Covronavirus, Disability and Access to Services Debate

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Department: Department for Work and Pensions

Covronavirus, Disability and Access to Services

Caroline Nokes Excerpts
Thursday 15th April 2021

(3 years ago)

Westminster Hall
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Caroline Nokes Portrait Caroline Nokes (Romsey and Southampton North) (Con)
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I beg to move,

That this House has considered the Fourth Report of the Women and Equalities Committee, “Unequal impact? Coronavirus, disability and access to services: full Report”, HC 1050.

It is a pleasure to serve under your chairmanship, Sir Graham, and I thank my colleagues on the Committee for their work on both the inquiry and the report. I am pleased to see the hon. Members for Jarrow (Kate Osborne), for Liverpool, Riverside (Kim Johnson) and for Lanark and Hamilton East (Angela Crawley) participating in the debate.

With your indulgence, Sir Graham, I would like to highlight that some of the issues we will discuss concern children with special educational needs, and when it comes to autistic spectrum disorders, there was one Member of this House who championed the issue, spoke in pretty much every debate on the subject, and chaired the all-party parliamentary group on autism. Cheryl Gillan is already much missed in this place, not least by me today. I know that she was a real expert and spoke with passion and knowledge in debates such as the one we are having today. I am sure she would have been present to put on record her thoughts about access to services for children with autistic spectrum disorders.

Relevant to this debate is our interim report, published in September last year, which was intended to inform the first six-monthly review of the Coronavirus Act 2020 temporary provisions. I will start by drawing attention to an important outstanding issue in this context—one that has not received a great deal of attention. The temporary provisions included unused provisions that relaxed requirements for sectioning under the Mental Health Act 1983, provisions that curtailed or restricted hard-won rights of disabled people to get the care and support that they needed in their everyday lives—the so-called Care Act 2014 easements—and a power to modify duties under the Children and Families Act 2014 in relation to assessment and provision for children with special educational needs and disabilities.

We welcomed the Government’s decision last year to repeal the unused Mental Health Act 1983 provisions. We very much welcome the recent decision to remove the Care Act 2014 easement provisions, and we look forward to this happening as swiftly as possible. Perhaps my hon. Friend the Minister for Disabled People, Health and Work will chase that up with the Minister for Care at the Department for Health and Social Care. Although the easements were not widely used, their availability in statute exacerbated a perception, which has existed among disabled people right from the outset of this crisis, that their rights are somehow seen as less important than other people’s.

The outstanding issue from our interim report is that one of the temporary provisions affecting young disabled people remains in place. The power to modify education, health and care plan duties was used by way of national notices issued by the Secretary of State for Education in May, June and July. The power remains available in the Coronavirus Act. My view is that this power must be removed.

We are in a very different place in the pandemic. As the Minister for Children and Families acknowledged in a recent letter to me, there is much less need for the additional flexibilities, yet the power is being retained, for the time being, as a contingency. The Government have said they will act to remove temporary provisions as soon as they are no longer necessary. They have done so in relation to the mental health and social care provisions. It is an important matter of principle: the Government must not hold on to emergency powers a moment longer than they absolutely need to. Removing the power to modify duties in relation to children’s and young people’s education, health and care needs would send a clear message to children and their families that the Government fully support their right to receive the provision they need. I see no reasonable justification for keeping the Secretary of State’s power to modify duties in statute any longer.

Over the last year, my Committee’s work has emphasised the unequal impacts of the pandemic on three groups of people with protected characteristics under the Equality Act 2010; women, groups of black and minority ethnic people, and disabled people—the subject of the debate today, who have received, sadly, relatively little attention. Yet the adverse effects on disabled people have been starkly disproportionate, including tragically high death rates. The chance of dying from covid was more than three times greater for someone with a disability than for someone who was not disabled. The chance of dying for a person with a learning disability was probably more than six times greater than that of the general population. A young person aged between 18 and 34 with a learning disability was some 30 times more likely to die than a young non-disabled person.

Our inquiry heard evidence about decisions and policies that might have contributed to those tragic statistics, such as a relative slowness to protect people in a range of social care settings, and a lack of clear and accessible information for disabled people. That is why we called for a discrete independent inquiry into the causes, including the decisions made by Government. The response, “Now is not the time,” will inevitably start to wear thin. The Government should commit to an independent inquiry, including into what led to disabled people feeling the brunt of the pandemic, and they should set out a timetable not just for its start but for its completion. They should do so now.

A major theme in our full report was the Government’s consultation and communications with disabled people during the pandemic. We heard that disabled people felt excluded and ignored. Witnesses pointed out that effective consultation with disabled people could have made it possible to avoid some of the problems that they faced early in the pandemic, such as a lack of accessible food shopping. Disability charities told us that the Government were talking to them, but in broadcast mode—not listening and not resolving problems effectively. When the Government did communicate with disabled people, their communications were not always psychologically informed, and too often they exacerbated disabled people’s already heightened anxieties. There was confusing guidance on shielding, and it was sometimes poorly thought through and poorly timed—for example, a text message sent at the weekend before important changes to guidance were issued on the Monday.

I want to see evidence that the Government have learned from what happened. Right from the outset, from the Prime Minister’s letter to the nation in March explaining the need to stay at home, communications have not been fully accessible. There were no accessible versions of that letter for several days. I know that a great deal of work is going on in the Cabinet Office to provide the shopping list of accessible communications asks put forward by disability charities last year; but the Government could and should go further and faster. I find it utterly incomprehensible, for example, that the Government have still not arranged in-person British Sign Language interpretation of their televised covid briefings. I raised that issue with the Prime Minister at the Liaison Committee in January, and the hon. Member for Lewisham, Deptford (Vicky Foxcroft) raised it again very effectively at Prime Minister’s Question Time yesterday. On neither occasion was a proper response forthcoming. The reasons relied on in written responses—that there is not enough space in Downing Street, or that there is not enough time to make arrangements—are weak. Surely the Government could have found space during the recent media suite refit. I am unsurprised that campaigners have resorted to judicial review, but I am surprised that the Government have not sought to resolve the issues swiftly and simply by finding both the space and the inclination to include a BSL interpreter.

Practices in health and social care added to disabled people’s perceptions that their lives were less valued than others. The guidelines issued by the National Institute for Health and Care Excellence on the use of the clinical frailty scale in making decisions about who should receive critical care if NHS resources had been overwhelmed were potentially discriminatory against disabled people. We heard from disabled people that, while they accepted that the guidelines were swiftly amended, it left a very bad taste.

Extremely concerning issues about the inappropriate use of “do not attempt resuscitation” notices, or DNARs, have been much more prolonged. The Government asked the Care Quality Commission to investigate in October last year, and last month the CQC found that that hundreds of inappropriate DNARs had been applied. These issues demonstrate a deeply worrying lack of concern for the rights of some groups of disabled people.

We all understand the pressures that people were under early in the pandemic, but more than 10 years on from the Equality Act 2010, it is shocking that disabled people’s rights were not properly considered in the formulation of policies and practices in health and social care. That is why we recommended a robust response to prevent such mistakes being repeated. We called on the Government to allow the Equality and Human Rights Commission to issue a statutory code of practice on the public sector equality duty, to provide greater legal certainty about the actions that public authorities must take to prevent discrimination. Greater certainty would provide more effective protection, so the Government’s dismissal of our recommendation is extremely disappointing. Their argument that the status quo is sufficient flies in the face of recent experience. If there is not a statutory code of practice, how will the Government prevent these issues from arising in future public health crises? Again, we have to learn from experience.

The pandemic has very clearly emphasised and exacerbated known systemic problems affecting disabled people. We know that the SEND system is facing a crisis. The aims of the Children and Families Act reforms have never been consistently achieved. Services for children with SEND are too often inadequate. In too many places, the integrated education, health and care services envisaged in the 2014 Act have never materialised.

I speak as a member of the Bill Committee that way back in 2012 or 2013 scrutinised the Bill that became that Act. We spoke endlessly in our debates about parents having to fight to get their children the services they need. However, parents are still struggling in an overly bureaucratic system and the evidence that they gave us through our inquiry was that they are still using the word “fight” when describing their attempt to get their children’s needs assessed and provided for. The Government acknowledged that in announcing their SEND review, but that was in September 2019, more than 18 months ago. The experience of children with SEND and their families during the pandemic must provide the impetus to sort these problems out. We called for the review outcome to be published in the first quarter of this year, but we are still waiting. The Government’s response to our report acknowledges the importance of these issues. The Government say they need more time to get the reforms right. Of course time is needed to grapple with the complex issues in the SEND system, but if much more time elapses people will start to question whether SEND is the priority that it ought to be.

The same is true of the review of adult social care. There is no doubt that the devastating experience of the pandemic in social care settings was exacerbated by systemic issues of funding, of workforce—including pay and staff turnover—and a lack of proper integration with NHS services. That is why we were disappointed in the spending review settlement for social care and disappointed that there was nothing on social care in the Budget. We only know that the Government intend to bring forward their proposals for social care later this year. That needs to happen sooner rather than later.

There are positives in the Government’s response and I do not denigrate the hard work that is undeniably going on in the Department for Environment, Food and Rural Affairs in relation to disabled people’s access to food and in the Cabinet Office on accessible communications; and the work that the Disability Unit is putting into the national strategy for disabled people. The Government have opportunities in the national strategy, the social care review and their SEND review to understand the particular problems faced by disabled people, their carers and their families in the pandemic, to understand the part they have played in those problems, and to start putting things right and restoring trust. I urge my hon. Friend the Minister in his response to make it clear that the Government will grasp those opportunities and do so in a timely fashion.

--- Later in debate ---
Justin Tomlinson Portrait The Minister for Disabled People, Health and Work (Justin Tomlinson)
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It is a pleasure to serve under your chairmanship, Sir Graham. I, too, want to put on record my personal tribute to Cheryl Gillan—a sad loss. No parliamentarian did more to champion the rights and opportunities of those with autism, and it was a great pleasure for me as the Minister for Disabled People to meet and work with her, and respond to her comprehensive, proactive and constructive letters, asks and challenges. With my ministerial hat on, I would say that her greatest legacy is how much she achieved for those who were reliant on having that strong voice in Parliament.

I thank my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) who not only spoke passionately in the debate but has, through her excellent chairmanship of the Women and Equalities Committee, held the Government and the whole of Parliament to account on a number of serious issues. She is a formidable parliamentarian, and is held in the highest regard among colleagues. Frankly, it is staggering that she is not in the Cabinet helping to lead the challenges that are often raised, and on which we must keep a laser focus.

The unprecedented challenges of covid have impacted all, including disabled people, as has been highlighted by the important report by the Women and Equalities Committee. In my role as the Minister for Disabled People I welcome the opportunity to talk through the measures that the Government have put in place for disabled people throughout the pandemic, and how we are responding to those serious recommendations. My involvement in my cross-Government capacity, and that of the Disability Unit for which I am responsible, is to influence and shape Government policies, sharing our subject matter expertise, data, and knowledge of lived experiences and connecting relevant stakeholders with colleagues across Government to reach the best outcomes for disabled people.

Before I turn to the specific points raised by my right hon. Friend and the report, I would like to say how proud I am of the roll-out of the vaccination programme, which was an absolutely key issue and ask of the disability stakeholders that I regularly meet with. The Government are now offering vaccines to all those aged over 45, those on the learning disability register or clinically extremely vulnerable people, and health and social care staff. I am very pleased that my own Department has linked with NHS services in England to share data on over 600,000 carers, allowing the NHS to invite those carers to book an appointment for a vaccine. This is a huge achievement, and makes a significant impact on the lives of disabled people as they navigate this pandemic. This is a good example of cross-Government work.

Turning to the specific points raised, from the very start of the pandemic, we have ensured that the views of disabled people and their families and carers have been taken into account when considering how best to support disabled people and link through to the relevant Ministers, Departments and agencies. Casting our minds back to the beginning of the pandemic, there was real concern about access to food and medicine, as a number of the people who have spoken in this debate have highlighted. In normal circumstances, Governments would typically take 12 to 18 months to develop policies, engaging, consulting and piloting before implementing new legislation. However, with the challenges of covid, that time was simply not available.

Therefore, by connecting key stakeholders with real lived experience, we were able to help relevant Ministers and Departments develop responses quickly. For example, we linked stakeholders including Disability Rights UK, Scope, Sense, Leonard Cheshire and the RNIB with the Minister for farming, fishing and food, my hon. Friend the Member for Banbury (Victoria Prentis), and her officials to engage through the food vulnerability stakeholder group. Within days, they were able to resolve this potentially serious issue, as the Committee report highlights. This is an example of best practice. Several speakers raised the challenge faced by those who did not get included in the clinically extremely vulnerable list, but an additional scheme was organised through 305 local authorities, Age UK, Mind, Scope and RNIB, which were able to then make referrals for priority online shopping slots. Again, these important changes were vital.

More widely, to identify potential issues and areas of real lived experiences, we have an extensive programme of engagement. I regularly meet with the Disability Charities Consortium, which includes Scope, Leonard Cheshire, Disability Rights UK, the National Autistic Society, Mind, Mencap, Sense, RNIB, RNID and the Business Disability Forum. That includes being joined by relevant ministerial colleagues to discuss aspects of the pandemic’s impact on disabled people. During covid-19, this forum’s work has included meetings with the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi); the Minister for Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately); and the Minister for Civil Society. It has been a real opportunity to share their expertise and help shape the urgent new policies that are needed to support those who are most vulnerable in society.

Furthermore, the Cabinet Office covid-19 taskforce considers disproportionately impacted groups, including disabled people, through policy development to tackle the pandemic. They do this through close working with the Equalities Hub and, within it, the Disability Unit, co-ordinating with other Government Departments and wider stakeholders to ensure a holistic approach to policy implications and delivery. In addition, we have regular stakeholder engagement through our regional network, which includes disabled people, carers, and crucially those with real lived experiences.

Turning to accessibility, I reaffirm that it is vital that public information on covid-19 is accessible to all, and we have made key strides in this area. These are things I was challenged on during my stakeholder engagement, and I happily raise these across Government. The Government are committed to providing both key covid-related guidance and communications in alternative formats, including large print, easy read, British Sign Language and audio. Most recently, this has covered ensuring that national restrictions, vaccination testing and the Government’s road map are accessible. We have now established BSL interpretation at the No. 10 press conference via the BBC News channel and iPlayer, available on all TV packages as part of Freeview. Accessible information is also available on the Government’s social media channels.

A significant further improvement, following the Committee’s report, is that the Cabinet Office now has a senior lead for accessible communications as part of the national resilience communications hub, who meets with a group of disability charities on a monthly basis. The group is briefed on the latest covid-19 guidance, including accessible versions, and works to ensure that communications to disabled people continue to be accessible and timely. Most recently, we held bespoke briefing sessions with the disability communications working group on 25 March, explaining the road map and communications activity, enabling charities to brief their audiences, prepare and share accessible communications through their network. I have personally pushed hard for that and I thank the Women and Equalities Committee for its support on the need for this vital additional layer of support.

Turning to health and social care, as we have seen, the covid-19 pandemic has had an unprecedented impact on the NHS and social care systems. Recognising the challenges in care settings, the Department of Health and Social Care made £546 million available in its adult social care winter plan, including money for vital infection control measures to ensure that disabled people getting social care and support are kept as safe as possible. The Government has also made £4.6 billion available to local authorities to address pressures on local services, including adult social care. Furthermore, the Minister for Mental Health and Suicide Prevention announced £500 million for mental health recovery, of which £31 million will be used to support learning disability and autism services, alongside an additional £3.6 million announced by the Minister for Care for disability voluntary sector organisations to provide practical support to disabled people to mitigate the impacts of covid-19.

I know many disabled people and their families have raised concerns about easements to the Care Act, which were introduced as a temporary measure to help local authorities continue to meet the most urgent and acute needs in the face of covid-19, when local authorities were experiencing extraordinary pressures. The measure was used sparingly and has now ended. In response to concerns about the use of “do not resuscitate” decisions and the clinical frailty scale, the Government recognised the issues and guidance was changed strongly and quickly.

It is important to recognise the particular challenges the covid-19 outbreak has had on families of children with disabilities or serious illnesses. Supporting vulnerable children is a priority for this Government and has been central to our response throughout the pandemic. Turning to the work done by the Minister for Children and Families, the Government provided £40.8 million for the family fund in 2020-21, which supported more than 90,000 low-income families who are raising children who are disabled or seriously ill.

I know there are concerns about the legal duties to provide support to children and young people with education, health and care plans. The Secretary of State for Education has not used this power since July last year and has made it clear that he would need a compelling reason before doing so again.

Caroline Nokes Portrait Caroline Nokes
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I thank the Minister for giving way on the point about the Secretary of State for Education’s powers. My right hon. Friend the Secretary of State has made it clear that he would require a compelling reason to use them, but he has not used them, he does not plan to use them and there is much less need to use them. Will my hon. Friend indicate whether there might be a timescale for when they are going to go?

Justin Tomlinson Portrait Justin Tomlinson
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That is a fair challenge. I do not have the answer, but I will certainly make sure that the Secretary of State for Education gives a clear response to that question.

While the covid-19 pandemic has unavoidably delayed the completion of the special educational needs and disabilities review, the Secretary of State for Education is clear that it remains a key priority for this Government. It is vital that we deliver on our promises to children and young people and the DFE intends to publish proposals for consultation in the coming months.

Several speakers talked about the importance of disability employment. I am incredibly proud, as the Minister for Disabled People, to have presided over record disability employment. In normal times, when I have the pleasure of travelling around the country on visits, when I talk to young disabled people and say, “If you were the Minister, what would be the single thing that you would want to see?” the answer is nearly always, “I just want to have the same opportunities that my friends have for work and career progression.” I have never lost sight of that. I speak as somebody who has employed and benefited from employing disabled people, both prior to being an MP and as an MP. We have faced unprecedented challenges, but we have not lessened our ambition to have a million more disabled people in work by 2027. I want to reiterate that that has not changed.

During covid, we have made changes to the support provided. We have recently announced over 300 more disability employment advisers, taking the figure to over 1,000. We continue to review our Work and Health programme. All of the plan for jobs is fully inclusive, and we have made changes to schemes such as Access to Work, where we now provide support within the workplace. We will keep that beyond covid-19, which will perhaps open up opportunities for more people who have not been able to access work opportunities up to now. I am proud that we have reached 20,000 employers signed up to Disability Confident. The equivalent of 11.2 million employees are now represented by businesses in the Disability Confident scheme, sharing best practice about helping disabled people into work, to progress in work and be retained in work. That is very much a priority for me and the Department.

While there will undoubtedly be opportunities to learn from our covid-19 response in the longer term, the overall picture is that the Government have moved fast and flexibly to provide support for disabled people in these unprecedented times. The importance of cross-Government work linked to and supported by those with real lived experiences is absolutely clear, as it allows us to move faster and more flexibly to provide support to those most in need, including those with disabilities.

To ensure that that notion is embedded at the heart of the Government, we now have ministerial disability champions in every Department, with whom I meet regularly, with the full authority of the Prime Minister. They are genuinely enthused, engaged and determined to play their part on behalf of their respective Departments. In our forthcoming ambitious national strategy for disabled people, we will demonstrate the very real and vital focus on cross-Government work to remove barriers and create a fully inclusive society as we return to normality.

In conclusion, I thank all the staff and volunteers across the country working on the frontline, and in particular those supporting people with disabilities, as we navigate these challenges. I thank again my right hon. Friend and her Committee for their fantastic ongoing work, the Committee’s important report and the recommendations it made. The Government and I personally take them very seriously, and we are acting on them.

Caroline Nokes Portrait Caroline Nokes
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I put on record my thanks to all hon. Members who contributed to the debate. I recognise that lots of Government Departments are very much in the frame here, whether it be the DHSC, the DWP, the DFE or, indeed, DEFRA, and my hon. Friend the Minister has not done a bad job of answering for all of them. However, what has been singularly lacking is the provision to him by those Departments of dates. When might we see an independent inquiry? When might we see the SEND review from the DFE? When might we see measures to integrate health and social care effectively from the DHSC? I ask him in particular to take back to fellow Ministers the message we heard repeatedly from colleagues about social care, the lack of attention on it, and the impact that has had on the lived experience of way too many disabled people up and down the country in every single one of our constituencies.

As my hon. Friend the Minister said, the pandemic gave the Government an unprecedented challenge, and in many instances there was really good cross-Government working to rise to the challenge. What Members need now is some sort of assurance that lessons have been learned and will continue to be learned because, should another public health crisis like covid hit us in future, we cannot afford to have disabled people pushed to the back of the queue, have their needs forgotten and feel, as too many of those who spoke to us of their lived experiences said, forgotten, marginalised and as if they did not matter. I urge him to ensure that that sensation is not left with them.

Question put and agreed to.

Resolved,

That this House has considered the Fourth Report of the Women and Equalities Committee, “Unequal impact? Coronavirus, disability and access to services: full Report”, HC 1050.