Learning Disabilities Mortality Review Reports
(Limited Text - Ministerial Extracts only)
Read Full debate
Lord Scriven
To ask His Majesty’s Government what assessment they have made of the effectiveness of learning disabilities mortality review (LeDeR) reports in improving life outcomes for people with learning disabilities.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, we are committed to reducing the health inequalities faced by people with a learning disability and autistic people. Through our 10-year health plan, we are working to improve access to, and quality of, care, delivering holistic, place-based support. LeDeR annual reports support this aim by compiling insights from local reviews into the deaths of people with a learning disability and autistic people. These insights help ICBs and providers to make improvements to care.
Lord Scriven (LD)
As the Minister will know, the learning disabilities mortality review was commissioned a decade ago, yet people with learning disabilities still die more than 20 years younger than the general population, and 42% of those deaths are avoidable—twice the rate of the general population—so it is evident that the LeDeR process is not creating the systematic changes required. With that in mind, will the Minister commit to meeting me and a small group of people to explore what new enforceable systems are required to end these tragic and unacceptable early deaths?
Baroness Merron (Lab)
These are indeed tragic deaths, and avoidable in a number of cases, as the noble Lord rightly says. I can do better than agree to meet him and his colleagues—I have already got agreement from Minister Zubir Ahmed, who is responsible for this area and will be very pleased to meet them.
Baroness Finlay of Llandaff (CB)
My Lords, will the Government commit to working further with the National Mental Capacity Forum? One of the leads that comes out in this report is a failure to implement adequately, particularly in giving support to people. Parents are often very important in providing support to a person with learning difficulties, but when that person is an adult they can feel excluded, and they are often very worried as to what will happen after they have died and the person remains alive.
Baroness Merron (Lab)
I understand the point that the noble Baroness makes—it is quite right. We will continue to take account of and work to support parents and those they care for in the way that she describes. Certainly, I will also discuss with the Minister continuing the work with the organisation to which she refers.
Lord Addington (LD)
My Lords, to slightly widen the Question, would the Minister look at the fact that anybody who has a communication problem has historically had very bad results, compared with the rest of the population, when dealing with the National Health Service? Those with a hearing impairment would be a classic example. Will the Government have a good look across the whole spectrum of those who have some form of communication difficulty and try to get those medical professionals briefed in different forms of communication for that very important interview?
Baroness Merron (Lab)
Again, I certainly accept the important points that the noble Lord is making. It is unacceptable that there are health inequalities and poorer life outcomes. Indeed, action could be taken. That is why our 10-year health plan recognises these inequalities and identifies particularly those with disabilities as a priority group for more of that holistic, ongoing support. Key to that will be the development of neighbourhood services, where such groups will be prioritised.
Lord Kamall (Con)
My Lords, I thank the noble Lord, Lord Scriven, for shining a light on this really important issue and for repeating the stat that people with learning disabilities and autism in England die almost 20 years younger than the rest of the population. That in itself is shocking, whatever your views.
The charity Mencap has cited a number of barriers that are stopping people with learning disabilities getting good-quality healthcare. These include failures to recognise that a person with a learning disability is unwell and staff having little understanding about learning disabilities in themselves. Could the Minister update the House on what specific steps the Government are taking, and with which partners they are speaking, to address these concerns?
Baroness Merron (Lab)
It bears repeating that it is shocking that people are dying on average up to 20 years earlier. As I have said, that is unacceptable. We work very closely with Mencap and other organisations, but what we are doing already is, for example, to the point that the noble Lord raised, improving identification of people with a learning disability on GP registers. In particular, a reasonable adjustment digital flag is being implemented in care records to make sure that support is appropriately tailored. In other words, if we do not know who people are and where they are, we cannot provide the support. That is an unacceptable reason.
The Lord Bishop of London
I thank the noble Lord for giving way.
My Lords, according to the learning disabilities mortality review of adults with a learning disability who died in 2023, 25.6% had a care package that did not meet their needs. We know that local authorities continue to face significant challenges to providing adult social care services. Can the Minister say what action the Government are taking to support local authorities as they respond to more complex needs to make sure that every person, including those with learning disabilities, has the correct care plan?
Baroness Merron (Lab)
As the right reverend Prelate says—or is it the most reverend Primate?
Noble Lords
Baroness Merron (Lab)
I am sure that all this will be clarified—but I will be delighted to change my reference. Indeed, this is extremely important, which is why we have a learning disability improvement standard to support NHS trusts, why each ICB has an executive lead on a learning disability and autism and why, among other things, we are rolling out the Oliver McGowan mandatory training on learning disability and autism.
Lord Blunkett (Lab)
My Lords, I was not sure who I was giving way to, but I am glad that God is on my side. Does my noble friend agree that, as part of that neighbourhood approach, two things should happen? The first is joined-up services, including good training for support workers where supported housing is concerned. Secondly, the major changes in abolishing NHS England should retain services at place level, rather than have the bureaucrats overseeing them.
Baroness Merron (Lab)
I agree with the points that my noble friend raises. Indeed, local provision is the responsibility of local trusts. I assure him that a huge part of our work is about improving care pathways and seeing people as a whole person. Part of the failing previously, I think, has been not to see those with learning disabilities and/or autism as whole people with a range of needs, just like anyone else, with those needs being specific to them. Certainly, moving from hospital to community under the 10-year plan will be a great assistance in that.
Lord Sterling of Plaistow (Con)
My Lords, everybody knows that this subject is dear to the Minister’s heart but, from my experience over many years, the workforce gets very nervous of having disabled people working with them. Employers and other people will give support, but the employees themselves have to feel comfortable with having disabled people working alongside them. Is the Minister able to do something about that?
Baroness Merron (Lab)
The noble Lord makes good points and I am glad that he does so. I have just had a word with the Minister from the DWP, who has confirmed—I am sure that the noble Lord will welcome this—that the DWP is working with employers on this. I can also say that, among staff generally, over 3 million people have completed the first part of the Oliver McGowan mandatory training, which is the Government’s preferred package. I am sure—in fact, I know—that that training is making a considerable difference in meeting the point that the noble Lord raises.
Baroness Fraser of Craigmaddie (Con)
My Lords, one of the problems the Minister has talked about in developing pathways is identification and data sharing. Could she be specific about the improvements that are being made within the 10-year plan to ensure that people with various learning disabilities—it is a huge umbrella term—are better identified and that that identification is shared across different health and care services?
Baroness Merron (Lab)
First, the learning disability improvement standard supports trusts in setting out the guidance on safe and—I emphasise—personalised high-quality care provision as a general umbrella, but specifically the reasonable adjustment digital flag is going on to care records, which makes sure that people receive the right tailored care. For example, by improving the identification of those with a learning disability on GP registers, which I think is key, we are promoting an uptake of annual health checks, which are absolutely vital for identifying undetected conditions early. That means that there can be health action plans following these checks.