§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jon Owen Jones.]
§ 10.3 pm
§ Mr. Eric Illsley (Barnsley, Central)I am pleased to have secured this debate on continuing care and respite facilities for people with learning difficulties. The Keresforth centre looks after people with learning difficulties in my constituency. It is fitting that I am able to debate this health issue relating to my constituency so close to the 50th anniversary of the national health service, and immediately after a debate devoted to the NHS. I pay tribute to my hon. Friend the Minister of State, Department of Health and his colleagues—especially my right hon. Friend the Secretary of State—for their stewardship of the Department since the election.
My constituency has benefited from the extra money that the Government have provided for the waiting list initiatives. It has also been made part of a health action zone covering Barnsley, Doncaster and Rotherham. That is particularly important in my area, which has a higher than average proportion of elderly infirm people and a very large number of elderly people suffering industrial diseases—a legacy of our industrial past. I sincerely hope that our health action zone status will help to deal with the problem, but I believe that, despite all the problems that Barnsley has now and has suffered in the past, ours is the lowest-funded health authority in the country; so we are somewhat hampered.
I want to discuss learning disabilities and long-term continuing and respite care in the Barnsley area, with particular reference to the Keresforth centre. My attention was drawn to some of the problems surrounding the centre by a number of elderly carers who wrote to me or visited my advice surgery. They were worried about staffing levels and problems in attracting staff; but on further investigation, and following discussions with the health authority, the community and priority services trust—which is responsible for the centre—and the local authority, problems came to light that went a little further than the immediate question of staffing levels. I refer to long-term planning problems.
There is a short-term problem in relation to the improvement of facilities, but what I want to discuss specifically is how, in the light of changes that have occurred over the past few years, we can make plans to deal with the problems of people with learning disabilities. In my constituency—and presumably throughout the country—there has been an increased demand for continuing care for such patients.
As my hon. Friend the Minister said when winding up the last debate, that is partly because the NHS now enables those people to live far longer than they could in the past. Planning assumptions made many years ago about the throughput of patients, how long carers would have to look after their children and so forth, must now be re-examined. Carers who are now elderly are looking after their adult children, and finding that respite care is not readily available because of the increase in demand for existing facilities.
A number of factors contribute to the present position. I have mentioned the longevity of patients, but there is also the increase in the number of emergency admissions. 1341 Such issues are well understood by Barnsley health authority and Barnsley metropolitan borough council—and, as I have said, by the trust that is responsible for the Keresforth centre. Blame should not be apportioned to anyone; it is a case of flagging up the issue for future reference, and considering how it can best be dealt with.
All the organisations that I have mentioned reacted swiftly when the issue was raised a couple of weeks ago, and the health authority has not been slow to provide money for the recruitment of nurses to alleviate the staffing problems that led to our investigation.
I also pay tribute to the staff of the trust and, in particular, those at the Keresforth centre, who do a difficult and demanding job. They perform their tasks well. I visited the centre two or three weeks ago, and was impressed by the difficult job that the nurses have to do, and the surroundings and circumstances in which they do it.
The problem is one of recognising the increased need in the area and providing for it—planning now for increased facilities. We have to start planning now.
The Keresforth centre opened in 1984, which was not long ago, yet the planning assumptions on which it was based are now somewhat out of date. At that time, most of the long-term care for learning disability was provided out of district. The centre opened with 48 beds in the day hospital, and grew to a maximum of 68 beds with day hospital and community mental health teams by about 1989. Unfortunately, there was little investment in the centre after that, and it suffered continuing problems.
The buildings which make up the centre were built for able patients. At the time, the people with learning difficulties for whom the centre was to cater were ambulant—they could walk about and use the facilities. Now, more and more patients are severely disabled and require wheelchair access, for which the facilities simply were not built, so there are immediate access problems.
Due to the increased demand, patients now have to share bedrooms and facilities. Some rooms are shared by four adult people with learning disabilities. As I said, those people are living longer—into adulthood—and they have problems of dignity and privacy. Some patients even enter into relationships with other patients, and they do not have the privacy to pursue those relationships with some dignity. Thus the facilities available for patients cause problems, which obviously causes friction, especially with patients with challenging behaviour—I understand that they are on the increase.
Responsibility for the buildings passed to the local authority, and, as my hon. Friend knows well, during the 18 years of Tory government—in particular since 1990—my local authority suffered greatly because of the amount of revenue support grant it receives as a result of the standard spending assessments. The money simply has not been there to invest in that provision. Sadly, one of the houses within the complex closed in 1995—an example of what the health service has done is that the initial cost of the buildings to the health service was 20 per cent. above average, and now it is 20 per cent. below average. The authority has gone a long way to improve its financial position in that regard.
The inadequacy of the buildings is compounded by increased demand. The learning disabled are living longer, which again is a tribute to the NHS. Assumptions were 1342 made on that basis. The number of severely disabled people has increased. Previously, there was a 50:50 split between the severely disabled and the mildly and moderately disabled. Now, the majority of patients are severely disabled. Emergency admissions have to be dealt with by the Keresforth centre, as that is the only remaining flexibility within the system, and it puts an extra strain on the availability of beds.
An increasing number of clients have challenging behaviour, which basically means violence. It is not a case of a patient being difficult to handle or a little boisterous, but of a patient going up to a nurse with a knife—that is difficult behaviour with which to deal. The result is a waiting list for placements at the Keresforth centre and a reduction in respite facilities for the elderly carers whom I have mentioned, many of whom are finding it very difficult to manage.
One carer appeared in a short television programme about the Keresforth centre. Mr. Madeley is 88 years old and cares for his 54-year-old disabled daughter. On national television, he repeated the claim that he has made many times, that he wishes that his daughter dies before he does, because he does not know what will happen to her if he is no longer able to care for her. Such a problem is not confined to Barnsley; there are carers of that age group all over the country. I came across a reference to one carer in Sheffield who, at the age of 95, is caring for an adult child. How can such people cope and look after their children in such circumstances?
Some of the letters I have received are very moving. One is from a Mrs. Robinson, who looks after her brother. She writes:
It is hard enough for me to let my brother go for respite care, but I need the break now and again to spend more time with my husband, daughter and son.That lady must have a very understanding family.A letter from Mr. and Mrs. Dobson—no relation to my right hon. Friend the Secretary of State, I assume—states:
We are the parents of Shaun, aged 31, who suffers from severe learning difficulties, epilepsy and double incontinence. He requires and receives lots of love, care and attention.Their son attends the day care unit.Mrs. Crossley writes:
My son is 25 years old and is severely mentally handicapped…hyperactive and incontinent.The father of the 25-year-old is in his 70s. He is also worried about provision for his son after he passes on.Staffing shortages at the Keresforth centre have, to some extent, been resolved. Every one of the letters that I have read out, and all the others that I have not, pay tribute to the staff, who do a marvellous job. They were originally employed to look after more able patients, but now look after more severely handicapped patients and those with challenging behaviour. The centre had some difficulty in finding suitably qualified staff, but the health authority came forward with additional funding to help to attract staff to Barnsley. I hope that, next year, further help will be made available.
There is a problem, and it is increasing as more and more pressure is put on the system. Elderly carers worry about what will happen to their adult children, and the number of patients is increasing. There appears to be no available funding for at least three years to expand and improve bedrooms and facilities at the Keresforth centre. 1343 Can my hon. Friend the Minister say anything to encourage us on that front? At the same time, will he take a long-term view and especially consider the nationwide problem of elderly carers? Then, we can begin to plan for their future and perhaps relieve some of their worries.
§ The Minister of State, Department of Health (Mr. Alan Milburn)I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on his choice of subject for this debate. It is of great importance to many people because it concerns not just people with learning disabilities but, as he rightly pointed out, parents, relatives and friends of people with learning disabilities.
My hon. Friend raised the particular issue of the Keresforth centre in Barnsley. Like him, I pay tribute to the staff who I know from what I have read have done a sterling job, often in extremely difficult circumstances. The joint review of Barnsley social services, which was undertaken in January and February last year, concluded that services for people with learning disabilities were of good quality. That is important and, I hope, offers some assurance at least to friends, relatives and carers of those who are provided with important services in that area.
I am pleased that the local statutory authorities are now fully aware of the concerns that my hon. Friend raised, and are seeking to address the problems. Barnsley health authority, Barnsley Community and Priority Services NHS trust and Barnsley borough council all acknowledge that there is a shortfall in community placements. They are holding discussions to find ways of addressing the problem.
I gather that there was a very constructive meeting last night. I do not know whether that was a coincidence, or whether this debate has acted as a spur. There is clearly joint ownership of the issue, and a recognition of the need to provide group homes for individuals with learning disabilities currently living in the community, where their current care arrangements are likely to break down.
The health authority has responded to the pressure on learning disability services by making some additional investments. For example, it has put in an additional £140,000 a year to increase nurse staffing. It has also put in £16,000 to maintain the provision of respite care.
The authority recognised that, because of the increasing dependency of residents at the Keresforth centre, there was a need for more nurses in the unit, and it recently increased the number of full-time nursing posts by four, as the first instalment of an acknowledged greater need. It also upgraded all vacant posts to E grade, and by the end of last month all posts had been filled. Furthermore, it created a separate fund to start addressing the need for long-term continuing care packages.
Both the health authority and the local authority recognise the need for more residential places, and the effect that those would have on the provision of respite care. They recognise the importance of working together to make the best use of available resources.
My hon. Friend asked about funding for Barnsley health authority, and I understand the problem. We increased Barnsley's allocation this year by nearly £6 million—a 5 per cent. increase in cash terms—to £110 million. It is nevertheless the health authority furthest from its capitation target, and we are committed to bringing all health authorities to their targets as soon 1344 as practicable. That is why Barnsley health authority received the highest growth in percentage terms this financial year of any health authority in England. Who knows—before long there might even be some more good news around the corner.
The issues that my hon. Friend highlighted are important nationally as well as locally. They reflect the fact that the pace of change in all walks of life has increased. Advances in medicine and science are helping people to live longer and better than ever before. Those are surely welcome developments. Patterns of family life are changing, and public expectations are rising, especially in what people seek from their public services.
People with learning disabilities and their carers are rightly expecting more from services than they did in the past. That is a welcome development. Many people with learning disabilities now aspire to a home of their own and a job, when previously their future would have been life in an old long-stay hospital or attendance at a large adult training centre. People with learning disabilities are also living longer, and an increasing number of people with multiple disabilities are surviving into adulthood.
In order to meet the pressures that those welcome developments bring, the health and social care systems need to change and to work more in concert. As my hon. Friend knows, the Government are determined to break down what my right hon. Friend the Secretary of State rightly called the Berlin walls between health and social care which work against the provision of well-co-ordinated services.
That is particularly true in the field of learning disabilities. People with learning disabilities can be on the fault line of the divide between health and social care. A recent national inspection of learning disability services found that successful arrangements for services for people with learning disabilities crucially depend on social services departments working together with other agencies, especially health, housing and further education. Where such arrangements are not in place, users are less well served. The measures that we are taking should make it easier for authorities to work more closely together.
My hon. Friend rightly referred to the breaking down of barriers that is epitomised by the successful bid for a health action zone in his area. Indeed, I was pleased earlier this year to launch the health action zone in the South Yorkshire coalfields. I know that a huge amount of hard work went into preparing the bid. An even greater amount of work is now going into making it successful and making it work on the ground.
The zones are at the forefront of the implementation of our plans to improve health and health care. They are the most vivid expression of a new spirit of partnership between organisations which, after all, have a common purpose—to improve the lot of local communities. That is certainly epitomised by the South Yorkshire coalfields HAZ, which is led by a partnership of health authorities and the metropolitan councils.
To give substance to the co-operation that will be necessary in the future, a new statutory duty of partnership will be placed on local NHS bodies to work together for the common good and to ensure that local government services and NHS services work in a much more integrated fashion than has perhaps been the case in the past. Before too long, a White Paper will be published on the development of social services and significant work on the regulation and inspection of services.
1345 My hon. Friend referred to the important role played in his local community, and communities up and down the country, by people who care for others. The Government value the vital role that carers play. Carers are a hugely important part of the fabric of our society. Caring is something that touches us all, and I know of the difficult decisions that families sometimes have to take.
My hon. Friend has raised those issues here this evening. As he said, carers often take on enormous responsibilities at a significant cost to themselves. That is why my right hon. Friend the Prime Minister recently announced that he had asked my hon. Friend the Under-Secretary of State to lead a Government-wide review of measures to help carers. The aim is to develop an integrated approach to carers across government as part of a new national strategy for carers. We want to address carers' concerns and give them more support than they have at the moment, which is what my hon. Friend's constituents are rightly crying out for.
In considering the needs of carers, we have recognised the importance of good-quality and accessible respite care to them and the people whom they care for. There is a lot more that we can do to ensure that appropriate and cost-effective services are available. The social services inspectorate has almost completed a project on short-term breaks for carers.
The aim has been to examine what works and why in the organisation, delivery and quality of short-term breaks. This has been done through a review of current 1346 research on the subject and by fieldwork visits to schemes of particular interest. We hope that the resultant report will assist authorities to drive up standards and get better value for money in this important component of their services.
Nationally, we have in place a programme of work to support the development of better services for people with learning disabilities, including increasing training levels and investing in initiatives to improve the recruitment, retention and return to practice of trained staff, who are desperately needed, especially in the learning disabilities field. However, it is for the local statutory authorities to determine the pattern of services to be developed locally in the light of local needs and resources.
As I said, a joint review of Barnsley social services, conducted by the Audit Commission and the social services inspectorate early last year, concluded that services for people with learning disabilities in Barnsley were generally of good quality. My hon. Friend has rightly drawn attention to the concerns of his constituents about the current levels of services and the future for their sons and daughters who have learning disabilities. The local statutory authorities fully recognise the need to develop the local capability to deal with demand and are seeking to address the problem. I have asked my officials to continue to monitor the situation in the hope that things can improve locally.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Ten o'clock.