way round from the Minister's, but we all approach this matter from slightly different perspectives. I hope that what I have to say will be complementary rather than antagonistic. The provision of proper services for each critical stage of life must begin with early appraisal or diagnosis, and the ability to pick up problems at the paediatric stage. This must be coupled with continuing professional assessment and an eye to the possibilities of development for the individual. Nowhere is that more important than in the increasingly clear area of the autistic spectrum, where up to 1 per cent. of young people may be affected to some extent.
Each individual and their family should have a clear choice in the matter of transfer from home to a placement at school. The transition from primary to secondary school can be fraught, particularly if there is not an exact match of the type of setting. In the crucial transfer to further education, I suspect that many local education authorities still do not implement fully their long-standing obligations for transition planning. At the same time as—or shortly after—that life event, an individual may transfer from child to adult residential provision, in which suitable placements can often be hard to find.
Another area in which Mencap, United Response in Business and other agencies are involved is the creation and best use of employment opportunities, which are enormously enriching where they are feasible. While I acknowledge that many day-care services need restructuring—an institution that I know well in my constituency has restructured itself totally—we cannot wish away the role of day centres. They still have a valuable role to play but cannot be provided on the cheap. That is also true of carer support and meeting the health care needs of service users.
I welcome the Government's recent aid package to carers, but we still await implementation of their pledge to extend invalid care allowance to people aged 65 and over. That is particularly important given the changing demographics of those with learning disabilities. The numbers are rising by some 1 per cent. a year. As more people survive to adulthood and, in many examples, old age and retirement, carers are often older and perhaps reaching the end of what would have been their working lives. They, too, may need help with income and housing.
That brings me to housing issues, which the Minister perhaps only sketched. Although nobody wants a return to long-stay institutions, there is still an important role for residential care. Only two days ago, the Minister published guidance on the full suite of national minimum care standards, but, to my knowledge, she has not yet provided an accompanying statement of the regulatory impact on those providing that residential care. That is greatly exercising national charities as well as private sector care homes and it would be tragic if, in pursuit of 548 a care standards ideal, we contrived a dearth in capacity and, perforce, drove people back to either health service-run institutions or other inappropriate care that inadequately supports community living.
Where, indeed, is the guidance on access to social housing promised in the White Paper? There are important questions to ask. How will we and local authorities know whether they are making adequate provision? How do those issues play into or out of joint investment plan budgets? Will the finance come from those budgets or from other resources? We do not yet have an adequate information base to ensure that needs are identified, let alone met. I am surprised that the Minister said less about that than she might have, because preparing a better database is important to driving the agenda forward.
There is a danger that aspirations may not meet reality and there may not be enough resources to fund the revenue costs of development without losing quality. Any general efforts to widen choice, which of course involve the possibility of direct payments where appropriate, are welcome. I defend direct payments, because they may represent a more cost-effective use of resources.
Implementation is central. I have read the 17 January debate on Bristol royal infirmary and remind the Minister that her ministerial colleague, the right hon. Member for Barrow and Furness (Mr. Hutton), sensibly said:reports do not implement themselves. They need to be monitored and implemented."—[Official Report, 17 January 2002; Vol. 378, c. 507.]All the more so in respect of learning disabilities, because the hon. Lady is dealing not just with a national health service under relatively unified control, but with a partnership involving local authorities, voluntary organisations, patients, parents, carers and a wide range of support services. If any one piece of that jigsaw is lacking—even, for example, the bus home from residential school—the rest of the package might be invalidated.
I refer again to the university of Bristol research. On residential placements, for example, it says:The existence of joint panels or joint policy statements did not necessarily lead to good working relations between frontline staff in day-to-day work with children and parents.That is a warning that mere words and aspirations do not guarantee policy success.
This is not a day for partisanship and I do not intend to breach the mood, but I must say that I find three aspects of the Government's approach and culture relating to complex social issues trying and often rather implausible. First, we have the aspiration. Fine words such as "rights", "independence", "choice" and "inclusion" are spoken as if nobody has thought of them before. Then adjectives such as "new", "modern", "high quality", "world class" and even "joined up" are attached. Finally, the third leg of the stool: plans are announced, but they do not always happen. I hope that the Minister learns from the shortcomings and achieves a strategy that works.
Let me examine three aspects: partnership working and investment, advocacy and monitoring. The White Paper deploys an impressive array of concepts to explain how the intended partnership is to work, and the keystone is the local learning disability partnership board. The boards were to be established by October last, so perhaps the 549 Minister will tell us whether they are all in place. A good test is how often they have met or, more basically, whether they have any members.
I am pleased that the boards have an incentive to get on with the job. Their first duty is to consider joint investment plans and tap into the learning disability development fund, which was to have involved £20 million of capital and up to £30 million in revenue. Due to the difficulty in making savings from long-term hospitals, that figure has been reduced to £22 million, which, as Mencap rather drily comments, "appears somewhat limited" in the context of an annual spend of more than £3 billion on adult learning disability services alone. That addition is welcome, but it is only a drop in the ocean.
Another aspect is the operation of implementation teams and their role in stimulating and supporting such local partnerships. The local disability partnerships are not to be statutory bodies, so their internal procedures and precise responsibilities remain hazy.
As regards the task ahead, we have already touched on issues such as housing. May I single out another, which impinges on employment prospects? The White Paper does not address the expansion of supported employment. The recent thrust of Department for Work and Pensions policies has aimed at progression to open employment through supported employment. That is not objectionable in principle, but there is a danger that it may displace chances for people with learning difficulties and, indeed, many people with physical disabilities. Our approach should involve finding out what is required across the pitch, whether in open employment that may be stimulated by the disability charities or in supported employment, and widening opportunities.
On the implementation target timetable, we have a precise and contemporary test. Joint investment programmes were supposed to be in place by April last year. Local action plans were to be developed to supplement the joint investment plans and submitted to the Department of Health's regional offices by 31 January—that is, yesterday. Therefore, the deadline expired 10 and a half hours ago. In these days of modest information technology capacity, it should not be beyond the wit of the Minister to tell the House how many such plans have been submitted, how many are outstanding, and what action she and her implementation team intend to take to chase up the laggards.
It is not just a matter of producing some words and calling that a plan. She should ask the implementation team to find out whether the local development plan and partnership boards have met and approved the joint investment plans that they have submitted. Is that a paper exercise, or do they really know what their priorities are?
I am pleased that the Minister stressed advocacy, because I have long been interested in that. It is an invaluable supporter for vulnerable people and harassed families. The national helpline is certainly valuable, as is the Department's —2 million extra for research, but I sense that the sums available from the strategy funds for advocacy are likely to be severely stretched. Can the Minister be sure that everyone who wants an advocate will get one in due course, and that that advocate will be qualified to support the circumstances of the particular case?
550 The hon. Lady may need to consider good practice in the workings of the system as delivered by the local partnerships. It may be necessary for someone in authority in the partnership—not advocating from outside—to field any individual case, to go on with that case and be the person in charge of it, and to knock official heads and budgets together to meet the needs of that individual.
On inspection and monitoring, the White Paper refers to the social services inspectorate and the Commission for Health Improvement. The Office for Standards in Education will chime in by inspecting schools and local education authority provision. I am not clear whether the implementation teams will also have a supervisory role, especially after the initial phase. Ministers need the ability to determine in a clear, joined-up way whether a partnership is working as intended. I have considerable sympathy with Mencap's suggestion of an annual report by Government to Parliament, ideally to be presented during learning disability week. It also suggests that, as well as an overview of achievements, that should include successful, person-centred outcomes and good practice.
That is the note on which I shall draw my remarks to a close. Today's debate is about setting up machinery to cajole an often cautious and defensive, but not malign, bureaucracy in the implementation of policy in an area in which every service user is uniquely different, and the range of services they require spreads broadly across national and local government. As the Minister said, there are more than 1 million people in England alone who have a claim on our attention.
There are genuinely shared objectives across the House, although perhaps—even in the minds of Ministers, dare I say—there are some tacit and even cynical reservations about the likelihood of success. Many service users and their families and carers have a direct interest in today's words being turned into reality, and an interest in seeing the frustrations and setbacks that they often encounter being alleviated or removed.
Conservative Members will press the Government to discharge their current responsibility to ensure that positive change happens. I am sure that all of us here approach this most sensitive of areas with a determination to avoid being accommodative or even patronising, but instead to be genuinely supportive and empowering.
§ Mr. Harry Barnes (North-East Derbyshire)
The hon. Member for Daventry (Mr. Boswell) initially welcomed the White Paper, and I welcome his welcome. He then made a number of criticisms, but in such a way that he stood on the shoulders of the report, because he had important points to make on partnership, advocacy and monitoring. We all want the admirable White Paper to be acted on and delivered. The principles contained in it will shape the future for people with learning disabilities.
At the start of his speech, the hon. Gentleman said that everyone in the Chamber spoke with one voice on this matter, and I agree. However, that has not always been the case, as he said in a point he made about me. Back in 1994, when the Civil Rights (Disabled Persons) Bill was introduced by my hon. Friend the Member for Kingswood (Mr. Berry), following the Bill that had been introduced a few years earlier by Alf Morris, now Lord Morris, there was blood on the Floor of the House on a series of Fridays over how the rights of people with disabilities should be 551 developed, including the rights of those with learning difficulties. That led to the resignation of Nicholas Scott and an apology in the House from Olga Maitland.
I welcome the change of attitude and approach that the Conservative party has displayed in opposition. The Civil Rights (Disabled Persons) Bill, which I picked up and ran with in 1995, contained a provision for a disability rights commission. Labour tried to amend the Disability Discrimination Bill that was going through the House at that time to include such a commission.
We argued that the most radical change we could get out of that Bill—we secured a number of changes to that legislation—was the establishment of a disability rights commission. When the Labour Government introduced that measure it was solidly supported by both sides of the House. The Conservatives had changed their position. At one time they blocked such a measure, but because of the criticisms in 1994 they rather reluctantly introduced the Disability Discrimination Bill in 1995. Their approach has been transformed, and I welcome that and the role that the hon. Gentleman has played in that transformation. It is healthy that we have this consensus, but that does not mean conformity in all areas. I may press the Government on various matters.
The hon. Gentleman made a distinction between mental health provisions and learning disability. Although it is right to make that distinction, there is not that absolute division in every area. The general description of people with learning disabilities includes people who suffer from mental health problems. There is an overlap, and we need to bear in mind the fact that some important considerations affect what is said about mental health legislation from the Department of Health and about this admirable White Paper.
I gathered from the hon. Gentleman's speech that he wanted to pursue a particular case. I am currently hoping to initiate an Adjournment debate about a vaccine damage case with which I have been dealing during the nearly 15 years for which I have been a Member of Parliament. There has been a great deal of correspondence between me and Government Departments, but now I want to make the case more public, and as soon as I can agree on a form of words with parents, helpers and others I shall be pressing strongly for the debate.
Discrimination takes many forms. When it involves race, ethnicity, nationality, faith and gender, it has moral aspects that call for legislation to educate society and also deal with the most obnoxious cases—although I accept that sin and laws do not always go together. Those considerations apply at least as strongly to discrimination on grounds of age and disability, but such discrimination is, moreover, logically peculiar. Discrimination plays on, indeed shamelessly exploits, differences. A white person is not a black person, a fact that some will emphasise to justify their prejudices. A man is not a woman; a Christian is not a Muslim, unless he or she converts; and in Northern Ireland people are very conscious that a Protestant is not a Catholic. Indeed, people are not allowed to forget that, because it is a tribal distinction made by extremists.
An able-bodied person, however, is potentially a disabled person. Nearly four years ago, I had a stroke in the Chamber. The current Speaker, then a Deputy Speaker, took me to St. Thomas' hospital and stayed for a couple of hours, along with my hon. Friend the Member 552 for Bolsover (Mr. Skinner). I have recovered now, but for a time I was clearly a disabled person, and I am well aware that as I get older and develop arthritis and other problems, elements of disability creep up on me.
Similarly, a young person is getting older, and, if he or she survives, will become an elderly person. My late mother developed Alzheimer's, which put her in not just the aged but the disabled category. We are all potentially old people with many disabilities. Discrimination against disabled people is therefore very peculiar: it is, in a sense, discrimination against oneself. People do not normally discriminate against themselves. When people come to me with tax problems I try to deal with them straight away, whereas I deal with my own tax problems last, so I suppose I discriminate against myself in certain ways; but discrimination against oneself is not a normal characteristic of human behaviour. People are generally very partial in their own cause.
The discrimination with which we are trying to deal is, then, both wrong and very odd. It should be possible for us, and for disabled people, to explain its peculiarity and to explain why it is actually against the interests of those engaging in it.
§ Mr. Boswell
These are interesting points. Perhaps the hon. Gentleman would like to borrow the old Latin tag "Everything that is unknown is inflated". One of the main difficulties with disability issues is the fact that there is ignorance in the population unless or until disabilities are encountered directly. That is why it is important for us to have had a lively and open debate in the Chamber and beyond, so that people understand the issues and how they should be handled.
§ Mr. Barnes
There is indeed a great lack of understanding, but avenues exist for the development of understanding. There are so many people with disabilities, including learning disabilities, that we all rub shoulders with them. Someone in most people's family networks will fall into one of those categories, which should enable us to sympathise and empathise.
In August, I led a Commonwealth Parliamentary Association delegation on a visit to Nigeria. There we met Professor Akinsete, leader of the national action committee on AIDS. I asked her whether the committee had made any mistakes. She said, "Yes. I am a professor of medicine, and we dealt with AIDS as a medical problem. But it is not just a medical problem; it is a wide social problem that encompasses a number of departments and interests. Now we tackle it by trying to bring together those departments and interests, and we are making much better progress." The committee is receiving good support from the Department for International Development's team in Nigeria.
When I saw that the White Paper had been produced by the Department of Health, I was a bit worried at first. What was happening here? Were the Government treating this as a purely medical problem? The White Paper, however, does not make that mistake. It does deal with health issues, but it also deals with housing, employment, family life, the problems of lifelong carers and the experiences of those with learning disabilities throughout their lives. It deals with special educational needs, pre-school provision and the transition that is involved when people leave school. Families begin to have fears at 553 that stage. Parents think, "Things were fine when there was school and the day centre, but we are getting older. What will happen to the child who is now growing up?" They have helped that child to subsist. Provision is needed to give people the independence that they need in order to function in society. As those people get older, their difficulties are compounded.
On Monday, I visited a special needs consortium in Clay Cross, which wants me to deal with some particular problems. It is based at the Clay Cross pre-school playgroup, but three other groups are attached to it, two in the constituency of the hon. Member for Chesterfield (Paul Holmes), the Newbold parish church pre-school and the Walton village pre-school, and another in the constituency of my hon. Friend the Member for Bolsover, the Stonebroom pre-school playgroup.
A lottery grant enables those playgroups to operate, but the funding for their special needs work goes up only to March 2003 and they do not know what will happen after that. They are exactly the type of group that needs assistance in line with the principles outlined in the White Paper.
While I admire the interdepartmental and interdisciplinary approach adopted in the White Paper, there is a worrying counter-trend in the Department of Health. It produced an earlier White Paper called "Reforming the Mental Health Act". I want to stress the links between the two concepts—the Venn diagram.
"Reforming the Mental Health Act" responded to popular fears about dangerous mental health patients. Obviously the public needs to be protected where there is a risk but there is a danger that the measure applying to mental health services is becoming a public protection measure and is taking away from some of the activities involved in community health provision. I am drawing on the experiences that the hon. Member for Chesterfield and I had when we visited the Hartington ward of the community health trust in north Derbyshire.
There are fears that the measure extends the criteria for detainment to those with drugs and alcohol-dependency problems, that there is no effective discharge procedure, and that patients lack rights prior to tribunals dealing with appeals. The measure may set back the campaign to reduce stigma, which we are anxious to do, deter patients from seeking help and break confidentiality. Professionals who share those feelings may want to detach themselves from that activity. Recruits may not want to work in that sector because of those pressures.
I hope that we will try to reconcile the two measures, although I recognise that we need to take public protection considerations into account. Whether the Department of Health should be leading on that is another matter, but in this White Paper the Department has been sensible enough to adopt the interdisciplinary approach. I want that approach to be taken to the mental health White Paper. I hope that, if there is a battle between the two White Papers, the one we are debating will be the victor.
The size of the problem in relation to learning disability has been outlined by the Minister. We need to deal with discrimination problems and to ensure that legislative, financial and support needs are met. I present the figures in a slightly different way from the Minister. In each constituency in the country, there are some 10,000 554 disabled people and 3,000 or so people with learning difficulties, of whom 500 are severely disabled people, so the problems are known to all MPs. It is a pity that more colleagues are not in the House today because we need to impress upon them the significance of the White Paper and the attention that needs to be given to it.
However, we are mistaken if we think that experts, advisers and politicians alone will solve the problems that have been highlighted in the White Paper. The Minister highlighted the significance of self-help provisions, and we must listen and give authority to organisations for disabled people. We are lucky in north Derbyshire because a number of organisations are doing exactly that. At Clay Cross in my constituency, the Derbyshire coalition for disabled people campaigns on behalf of disabled people in Derbyshire. At Ripley, outside my constituency, the Derbyshire centre for integrated living is the servicing, enabling body. Some of the same people are active in the two, but although their areas of responsibility cross, they wear different hats. Many areas have disabled access groups. In Dronfield, where I live, there is an active access group which is keen on the proposals in the White Paper.
Because of the impact of the Derbyshire coalition, North East Derbyshire district council has provided a breakthrough to work programme for disabled people, including those with learning difficulties. It has been able to place into work, sometimes in the district council itself, people with those difficulties.
The Minister mentioned London People First and Carol Lee. London People First is made up of people with learning disabilities. One of the proudest moments for me in my period in the House was when I introduced the Civil Rights (Disabled Persons) Bill, and London People First produced it as a document for their members, in a form that was meaningful to people with learning disabilities. I will always remember my visit to that organisation when that document was produced. No doubt it will be working on the White Paper so that its members also have access to it.
We must listen to and empower such groups. We can do that through developing further the correct legislative framework and providing for self-advocacy, for example, which the Minister mentioned.
The Government have made a sound start. They have made full use of the Disability Discrimination Act. The scope of that legislation developed considerably, partly because it was in conflict with the Civil Rights (Disabled Persons) Bill which I was introducing at the time. Initially, the Disability Discrimination Bill was not intended to apply to Northern Ireland, so all the Northern Ireland parties signed up to the Civil Rights (Disabled Persons) Bill. That led the right hon. Member for Richmond, Yorks (Mr. Hague), who was the Minister responsible at the time, to announce that Northern Ireland was to be included in the disability Bill. There was some lack of provision in terms of transport and education, but this was rectified as the Bill went through the House. Some Conservative Members who were interested in extending civil rights were working behind the scenes to improve the legislation and some agreed to block my Bill so long as the Government's proposed legislation was changed in line with their requirements. That is all good politics and helped to improve the legislation which is now in force.
555 The Human Rights Act 1998 offers other avenues that can be pursued and developed. As I said earlier, the big achievement that resulted from the 1995 Act was the establishment of the Disability Rights Commission. It is only a pity that it was not set up a few years earlier.
The White Paper states on page 23 at paragraph 2.2:The Government is committed to enforceable civil rights for disabled people in order to eradicate discrimination in society.There has always been support in Government circles for the provision of full civil rights for disabled people and there have been encouraging indications that the Government have that objective in mind. The White Paper helps them to work towards that end.
In current legislation the problem is medically defined in terms of physical and learning disabilities. We need provisions that are directed against the discriminator. The primary factor is the perception in the mind of anyone who is crude enough to discriminate on the grounds of disability. The fact that a person is disabled is secondary; the hideous factor is the discrimination, although I agree that those whose problems are covered by the legislation to help chronically sick and disabled people need empowerment, assistance and the right to lead full and decent lives. That is required from future legislation.
The White Paper sets out the rights that people with learning disabilities should have, including the right to vote and ease of access to electoral provision. It proposesproviding comprehensive guidance to electoral administrators on helping disabled people, including those with learning disabilities, through the whole electoral process—from registering to vote until polling day itself.I have always taken a considerable interest in electoral registration matters. The Minister who introduced the rolling register that is now in place was kind enough to describe me as the father of the rolling register. However, there is a great deal more to be done and we have various issues to pursue.
In 1994, when my hon. Friend the Member for Kingswood introduced his Bill on civil rights, I introduced a Bill on electoral matters which included proposals concerning access to polling stations. Giving everyone, including disabled people, registration rights still does not cover the difficulties faced by disabled voters, who should have the same right as able-bodied people to exercise their franchise in person. They should not be pressurised to resort to proxy votes and postal votes. Obviously they should have the same access to those facilities as anyone else, but if they want to vote in person everything should be done to enable them to do so.
My Bill was not successful, but those provisions were included in the Civil Rights (Disabled Persons) Bill—a Bill I inherited from the disability movement and to which I added provisions to address that particular concern, which is shared by many disability organisations. I commend the publications by Scope, which produced three reports at consecutive elections about the continuing problem of access to polling stations. As votes are the building blocks of democracy, I hope that this matter will be further pursued and that the Home Office as the body responsible for such measures, will respond to the points that are raised in the White Paper.
The White Paper is an extremely valuable document. Along with the hon. Member for Daventry, I have climbed onto the shoulders of the report which has provided us with a commendable platform to present our argument.
§ Paul Holmes (Chesterfield)
Liberal Democrats very much welcome the aspirations outlined in "Valuing People". As we have heard, it is a major and long overdue updating of its 30-year-old predecessor, the White Paper "Better Services for the Mentally Handicapped". Society has moved on a great deal since then, and in respect of attitudes towards all kinds of disability it has undoubtedly changed very much for the better.
As a teacher in mainstream secondary schools from 1979 to 2001, I certainly witnessed some of that change for the better. In recent years I taught mainstream classes of 30 and more pupils into which children with Down's syndrome and degrees of autism including fragile X syndrome have successfully been integrated, something that would have been very unlikely 30 years ago or even in 1979 when I started my teaching career. Regrettably, class sizes in secondary schools have got worse in recent years, otherwise the integration of children with all sorts of special needs would have been even more successful.
There can be little doubt that if the White Paper fulfils its promises to those with learning disabilities, and their carers, we will witness an even more dramatic change for the better. We very much welcome the inclusiveness agenda and many of the excellent proposals in the White Paper, but having willed the end are the Government prepared to will the means to the end and provide the financial resources that are necessary to fulfil the White Paper's promise of setting the four key principles of rights, independence, choice and inclusion at the core of provision of services for those with learning disabilities? As a former teacher, I know that those principles can work in a school setting if the money is there to provide the adaptations, support workers and the extra or adapted teaching materials. It cannot be done on the cheap or as a short-term project.
In the light of my own experience, I want to raise some concerns that are shared by Mencap, the Association of Directors of Social Services and the Royal College of General Practitioners. I welcome the establishment of a new learning disability development fund, and new money to fund the modernising of day centres and the development of supported living approaches. However, it is important to set the figures in context. In 1999–2000, for example, provisional expenditure on adult learning disability services was in excess of £3 billion, of which £1.4 billion was spent on health and £1.6 billion on social services. In addition, social services contributed about £308 million, and the Department of Health about £107 million, to supporting disabled children, not all of whom, however, had learning disabilities.
Set against that, the White Paper establishes a development fund of up to £30 million revenue and £20 million capital per year, for just two years. Such a figure is hardly significant compared with the overall sum. Obviously, much can be done by using existing funds more effectively, but the key point is that the White Paper's ambitious tones have been accompanied by distinctly unambitious funding. Indeed, it now appears that the initial revenue figure of up to £30 million has in practice been scaled down to an even more disappointing £22 million.
So, however much one might welcome the sentiments behind the White Paper, they are in danger of being made unrealistic by simple underfunding. Of course, we have 557 witnessed precisely the same elsewhere—for example. the excellent new national care standards for residential homes have already been undermined by gross underfunding. The relevant Government impact assessment was a massive 20 times lower than that of the Leonard Cheshire organisation. The Sue Ryder Foundation has already closed one home, NCH Action for Children has withdrawn provision in Wales altogether, and private care homes the length and breadth of the country are closing in record numbers. This excellent White Paper must not be undermined in the same way, yet a general vagueness about funding seems to beset the issue of housing for those with learning disabilities and, specifically, the impact of housing provision on the lives of those with learning disabilities.
As the White Paper correctly points out:Department of Health research has shown that supported living is associated with people having greater overall choice and a wider range of community activities.It makes the further obvious point thatsmall scale ordinary housing is likely to lead to better outcomes across a range of factors than large-scale housing or hostel provision.That issue is all the more important because in England about 60 per cent. of adults with severe or profound learning disabilities—some 87,000 people—live with their parents. I welcome the White Paper's plans to resettle some 1,500 people who still live in long-stay hospitals, and to provide alternative living solutions for those who live with carers aged over 70. A cut-off age of 70 may be arbitrary and should surely be based on a needs assessment of individual families, rather than the nearest convenient round figure. However, I know from experience that it is better than no date at all. I have recently had to fight for many months to secure such an alternative living solution for an 85-year-old constituent of mine and her dependent adult son with learning disabilities. Her son himself is almost of pensionable age.
The Government have not yet clearly explained how the expansion of housing provision and the essential accompanying support will be funded. Because of more than 20 years of severe Government underfunding, local councils often provide housing and support only when there is a crisis in the family home. Independence and choice in one's living arrangements, where possible, are fundamental to the White Paper's four key principles of rights, independence, choice and inclusion. I would like the Government to make a full assessment of the full costs of providing housing for all people with learning disabilities.
Another of the White Paper's welcome aspirations is the stated objective of increasing the number of people with learning disabilities in work from the current lamentable figure of 10 per cent. to 30 per cent.—the same as for other disabled people. Although 30 per cent. is a poor enough figure, it would at least be a step forward. If the targets are to be achieved, the best way to do so is surely—as we have heard—through supported employment schemes. Can the Minister provide full assessments of the cost of such schemes, and a guarantee that funding will be ongoing? That would ensure that, once the targets are met, there can be no falling back in future.
Despite my general support for the White Paper, I am disappointed by its lack of attention to the needs of children with profound and multiple learning disabilities. 558 Intellectual impairment is often accompanied by profound sensory impairment. Such people have the most profound needs, and any examination of the learning needs of this country's learning disabled must make them a priority. I call on the Minister to ensure that local agencies are obliged to target services toward that group, but she must also make a clear assessment of the cost of making such provision, set specific targets to meet their needs, and above all earmark the funding increase to ensure that those needs can be met.
On the proposed major changes to the provision of day services, we welcome the White Paper's requirement for local authorities to examine their dependence on day centres, and its moves to modernise day care centres, many of which are antiquated and inadequate. Change is essential if those centres are to provide the learning-impaired with meaningful experiences. The watchwords must be flexibility—with more activities provided outside the traditional hours of 9 to 5, Monday to Friday—and quality, with services tailored as well as possible to individual needs. The Minister must also note concerns that modernisation should not result in a reduction of services, and that the existing service is not removed before working alternatives are introduced.
On self-advocacy, I welcome the key actions listed in chapter 4 of the White Paper and agree with its assertion that the provision of advocacy services has been patchy and that those with learning disabilities have had little involvement in decision making until now. The £1.3 million that will be provided for self-advocacy and advocacy schemes across the country is to be welcomed, but I know from talking to representatives of disability associations that some uncertainty exists about how the cash will be split. Some fear that its provision may not extend much further than the initial three years.
The White Paper promises£1.3 million per annum for the next three years to develop and expand advocacy services in partnership with the voluntary sector.However, will funding dry up after that time, leaving stranded those who rely upon such services? Will the Minister give assurances that existing self-advocacy schemes that are funded by social services will receive ongoing funding, instead of the Government counting their existing money as part of the promised £1.3 million? Will she give assurances that, when new self-advocacy schemes are set up under the new fund in the White Paper, social services will not withdraw money from other existing self-advocacy services? Will she also give assurances that, when new self-advocacy schemes are set up under the White Paper, they will have a long-term and consistent stream of funding that will continue beyond the three-year commitment made in the White Paper?
Finally, on the question of practical and funding problems, I draw the Minister's attention to the resource implications for general practitioners of resettling into the community those who used to be concentrated in the old-style mental handicap hospitals. About 60,000 former residents have already been resettled and registered with their local GP. However, the Royal College of General Practitioners calculates that that often represents a fourfold increase per patient in the GP's drugs bill and work load. Dr. Graham Martin, the chairman of the RCGP's learning disabilities working group, points out:GPs and Primary Care Trusts need extra resources if they are to provide the level of care that is appropriate for patients with learning disabilities and which they deserve.559 My concluding point, which shows that money and other resources are not the only issues, concerns educational principle. The Minister has mentioned protecting the rights of those with learning disabilities in terms of access to mainstream education, and I have already referred to my experience of working with children with learning disabilities in mainstream education. However, the Government are undertaking a disastrous lurch in the direction of creating an irrevocable two-tier system of education in England, as we will discover in next week's debate on the Education Bill. Specialist schools of various kinds will select by aptitude, ability and aspiration, while "bog-standard" comprehensive schools will take the rest, along with £500,000 less per school.
The Government's own figures, such as those published by the Department for Education and Skills for 2000–01, make it clear that across the country as a whole—not just with individual schools, but right across the spectrum—specialist schools, faith schools, grammar schools and technology colleges take less than the national average of pupils who qualify for free school meals or have special educational needs. The latter category includes children with learning difficulties, who will not be good for schools' league table positions.
Can the Minister reassure us that by some miraculous amendment next week, safeguards will be put into the Education Bill to protect the rights of children with learning disabilities, which the White Paper sets out to enhance, but which the increasing development of a two-tier education system is undermining?
In his foreword to the White Paper, the Prime Minister says:I know the publication of a White Paper, however good its proposals, does not itself solve problems. The challenge for us all is to deliver the vision set out in this document so the lives of many thousands of people with learning disabilities will be brighter and more fulfilling.I hope that the undoubted good intentions in the White Paper really will be implemented and funded, and will also be protected from the impact of other less worthy Government initiatives such as the Education Bill.
§ Mr. Laurence Robertson (Tewkesbury)
I welcome the opportunity to take part in the debate, even though it draws us away from our constituency engagements on a Friday. For me that is unusual, but this is such an important debate that it is a privilege to take part in it, especially given the tone of the discussion so far. Hon. Members may put different emphasis on different policies, but everybody in the House wants to see the same outcomes, and we have already heard some thoughtful speeches.
As the Minister would expect, I want to talk about special educational needs in the overall context of what we have to do to prevent people from being excluded from society. The White Paper, like the debate so far, acknowledges that many people are excluded from society through no fault of their own.
Before I entered the House, my main occupation was in the textile industry and in manufacturing, but for four or five years immediately before I came here I did a lot of charity work and fundraising, some of it on a professional basis. One of my roles immediately before I was elected was working with homeless women in London.
560 That was an eye-opener, and also in some ways a useful introduction to the House of Commons, because the people with whom we were dealing had severe problems and were excluded from society. It is interesting to note that the people who wanted to help them came from what could be described as the elite, and the job stretched my abilities—and, I should add, my education—in every direction. That was a useful preparation for coming to the House, because when we deal with our constituents we often get stretched in many directions.
What struck me particularly at that time was the prevalence of mental illness, and the way in which it affected people. My role was to raise money to create a hostel for homeless women in London, and that was successfully done. The home took in homeless people and resettled them, but it was not simply a matter of putting someone in a home and then finding them a flat. We had to get people to try to understand why they had become homeless in the first place, and to deal with the problems that had caused that. When we got them into their own home again, we had to continue to work with them to ensure that they did not have further problems.
Many of those people had mental illnesses. They were not necessarily young people; some were older, and some were refugees. They came from all walks of life.
One of the common factors was that those people had never been rich; they were obviously quite poor. That does not mean that rich people do not have mental illnesses or become homeless. They certainly do. I became aware of many quite well-off people who had mental illnesses and had become homeless, but they were shielded from the glare of publicity, and did not become obvious to us or to the rest of society because they had friends who could look after them.
Many people with learning disabilities and mental illnesses do not have such friends, and they end up in hostels or on the streets, with severe problems. That taught me a thing or two about what is going on in society—both what we see and what we do not see. My work had a profound effect on me.
When I entered the House I, like many other Members, was asked to make one or two speeches on crime, and I began to think about the massive changes that had taken place in the 20th century. The rise in crime was pretty constant during that century and, on the face of it, it is difficult to correlate social factors with that rise in crime. The provision of health care, education and housing was far better at the end of the 20th century than at the beginning, and there was far more prosperity, so I began to ask myself why, if all those social factors had improved, had crime increased so tremendously during that century?
I came to two conclusions. One was that attitudes had changed. The world had changed, and people were not taught to tell right from wrong as they once were. However, to say that is to oversimplify. It also became clear that there was a group of people who probably had not shared in the great improvements and advances of the century—people who had not got much better health care or education and were not much better off.
§ Mr. Boswell
I shall not go into all the interesting points that my hon. Friend is beginning to touch on, such as the relationship of social developments with criminality, and I would not want to identify deficiencies 561 in basic skills too closely with learning difficulties, although there is some correlation between them—but does my hon. Friend not find it remarkable and disturbing, as I do, that about 60 per cent. of the population of our prisons now have severe functional difficulties with basic skills, which may by definition make them unfit for economic participation in the labour force?
§ Mr. Robertson
My hon. Friend is right, and has picked up a point that I was going to make.
If we think about the people who have not shared in the great advances of the 20th century, we begin to understand why things have gone wrong for some people. I do not, of course, mean to suggest that everybody in that category ends up as a criminal. That is obviously not true, and I do not think that anybody in the House would assume that that is what I am saying.
As I continued to study crime and the prison population, I found that, as my hon. Friend says, about 60 per cent. of the prison population are either illiterate or semi-illiterate. Again, I am not saying that anyone who is illiterate will automatically commit a crime, but there is a reason to look more deeply for the causes of crime.
I am not saying that all prison sentences are strong enough; indeed, I think that many of them should be stronger. None the less, we need to understand why the crimes are committed in the first place. There is an obvious correlation between the crime figures and a lack of education and basic skills. I was astounded when I checked up on this, because I could not believe the figures, but I found that more than 90 per cent. of prisoners have some form of mental illness or other mental problem.
Those problems fall into five different categories, but most prisoners—indeed, almost all prisoners—have some form of what used to be called mental deficiency. I hesitate to use that term, but do so in the absence of a better one. There is a great problem. Yes, we must address sentencing policy, but that is a matter for another debate; in this debate, we must examine why people end up in that position when we allegedly have an education system that prevents that.
Many people leave school either illiterate or semi-literate. That is a factor in crime and social exclusion. Today's world is extremely competitive. In that respect, the world has changed more in the past 20 years than in the preceding 80 years. I have the pleasure of being a member of the Standing Committee on the Office of Communications Bill, in which we are discussing the massive changes that have taken place not only in television programmes, but through the emergence of the Internet.
The changes in the world and the pace with which they have taken place are incredible. Now, only the strong survive—but in a civilised society we must do better than that. People who are not properly educated will be disadvantaged and excluded from society to some extent. We have to ensure not only that they have some way of making up ground, but—more important—that they do not fall by the wayside and become involved in crime or drugs. That is a big challenge.
There is a problem of acceptance. I hope that I will be allowed to take a gentle swipe at politicians, perhaps even those of my own party. There has been a reluctance to 562 accept that people who are not well educated and who therefore have no job or are caught up in the dependency culture are more likely to fall by the wayside and to turn to crime. The problem is that that is regarded as an excuse for crime. It is not an excuse: many people in the same circumstances do not turn to crime. However, it sometimes serves as an explanation, and as a reason to look deeper.
I am glad that the shadow Home Secretary, my hon. Friend the Member for West Dorset (Mr. Letwin), has recently opened up that debate, and I applaud him for doing so. He made it quite clear—
§ Madam Deputy Speaker (Sylvia Heal)
Order. The hon. Gentleman must relate his interesting remarks to the White Paper on people with learning disabilities.
§ Mr. Robertson
I certainly shall, Madam Deputy Speaker, and I apologise for straying.
My point is that learning disabilities or mental illness are often not recognised. Physical illness is much more easily recognised than mental illness. That failure to recognise and address the issues might be because of the stigma that attached to mental illness in the past, or because we find it frightening to talk about, or because we find the people who suffer mental illness rather challenging.
Some of the problems that children have, such as autism, dyslexia and dyspraxia—an illness I came across only recently—are not recognised and identified quickly enough, and not dealt with properly. The result is that many children, through no fault of their own but because of their learning disabilities, do not receive the education that they deserve.
The need to provide education to such children brings me to the issue of special educational needs. With my hon. Friend the Member for Daventry (Mr. Boswell) and the Minister, who was then at the Department for Education and Skills, I had the pleasure to serve on the Committee that considered the Special Educational Needs and Disability Act 2001. Although we welcomed much of its content, certain aspects of that legislation caused me concern.
The legislation emphasised inclusion, which in theory I applaud, but when that inclusion in education does not provide for the child, that child becomes excluded from society later. The legislation was rather prescriptive, stating that the child had to be educated in a mainstream school unless there was an appropriate statement; and even if there was a statement, the child had to be educated in the mainstream unless that wasincompatible with the wishes of his parent, or…the provision of efficient education for other children.The emphasis was on inclusion.
Many children, especially those with moderate learning difficulties, are included and do very well in mainstream schools. However, in my opinion, many children with moderate or more severe learning difficulties—perhaps with emotional and behavioural difficulties—need special provision. The 2001 Act was not helpful in that respect—in fact, it was rather destructive.
My remarks are founded on my experience in Gloucestershire, which, for the avoidance of doubt, is run these days by an unholy Lib-Lab alliance, or pact as it 563 used to be called. I make that point lest people think that Gloucestershire is run by the Conservatives; it has not been for a long time. I am greatly concerned about education policy in Gloucestershire. I am not the only one concerned about special educational needs provision; a damning Ofsted report was published in January.
Inappropriate education can lead to exclusion, even though the intention is to include. Although it might be regarded as inclusive to educate all children in one school, if some children fall behind because they cannot cope with that education, they will end up excluded from society. The theory will not work in practice. Many pupils and parents in Gloucestershire are concerned about the removal of the special schools.
The Minister, dealing with the 2001 Act, said repeatedly that the Act and Government policy at that time should not lead to the wholesale closure of special schools, but Gloucestershire county council decided otherwise and that it should close the special schools. Bownham Park school in Stroud was earmarked for closure. Parents, pupils and everyone else connected with the school ran a tremendous campaign to keep it open; unfortunately, the adjudicator decided that the school should close, with the decision being announced the day after the general election. That is not a political point; it is a fact.
That was extremely sad, not only for those involved in that school, but for many other teachers and head teachers throughout the mainstream sector. They recognise that, regardless of the good intentions of any Government, historically resources have never followed pupils. Mainstream schools have never had adequate resources to provide the support required by children with special needs.
The council has not learned the lesson. This morning, I received an e-mail telling me that Gloucestershire's cabinet has now raised closure notices on Dean Hall school and Oakdene school in Forest of Dean. Oakdene provides for children with severe learning difficulties. The hon. Member for Forest of Dean (Diana Organ) is to present to the cabinet a petition carrying 5,000 signatures, protesting against the closures. Although we hear from the Government that their policies are not intended to lead to the wholesale closure of special schools, in Gloucestershire—the area that I am paid to represent—there is a programme of wholesale closure of special schools.
The one special school that falls in my constituency, Alderman Knight school, has sent a delegation to the House of Commons and run a tremendous campaign to try to protect itself. Not only do pupils at that school have learning disabilities as described in the White Paper, but they have physical disabilities as well. It is extremely difficult for those children to be educated in mainstream schools. The Minister will be tired of hearing me make this plea, but I urge the Government to re-examine their policy of inclusion.
I do not want the House to think that it is only my opinion that provision for special educational needs is not working well in Gloucestershire. Paragraph 5 of the Ofsted report describes the background in Gloucestershire, and states:Against this generally favourable background, the LEA has serious weaknesses.One of the serious weaknesses listed is the strategy for special educational needs. The process that I have been describing is one such reason for the Ofsted report's criticism.
564 Looking in more detail at the section in the Ofsted report on special educational needs, one paragraph says:The strategy is to promote inclusion by educating pupils with moderate learning difficulties in mainstream schools, and as a consequence, closing the area special schools providing for these pupils.Again we find that the policy is leading to the wholesale closure of such schools. The report continues:The closure of the special school in the first area to be tackled was only achieved after the intervention of the office of the schools adjudicator. In the remaining three areas, there is confusion in the schools and among parents as to whether the closure of special schools or a change of status is being considered…As a result of the slow process, the special schools towards the end of the cycle of the review fear that it will become increasingly difficult to recruit staff, maintain pupil numbers and ensure that the pupils' curricula needs are met.Scare stories lead to staff disappearing, which then leads to falling roll numbers. Then people can turn round and say that there is no demand for the services of such schools—but we all know that there is.
The report goes on to say:Despite the existence of the development plan, most of the schools visited had no confidence that the members of the council have a strategy for the future of special educational needs provision in the LEA.That means that because the schools are earmarked for closure, but there is not an adequate replacement policy, the resources will not follow the pupils into mainstream schools. The report goes on to make another point:Most serious of all, although the documentation makes constant references to inclusion and facilitating access, it fails to show how its proposed changes will raise the standards of achievement of pupils with special educational needs.That is the crucial point. In other words, we are talking about theories and not setting out how the standards of achievement of pupils with special educational needs will be attained.
Highlighting the problem further, the report goes on to say:In addition to the extensive special educational needs provision within the county"—of which I am proud—the LEA maintains a number of pupils in out-of-county placements. The total number has reduced…but the number of pupils whose placements are joint funded with the social services department has doubled. Very few of these pupils need to go to schools out-of-county for educational reasons. Rather"—this is the crucial point—they are placed outside because of inadequate respite, fostering or residential arrangements within the county.The report recommends that the LEA needs towork with health authorities and the county's social services department, to reduce the number of cases where exceptional needs prevent the completion of special educational needs statements within 18 weeks".The statementing situation is obviously of great concern. I fear that you will call me to order if I go down that road, Madam Deputy Speaker, so suffice it to say that the approach is rather "one size fits all", which we want to try to avoid.
565 In general, I welcome the fact that the White Paper addresses the difficulties caused to many people by the fact that they have learning disabilities, whatever that means—the definition is quite wide. I have tried to highlight one or two areas where people can fall by the wayside, end up homeless or perhaps committing crime, or are excluded from society even if they are not homeless or criminals. I hope that the White Paper will address those issues. I hope that it is also able to identify ways in which we can put things right.
I did not go to a grammar school, because, as I have said before in the House, I failed to negotiate the 11-plus successfully. I went to a secondary modern school. I make that point only because I went to the school appropriate for me; it provided me with the appropriate education. So I would not want people for the sake of the theory of inclusivity to be excluded from society. That is the plea that I yet again make to the Minister, with whom I have some sympathy because, even though she has changed Departments, she still has to suffer my pleas.
§ Mr. Boris Johnson (Henley)
I am very pleased to take part in this debate. I am afraid that I will speak not as magniloquently as some of the previous speakers, but briefly.
The only charity in which I have any involvement is a charity for Down's syndrome children. I have recently been to see it in action, not in Britain but in Moscow. I hope that the House will forgive me if I begin by giving everybody in Britain a pat on the back for the way we treat people with severe learning disabilities. The objective of the charity—it is called Downside Up, and I have absolutely no inhibition about plugging it in the House—is to export to Russia our ideas about what constitutes disability and how parents should cope with having a disabled child.
It is no exaggeration to say that during the communist epoch—and, indeed, it continues to be so to this day—the Russian approach to Down's syndrome children has been barbaric. In many Russian hospitals, as soon as Down's is diagnosed in a new-born child—from the epicanthal fold, the disposition of the thumb and so on—parents are told that it would be best if their infant were left to die and if nature were allowed to take its course as soon as possible.
I met a man called Alexander who received just such a verdict seven years ago on the birth of his daughter. He told me of his fury at that verdict and of his joy at what his daughter had since achieved. One could see that she could read fluently, sing, dance and all the rest of it. She patently enjoyed life to the full.
I felt that the charity was doing something wonderful and remarkable in exporting a particularly British concept of the value of the individual, not as a unit that might be deemed valueless to communist collectivity, but as a person with rights and potential. That is of course the theme of the White Paper "Valuing People". You might be surprised to discover, Madam Deputy Speaker, that I have read it very carefully. I think that it is rather good; on the whole, I find it hard to dissent from anything that it says, although I am not quite sure that the Minister is entitled to crow in such extravagant terms about the absence of jargon in it.
566 I listened with great interest to the speech of my hon. Friend the Member for Tewkesbury (Mr. Robertson), in which he dwelt so eloquently on the themes of social inclusion and exclusion. We now use those bits of jargon repeatedly in the course of our daily lives, but I have to confess to the House that I do not know what they mean. What is social inclusion and what is social exclusion? I know that the Minister has other things on her mind, but I should be grateful if, when she replies to our debate, she could supply a snappy definition of social inclusion, as well as social exclusion; is it not being invited to top parties? The Deputy Prime Minister, I believe, runs the social exclusion unit; doubtless, such a definition would help him to explicate its function to the wider world.
The White Paper is admirable in its aims. However, Members will not be surprised that I wish that it had more bearing on the situation on the ground as I see it week in, week out in south Oxfordshire. My experience is of parents at the end of their tether, trying to cope with children with severe learning disabilities, and who are now finding that central props in their lives have been, or are about to be, kicked away. Because of its great affluence, Oxfordshire has had a poor per capita settlement in social services, and there is currently a shortfall of at least £5 million. As Members will know, housing in Oxfordshire is expensive and it is hard to recruit and retain staff, which is why valuable day care centres are under threat. Families in the Henley area in particular are greatly concerned about the future of the Chiltern respite centre, where overnight stays have just been curtailed. I am currently in lengthy correspondence with the parents of a severely disabled young man who faces eviction from his care home and has nowhere else to go because of shortages and difficulties in social services in south Oxfordshire.
In conclusion, for all the White Paper's fine words and good intentions, it envisages only £50 million of new money. How much of that will go to help the most vulnerable people in Henley and south Oxfordshire? One cannot but admire the White Paper's intentions, but it is legitimate to wonder how many parsnips its fine words will butter in the day care centres of south Oxfordshire. I hope that the Minister can give some comfort to the most vulnerable people in my constituency and society at large.
§ 12.2 pm
§ Mr. Andrew Rosindell (Romford)
If there is one thing that we, as Members of Parliament, must do for our constituents, it is to value the people whom we are elected to represent. I therefore welcome the White Paper and all the contributions to our debate.
We rightly approach the issue largely through consensus, as we all encounter it every week in our constituencies. People who are disadvantaged for whatever reason deserve our support and the backing of Members of Parliament on both sides of the House. I therefore thank the Minister for presenting the White Paper. As was made clear by my hon. Friend the Member for Daventry (Mr. Boswell), Opposition Members endorse an overwhelming majority of the points that it raises and we shall certainly work alongside Government Members to achieve many of its objectives. As the House knows, I am a new Member, elected for the first time last year. I had not encountered the issue before, and it is yet another area in which I am getting an education. Most citizens do 567 not often come across people with learning disabilities who are disadvantaged in the ways that we have discussed today.
As a Member holding regular weekly surgeries, it is my experience that parents of people with learning disabilities come to see their parliamentary representative to ask me to raise issues in Parliament or with the local council; I am a councillor and will remain one until the local elections. I feel responsible; it is my duty as an MP to do everything that I can and use every possible opportunity to raise issues of concern to parents who have to live with their children's disabilities day in, day out, and to the voluntary sector. I shall therefore raise those issues, as is my duty, in the London borough of Havering, of which my constituency is part, and the United Kingdom Parliament.
We must do everything in our power to support the voluntary sector. Government schemes are not necessarily the way forward. If we can use as many of the available resources as possible to assist local voluntary groups to provide a service to the community, that is often a far better way of providing for those with learning disabilities. There are many such local organisations and voluntary groups in my constituency and in the London borough of Havering.
§ Mr. Boswell
Does my hon. Friend agree that the system of direct payments to service users and their carers is almost tailor-made for accessing the range of opportunities that the voluntary sector can offer?
§ Mr. Rosindell
I endorse my hon. Friend's point. In all areas of Government policy, we should ensure as far as possible that money is given directly to those providing the service. That is a more efficient system that reduces red tape and bureaucracy and means fewer bureaucrats and civil servants spending taxpayers' money, which can instead be spent directly where it is most needed, by those at the grass roots who understand the priorities and how the money can be used to best effect for the people whom we wish to help.
In my constituency and in the London borough of Havering, we are fortunate to have so many organisations dedicated to the care of those who suffer from learning disabilities and to assisting the parents and relatives who live with the problem day in, day out. Last Friday, I visited St. Bernard's day centre in the constituency of the hon. Member for Hornchurch (John Cryer) with my hon. Friend the Member for Upminster (Angela Watkinson). The centre serves all three of the borough's constituencies—Romford, Hornchurch and Upminster. I met the parents and afterwards the people who attend the day centre and who need vital care.
Parents raised several issues that I hope the Minister will consider. There seems to be an immense shortage of respite care. I hope that the Government will find ways of enhancing the opportunities for respite care, which is so badly needed, particularly when the parents are elderly. It is incredibly difficult for people reaching their later years—people in their 60s or 70s or even older—to cope with a child who is growing older and who has huge problems and learning disabilities. Respite care would go a long way to assist them. That was the main issue that parents raised.
I have not heard mention today of speech therapy, which is another matter regularly raised by parents. Recently, the parents of a young boy called Patrick who 568 lives in my constituency came to see me. They are distraught. He attends a local special needs school, Dycourts, which is in the Upminster constituency but serves the entire borough of Havering. He desperately needs more speech therapy, but there is a chronic shortage of teachers who can provide that service. It is difficult to find people willing to take on the task.
Patrick's parents, who are not necessarily well off, are told that they can pay £50 an hour for that service through the private sector, but the local authority cannot provide the service because of the shortage of speech therapists. I hope that the Minister will look into that matter, too. The problem is growing. The ability to communicate is the most important tool that any human being can have. People with learning disabilities who cannot speak or communicate with their family or those around them are hugely disadvantaged. I hope that the Government will consider further the role of speech therapy. I wrote to the Secretary of State for Health on 21 November about the specific case to which I referred—I have the letter here—but I am sorry to say that I have not yet received a reply. I hope that the Minister will look into the matter.
I welcome the White Paper and practically everything that it contains. I should like to highlight one or two points. The Prime Minister speaks in the foreword about a brighter and more fulfilling life for people with learning disabilities. He says:It is a challenge that I am determined this Government will meet.I applaud that commitment and I hope that he intends to follow it through, but without adequate funding, such words can mean nothing. I hope that the Minister will ensure that, whatever proposals are made, the Government will make certain that adequate funding is made available for the aims that we all want to be achieved. I applaud everything that has been said, but believe that we must not give false hope to people who are in great need of help. We must be careful not to promise the earth and propose services that cannot be provided simply because the resources are not made available. I urge caution on the Minister with regard to making promises that we might not be able to keep. We must be careful about the words that we use. Maximising opportunities for disabled children must be our first priority. Disabled children in Britain need and deserve better support and protection and greater opportunities. I hope that we will all work to ensure that that is what they get.
I mentioned respite care and the need to support those who dedicate their lives to looking after disadvantaged people. I refer especially to the parents of such children. I urge the Government to do more for those carers—people who could probably do so many other things with their lives, but who devote themselves to their children and others who need their support. Respite care is one means of giving such people greater opportunities to take the rest that they need from having to cope with the daily life of caring for somebody who has severe learning disabilities.
I am pleased that housing is highlighted in the White Paper. We must ensure that the institutional development and buildings that we have had for many years are phased out. We should give people the opportunity to live in places where they feel comfortable. Residential care is so much better for everybody. We should work towards purpose-built modern buildings, so I am glad that that is highlighted. Such work is being done in my borough, and I applaud it.
569 The White Paper also talks about giving people a fulfilled life—something that we all endorse. That includes modernising day services, giving people equal access to education and lifelong learning and opposing any form of discrimination. Yes, discrimination does exist. I endorse the comments of my hon. Friend the Member for Henley (Mr. Johnson) about the puzzling nature of some of the expressions that are used. There is uncertainty about what terms such as "inclusiveness" mean. When such expressions are used, it is most important that we see action that improves people's lives. Words often mean little to people. I think that they mean little to the vast majority of our constituents, who want positive changes and action that will allow people to lead happier, better and more fulfilled lives. Words are not as important as real action, which will provide a better future for people who deserve a better life. As Members of Parliament, or, in the case of the Minister, as members of the Government, we can use our power to achieve those things for the people whom we represent.
§ Mr. Richard Bacon (South Norfolk)
My hon. Friend mentioned lifelong learning, which is of great interest to me. It is a tragedy for many people who want to engage in lifelong learning that the Government took such a strange attitude to the quality of individual learning account training providers, as a result of which they were forced to close down the scheme having overspent on it by £63 million—
§ Mr. Rosindell
I am sure that my hon. Friend's point is valid, but perhaps a question could be put to the Minister on another occasion when we are debating that subject.
"Discrimination" is a word that is used frequently; I hear it regularly in this place, particularly from Labour Members. I am concerned that we should not use words that inflame the situation. Sadly, it is a fact of life that people are different. We will not change that through legislation. The word "discrimination" is used so often, and it is not necessarily an appropriate word in every instance. No one denies that discrimination exists, but it is important to get to the root of problems rather than use words as a cover for political correctness.
I want to refer to an article published in Community Care last June. It states:Research published this week by Mencap to coincide with National Learning Disability Week reveals that despite positive attitudes to people with a disability, many people with a learning difficulty still face discrimination in everyday life and exclusion from mainstream society. Nine out of 10 people with a learning difficulty experienced bullying in the last year.None of us would condone that. All of us want those problems to be eradicated. We must bring people together without trying to pretend that differences do not exist; they do. We must be careful that we do not give the false impression that everyone in society, whatever their educational background, and whatever disabilities they may have, can suddenly be lifted up to exactly the same level. Of course, we would all love that to happen, but we 570 must be realistic. We must do everything we can, but we should not use words that can give an impression that can ultimately lead to disappointment.
I want to refer to one or two cases from constituency, and my borough, Havering. In Havering, many aspects of the White Paper are applauded by councillors from all parties, and, indeed, by borough officers. Only yesterday evening, I received details of some of the progress being made in my borough in relation to the points raised in the White Paper, even at this early stage. Havering continues to fund the excellent London People First organisation, which operates in my constituency. It has helped to establish the second service user parliament in the United Kingdom. Assisting more people with learning disabilities and their carers to access direct payments has provided a great advantage. Havering provides cash payments to help people with learning disabilities to organise their own care. If people can do that without being guided all the time by those who work in council offices, that is a good thing. Let us give people more opportunities to be independent and to make their own decisions. It must be a good thing to work towards promoting independence and reducing reliance on local social services departments.
Developing a person-centred approach is vital, and in Havering, we have excellent services such as the Jackson's Cafe. We have initiated or funded a number of other new developments, such as the new supported housing schemes, which residents are incredibly excited about. Those schemes give them the opportunity to lead more independent lives. A new joint community learning disability team is a model for people in many other services who have come to see it as a service that integrates all health and social services provision.
A new worker is also being employed, funded by a local bank and employed by Havecare, a local voluntary organisation dedicated to looking after the interests of carers and those with learning disabilities, and helping them through difficult periods. The new person is being employed for that purpose in a public-private partnership in this instance, and I hope that that will be a success.
The last long-stay hospital in Havering—Little Highwood—will close in 2003, and the residents will all be housed in purpose-built quality homes. That must be the way forward for all those with learning disabilities who need care outside the family home. Havering has also established a local partnership board, consisting of representatives from all the key local sectors, including voluntary groups and other organisations involved in the care of people with learning disabilities. We are establishing a pooled budget under the Health Act 1999, under which budgets between health and social care are to be pooled to avoid divisions and complications between services. That is another positive step forward.
My borough supports a range of activities, such as theatre productions and sports for the disabled. These are leisure activities that we should encourage and support, as they give people the opportunity to get out and take part in the activities that the vast majority of people take for granted—
§ Madam Deputy Speaker
Order. I must ask the hon. Gentleman to relate his remarks to the White Paper.
§ Mr. Rosindell
I am about to come to that, Madam Deputy Speaker. If there is a criticism of the White Paper, 571 it is that it does not address the funding issues, especially the need for more revenue to support the large number of children surviving into adulthood who would previously not have survived, and the number of older people with learning disabilities whose life expectancy has increased to the point at which many outlive their families, particularly their elderly parents.
More children are being diagnosed with disorders such as autism and attention deficit disorder, yet few specialist services exist to support the parents of those children. The same can be said of primary health care. Although it is slowly improving, people with learning disabilities are, sadly, not particularly well cared for by their general practitioners. They need specialist primary care services. To some extent, the White Paper is Government policy without guaranteed Government funding. A thorough review of the needs of people with learning disabilities and their carers in the next comprehensive spending review later this year would make that point, and I hope that the Minister will take that on board.
§ Mr. Boswell
Is my hon. Friend aware that a thoroughly desirable practice is growing up in primary care trusts, in which one of the partners specialises in a particular area of practice? It might be possible for a named individual in each trust to take the lead on learning disability issues, to set an example and to provide a focus of interest in the trust.
§ Mr. Rosindell
I support that view. Making an arrangement whereby someone specialises in an area is the most efficient way to deal with a policy or need. My hon. Friend makes a valid point and I hope that the Minister takes it on board.
The additional costs to local government need to be addressed as councils will be held responsible for the loss of such services. Councils need to show community leadership in speaking out for people with learning disabilities, who are frequently misunderstood and discriminated against. They are also disproportionately the victims of crime that is often repeated and targeted. I am sure that we all agree that that is shameful.
Local government has a role in promoting the needs of people with learning disabilities and their integration in society. That campaign has been running for at least a century and I hope that it does not run for yet another century. We must address these issues and I hope that the Government and the Minister take those points on board. We must all work together on the objectives set out in the White Paper and Conservative Members will do all that we can to play our part in achieving their success.
§ Jacqui Smith
This has been a well-informed and constructive debate. Hon. Members on both sides of the House have made good use of their constituency experience to contribute to achieving an objective in which, as the hon. Member for Romford (Mr. Rosindell) made clear, we all share: turning the aspirations of "Valuing People" into reality for people with learning disabilities and improving their opportunities.
The hon. Member for Daventry (Mr. Boswell) has a long history of involvement in this area, before and since being elected to the House, and he raised a number of important issues, which I hope to cover. One relates to 572 the challenge for providers of learning disability services. Some people have particular needs and display particularly challenging behaviour, so recognising those needs and enabling local providers to develop specialist services for people with severely challenging behaviour is a priority for the £20 million capital element of the learning disability development fund.
The hon. Gentleman and other hon. Members also emphasised the need for national and local partnership to deliver the improvements that we want to achieve and suggested that levers are required to ensure its existence. I concur, which is why I am pleased that the flexibilities made available by the Health Act 1999 are being used to achieve better joint working between health and social services departments. The hon. Member for Romford referred to that. In fact, 23 of the 65 areas in which Health Act flexibilities are in place cover learning disability matters.
I strongly agree that that partnership must involve the voluntary sector and the hon. Member for Daventry is right that direct payments provide a way to ensure that. I referred to the Department's important partnership with Mencap to provide a telephone helpline, but partnership does not always come easy, which is why the Department's website already contains advice to partnership boards on developing partnership working. We shall issue further guidance after consulting.
The hon. Member for Daventry also made an important point about transitions. They do necessarily happen at a particular age or time. Everyone—even adults, but especially disabled children and young people—goes through a range of transitions, whether from home to school, from school to school, or from living at home to living independently. It is precisely because of those different transitions that we need to develop a person-centred approach to designing services, and to back that up the Department has published further guidance on person-centred planning to ensure that partnership boards have the understanding and expertise to make that a reality.
Several hon. Members rightly referred to carers. I am sure that all hon. Members would want to put on record their admiration for the work of carers. They ensure that the people in their care, especially learning-disabled people, have the opportunities that we would want them to have, so we have a responsibility to support carers. The Government's strategy on carers is taking that forward in a range of ways.
My hon. Friend the Member for North-East Derbyshire (Mr. Barnes) and the hon. Members for Romford and for Daventry raised the issue of older carers who are concerned about their responsibilities for their sons and daughters with learning disabilities. In the revenue and capital expenditure of the development fund we give priority to supported living approaches, especially for people with learning disabilities whose carers are becoming elderly, because we recognise that that is a particular need.
The hon. Member for Daventry made a particular point about the regulatory impact assessment for care standards for younger adults. I understand that that has been placed in the Library. In wider terms, the provisions of the Care Standards Act 2000 on common national standards and improved quality of residential and domiciliary care will 573 help learning-disabled people by ensuring that care is of a high standard and that users can feel confident that those standards put their interests at the very centre.
Several hon. Members, including the hon. Member for Chesterfield (Paul Holmes), raised the issue of housing. As I have already said, there is priority in capital spending for housing. Along with the Department for Transport, Local Government and the Regions, we are developing the joint circular and guidance on commissioning the housing care and support services required to support housing choice. That has been delayed, but it was partly so that it could coincide with the important work on supporting people. It is vital that those policies are developed in tandem. The guidance will include a discussion of how local strategies should be developed to shift provision and offer more choice, how people with learning disabilities and carers can be involved in the planning and commissioning process, information about the costs of schemes and how capital and revenue funding can be secured, the differences between the options and practical examples that can be drawn on, and performance indicators to monitor progress.
Some of the resources for housing choice will come from the development fund, but there are other important sources. The majority of capital funding for new housing provision is through the Housing Corporation's approved development programme. It allocates resources to registered social landlords in line with the priorities identified by local authorities in their housing strategies and within the framework of Government legislation and housing policies. That is why it is important that the role we have given learning disability partnership boards, particularly to develop their housing strategies by 2003, feeds into the establishment of needs and priorities within the local authority housing strategy. We want them to benefit from other forms of housing support as well. We also want local authorities to map both current housing provision options and—because we want to promote choice and broaden scope—their future development.
I assure the hon. Member for Daventry that the local learning disability partnerships are all operating. As he said, the joint investment plans were due to arrive in social care regions yesterday, but in the circumstances I am afraid I cannot tell him precisely how many have been received. I can, however, assure him that the information will be passed to the Department as a matter of urgency, and that the plans will then be evaluated so that we can ensure that they cover many of the priorities raised today.
Another important lever for the securing of partnerships is the allocation of the development fund through pooled budgets, although health authorities will provide the route. The Local Government Association is currently conducting a survey of the partnerships, and I understand that the results so far are encouraging, but if the survey prompts any concern we will act to ensure that the partnerships work effectively. They are, after all, crucial to our ability to make a difference at local level.
Many Members mentioned advocacy, and in particular self-advocacy. In response to representations by the taskforce, we have provided additional funds for self-advocacy.
The hon. Member for Daventry raised the important question of how we would monitor and evaluate the difference that our policies would make. As I have said, 574 we are developing and we will consult on performance indicators and statistics, and will take account of feedback and data from the helpline and the implementation support team. As the hon. Gentleman suggested, the social services inspectorate will make an assessment, and we will evaluate the joint investment plans. The £2 million research programme that the hon. Gentleman mentioned will enable us to focus on success in particular areas, and the Social Care Institute for Excellence, with its remit for identifying and sharing best practice, will play an important part. We will also carry out a national users survey.
The hon. Gentleman asked about the Government's plans to report to Parliament. I assure him that we will report. We are currently considering how we can ensure that our report includes the perspectives of users and carers.
§ Mr. Boswell
I am grateful for that assurance and I am glad that the Minister is focusing on the issue, but she has said nothing about the frequency of reports. Will she reflect on the need not just to report once on the implementation phase, but to set up machinery for reports at convenient points—annually, or perhaps a little less often—so that the House can keep in focus the success of the policies as they develop? We realise that that will take time.
§ Jacqui Smith
I can assure the hon. Gentleman that we will ensure that it is an ongoing report.
My hon. Friend the Member for North-East Derbyshire rightly outlined the struggle for disability rights. It is easy to forget when we talk about progress that those rights were not won easily. I pay tribute to him and to other hon. Members who have fought valiantly on behalf of disabled people to ensure that those rights are clearly represented both in policies and in legislation.
My hon. Friend raised points about the relationship between mental health and learning disabilities, and about the mental health White Paper. Most psychiatric disorders are more common among people with learning disabilities than in the general population. A person with a learning disability who has a mental illness should expect to access services and to be treated in the same way as anyone else.
That will require mainstream mental health services to become more responsive, and specialist learning disability services to provide facilitation and support. Clear local protocols should be in place to promote collaboration between specialist learning disability services and specialist mental health services. That work will be facilitated not only by the extra investment that the Government are making available for mental health provision, but by the standards and reforms laid down in the national service framework for mental health.
My hon. Friend strayed a little into mental health legislation. I assure him that, while the Government's proposals in relation to mental health legislation widen the definition of mental disorders, those will be balanced by very tight criteria on detention and compulsory treatment.
The legislation is currently in preparation. We have taken the opportunity to continue discussions with stakeholders and to ensure that in both the Department of Health and the Home Office, the views of stakeholders—the sort of people whom my hon. Friend talked about—are taken on board.
575 My hon. Friend made a very important point about tackling disability discrimination. It is right to do so not only on moral grounds but because it leads to better services for all of us. Services that discriminate are not good services for anyone. That is an important reason why we need to tackle that discrimination.
My hon. Friend rightly pushed for further progress on delivering enforceable rights for people with disabilities. I know that the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Liverpool, Garston (Maria Eagle), is looking in detail at the disability rights taskforce recommendations which still need to be implemented to determine how to take those forward.
I was pleased that my hon. Friend for North-East Derbyshire mentioned the special educational needs and early years project in his constituency, although I noted his concern that the money was limited to 2003. The significant extra resources that the Government have invested in developing early years provision demonstrate their commitment both to identifying and to dealing with children with special educational needs. I assure my hon. Friend that across government consideration is being given to the means to continue that support as we go into the next spending review period.
My hon. Friend made the important point that being included in a community is partly about having access both to the vote and to democracy. I share his respect for Scope's work to raise that important issue.
The hon. Member for Chesterfield spoke from his background as a teacher— which is my background too— about the progress that has been made on the inclusion of children with disabilities and learning disabilities into mainstream schools. I do not want to introduce an element of discord, but I should point out that the hon. Gentleman is wrong about class sizes. Average class sizes have fallen under Labour.
§ Paul Holmes
Is the Minister saying that the Government's own figures are incorrect? For children under seven, class sizes have fallen, but for children aged seven to 11 and 11 to 16 class sizes have risen in the past five years.
§ Jacqui Smith
I do not think that that is right. Average class sizes in all age groups have fallen under Labour.
The hon. Gentleman is right that we need to provide support to enable disabled children to be included in mainstream schools, and the £220 million schools access initiative and other investment in special educational needs is important in that respect. I do not share the hon. Gentleman's negative view about the effect of inclusion on standards in schools. In fact there is quite significant work, much of it sponsored by the Department for Education and Skills and previously the Department for Education and Employment, that demonstrates links between achieving high standards and adopting an inclusive ethos.
On behalf of his constituents, once again the hon. Member for Tewkesbury (Mr. Robertson) referred to the reorganisation of special educational needs provision in Gloucestershire. As he said, we have engaged in this debate on many occasions and I repeat that the Government's plans, policies and investment in special educational needs are certainly not directed at closing special schools, which have received increased investment 576 under Labour. The hon. Gentleman rightly referred to local decisions on reconfiguration and drew strongly from the Ofsted report into Gloucestershire. That report is available only because the Government considered it important to monitor the activities of local education authorities. I have no doubt that the hon. Gentleman will continue rightly to raise that local issue.
Several hon. Members were concerned about resources. We make no apology for providing an extra £42 million in addition to the £3 billion that is currently spent on learning disability services. Much of the work that is carried out locally by the learning disability partnerships and at a national level by the taskforce and the Government relates to looking at the objectives that we have set ourselves and ensuring that the £3 billion is spent in a way that meets the aspirations of people with learning disabilities—[Interruption.] The hon. Member for Daventry twitched so I thought that he wanted to intervene.
§ Jacqui Smith
Good. I am glad that we are back to consensus.
The hon. Member for Chesterfield referred to employment. I can assure him that the Government aim to enable more people with learning disabilities to participate in all forms of employment, to undertake paid work whenever possible and to make a valued contribution to the world of work.
We recognise the importance of supported employment as an option for people who are unable to work without support. Last year, we modernised the former supported employment programme which is now workstep. Workstep enables providers to offer tailored support to individuals and their employers and to encourage development in work with progression to working without support where this is right for an individual. We have backed our commitment to this initiative with a further £37.2 million which will be used to help providers modernise their support approaches, encourage more effective use of information and communication technology and increase provision by around 2,000 places.
I touched on the issue of children and adults with profound and multiple learning disabilities in my opening remarks, but I should like to reassure the House that the proposals in "Valuing People" apply not just to the more able but equally to people with learning disabilities. Such people require long-term intensive health care because of their complex disabilities, and they place significant challenges on services. That point is also made in last August's implementation guidance.
When the revised joint investment plans are evaluated, we will ensure that the objectives deliver on the need to ensure that improvements apply equally to all learning-disabled people. I have already mentioned the capital fund's focus on providing additional facilities for those with challenging behaviour. Of course, integrated services for children will be supported in particular by the £60 million that will be made available through the "quality protects" programme, which focuses on developing much better integrated services for disabled children.
§ Mr. Boswell
On children with profound and multiple learning difficulties in particular, will the Minister 577 consider and take very seriously the message in the Mencap report, "No Ordinary Life", some of the content of which I found genuinely disturbing? The report perhaps reflects the existence of an even greater problem than constituency experience has led us to believe.
§ Jacqui Smith
I certainly undertake that, as in the past, we will listen to what Mencap has to say, because it has great expertise in terms of where the problems lie and where developments are needed.
The hon. Member for Chesterfield also mentioned day services. I can assure him that we believe that action on modernising day services and the provision of extra resources must be a priority. According to last August's guidance, the learning disability partnership boards should prepare modernisation programmes by 31 January 2003, which should show the steps needed to achieve modernised services by 2006, with particular reference to existing large day centres. However, it is precisely because we understand the need for bridging finance— for conversions, for example, to ensure that facilities remain available as alternatives are developed— that we have made it available, through the learning disability development fund, to support the modernisation programme.
The hon. Member for Chesterfield also made an important point about the role of primary care and GPs. I can assure him that the taskforce will include a GP, whose presence will enable us to consider many of those issues. It is of course right that significant extra funding for health authorities should also benefit those with learning disabilities, in terms of their primary care needs.
The hon. Member for Tewkesbury made a wide-ranging contribution, part of which I have already dealt with. I agree with him that a disability that is not visible is no less important; in fact, people with such disabilities are in some ways more open to discrimination. We should therefore be aware of the need to listen to the views of users and of those with learning disabilities on how such discrimination impacts on them, so that we can counteract it. Given the concerns that the hon. Gentleman expressed about mental health problems in prisons, he will doubtless welcome the extra Government investment in mental health care in prisons, which will ensure an additional 300 in-reach workers by 2003–04
The hon. Member for Romford, some of whose comments I have already referred to, mentioned speech and language therapy in particular. I can assure him that 578 some of the extra funding being made available through education budgets, particularly for special educational needs, is specifically targeted at speech and language therapy. The employment of more speech and language therapists is an important part of the NHS plan, and the use of Health Act flexibilities will enable us to bring together the therapy provided in the health service and the needs in the education service as we have not managed to do before.
I am sorry that the hon. Gentleman has not had a response to his letter, and I shall certainly chase that up vigorously when I return to the Department. I welcome the developments in Havering that he outlined, which are designed to make a reality of our proposals.
The hon. Member for Henley (Mr. Johnson)— who we are all disappointed to see has now left the Chamber— made some important points. I especially support and commend the work of the Downside Up organisation in exporting good practice from this country to other countries. I agree with the hon. Gentleman that we have many social and health care services in this country that do excellent work— and that includes the voluntary sector. Sometimes, when we talk about the challenges and the ways in which we need to improve, we also need to take stock of what we can be proud of, and we should commend the people who do that work.
The hon. Gentleman chided the Government on the use of the term "social exclusion", and perhaps this would be a useful note for me to end on. He challenged me to say what social exclusion meant in the context of people with learning disabilities.
To define social exclusion we need to explain the effects that it has on people, and what we need to do to counter them. For me, social exclusion for people with learning disabilities is when they cannot get access to a proper job, and cannot get on a bus or choose where they want to live. It is when they cannot meet people apart from their families and their carers, and cannot take part in sporting or other leisure activities or make decisions for themselves.
It is in order to tackle those issues and improve the opportunities that we have set out the programme in "Valuing People", and I welcome the commitment that we have heard today from both sides of the House to work to ensure that we make that a reality.
§ Motion, by leave, withdrawn.