Health: Learning Disability and Autism Training

Baroness Watkins of Tavistock Excerpts

Monday 10th February 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register and thank the noble Baroness, Lady Hollins, for securing the debate. I will speak only briefly because other noble Lords have made several of the points that I wished to contribute, particularly the noble Baroness in relation to the co-design and co-delivery of inclusive education with experts by experience, and the noble Lord, Lord Sterling, in his statements about teacher education and early diagnosis. Of course I follow the noble Lord, Lord Wigley, and his excellent outline of how Mencap is working successfully in Wales through Treat Me Well.

In 2019, the Government held a public consultation on the potential introduction of mandatory training relating to learning disability and autism for all health and social care staff in England. The review was predicated on concerns identified in the learning disability mortality review programme. As already outlined, it made specific reference to the circumstances of Oliver McGowan, a teenager with autism who died in 2016 after being given anti-psychotic medication when treated for a seizure.

In response to the consultation, the Government made a commitment to pursue the introduction of mandatory training in this area, with trials beginning in April this year and due to report in March 2021. This is extremely welcome, and the results of the trials will inform the content and nature of the delivery in future. However, I particularly ask the Minister whether sufficient resources will be made available to ensure that the training, even at tier 1, will not rely on computer-assisted learning alone. Without interaction with families and other people with lived experience of supporting people with learning disability and autism, success will not be achieved. In tier 2, for example, it is essential that staff are trained in the accessible information standard, so that they can explain to people seeking help in care what is actually going on.

For tier 3—education for staff directly providing care and support for people with learning disability—learning disability nurses are key. Noble Lords will be aware of the ongoing shortages of learning disability nurses and the challenges of recruiting them, particularly as students of nursing. The Council of Deans of Health welcomes the new student support arrangements, as I do, particularly the additional student maintenance grant for learning disability and mental health nursing students. That will assist in recruitment. It is vital that there is increased partnership working between the independent and voluntary sector, the NHS and universities to ensure the sustainability of the profession and appropriate clinical placements during training. Let us be clear: CPD and the NHS alone will not solve these issues. Can the Government clarify that the new maintenance support arrangements will be fully funded for nurses in training for at least all new intakes during this Parliament?

The development of a postgraduate certificate programme in learning disability and autism, with co-creation from patients and families involved in a meaningful way, may be a gateway to encouraging more health and social care staff to enter learning disability care, and to retaining those staff with clear pathways for career development. If the Government are to achieve their mandate of further reducing in-patient provision by 2023-24 at the latest, it is essential that significant investment in staff development and recruitment of new staff is undertaken. Not everyone who works in a hospital environment is well suited to more community-oriented provision, as we found when we closed mental health hospitals in the 1980s and other learning disabilities facilities.

I warmly support the Government’s plans but seek assurance from the Minister that adequate investment will be made in health and social care education for competence to work with people with learning disability and autism to enhance services for this vulnerable group, not only to save lives but to improve the experience of people with learning disability and autism who access and rely on the NHS and social care services. For once, I will steal a line from an independent insurer, Bupa: we need to ensure that people with learning disability and autism

“live longer, healthier, happier lives.”

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[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank all noble Lords who took part in this short debate. In particular, I thank the noble Baroness, Lady Hollins, for her Question, which has allowed us to have this important and moving debate, and for her dedication to this issue; she said that she has been working on it for more than four decades. She has certainly gained this House’s unremitting respect for her work. In particular, I thank her for her vital work as independent chairperson for the care and treatment reviews of people with a learning disability and autistic people in long-term segregation. That work could not be more important, and her contribution in that respect is invaluable.

Noble Lords will know—they have demonstrated this—that the care and treatment of people with learning disabilities and autistic people has come under intense scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society—and rightly so. Tonight’s debate has been part of that. Everybody should receive the same high-quality care, whether or not they have a learning disability or are autistic. Despite this, as has been said, there remain serious disparities in the quality of care and support that they receive. As has also been said, evidence shows that they can experience poorer health and die sooner than the population as a whole. We must change that.

As the noble Baroness, Lady Hollins, rightly said, these disparities can arise as a result of health and social care professionals lacking the training or experience—or, sometimes, just the confidence—to deliver effective and compassionate care. I have no doubt that staff want to support everyone, including people with a learning disability or autism, to the best of their ability. Like the noble Lord, Lord Wigley, I pay tribute to Mencap’s survey for its Treat Me Well campaign, which found that almost half of staff responding thought that a lack of training on learning disability might be contributing to avoidable deaths and that two-thirds of staff wanted more training focused on learning disability. We are listening to that.

As noble Lords are aware, last year DHSC consulted on proposals for mandatory learning disability and autism training. The consultation was in response to the Learning Disabilities Mortality Review programme’s second annual report, which recommended the introduction of mandatory training. A common theme in the deaths reviewed by the programme was, as has been pointed out, the need for better training and awareness of learning disability. The same is true of autism. We published our response to the consultation in November, setting out our plan to introduce the Oliver McGowan mandatory learning disability and autism training across the health and social care system. The training is named in memory of Oliver McGowan in recognition of his family’s tireless campaigning—including a previous debate on this matter—for better training for staff.

In future, we want all health and care professionals, before starting their career or through continuing professional development—a point made by the noble Lord, Lord Addington—to undertake learning disability and autism training, covering common core elements so that we can be confident that there is consistency across education and training curricula. We are working with professional bodies and the devolved Administrations to align syllabuses and training requirements with the learning disability and autism capability frameworks at the earliest opportunity.

We have committed £1.4 million to develop and test, during 2020-21, a package of learning disability and autism training in a range of health and social settings to help us better to understand the implications of mandatory training and the associated costs before wider rollout in 2021. I assure the House that the training will involve people with lived experience at every stage throughout its design and delivery, which I know is critical to its success.

We are also clear that, to realise fully the benefits of this training, it must be mandatory. We will undertake a number of actions, recognising that different approaches will be needed for different staff groups to make sure that it is effective. These will include proposed changes to secondary legislation to ensure that providers who carry out regulated activities ensure that staff receive training that is appropriate to their roles. We will also explore options for those working in non-regulated activities.

I will just pick up on a few of the specific points raised. The first is e-learning, raised by the noble Baronesses, Lady Hollins, Lady Watkins and Lady Thornton. In the consultation on mandatory training, we heard very clearly that having a face-to-face component is important. We will consider how to build this in in an appropriate way as we develop and trial the training package. We are currently developing the specifications for trial and evaluation.

In response to the question about the timeframe from the noble Lord, Lord Addington, and the noble Baroness, Lady Thornton, the strategic oversight group met for the first time last week. We will publish invitations to tender later this month, and will then seek to appoint and sign contracts with suitable training and evaluation partners in April. We will commission and publish an evaluation of the training package by March 2021 to inform a wider rollout of mandatory training across the system. I hope that is reassuring. Of course, we will seek to learn best practice from anyone we think can help us; this will include the devolved nations, which I hope is reassuring for the noble Lord, Lord Wigley.

I will just pick up on the question raised by the noble Baroness, Lady Watkins, regarding workforce, which will of course be critical to making sure that this is effective. In addition to our new maintenance grant funding for eligible pre-registration nursing, midwifery and allied health students, we announced additional payments of £1,000 for new students who study in challenged specialisms, which would include learning disability specialisms. I think that answers the question she raised.

On the question regarding the review of the Mental Health Act raised by the noble Baroness, Lady Hollins, this was completed in December 2018 and its findings were clear that we need to modernise the Mental Health Act to ensure that patients are not detained longer than absolutely necessary. We have said we will bring forward a White Paper in the coming months. We intend to pave the way for a reform of the Act and tackle the issues raised in that review to ensure that people subject to the Act are treated with dignity and respect. The intention is to ensure that we provide more patient choice and autonomy and enable patients to set out in advance their care and treatment preferences, and also to improve the process of detention, care and treatment. I hope that is reassuring. The reason for doing it in this White Paper process is because of some of the complexities around the legislation and to ensure that there is appropriate pre-legislative scrutiny.

[Baroness Watkins of Tavistock]

I would just like to clarify that my question about funding for the maintenance support was not about whether it applies to the learning disability group but whether it will apply for all five years of intakes of this Parliament.