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Joint Committee On Human Rights Seventh Report

4 LIVING WITH A LEARNING DISABILITY

I think of life as a person with learning difficulties as being taken to watch a football match, where life is that football match, and never being allowed to join in. People with learning difficulties have the same dreams, inspirations and aspirations as everyone else but we are held back from engaging in life. If you think of your most cherished moments in life, of the things that you still look back on and smile, I expect it is something that people with learning difficulties would get held back from doing.

Andrew Lee, Director, People First (Self-Advocacy)[97]

I moved to [a new home]… where people were bad the staff said they could not stay up. I was there 8 years. I used to run away - it was hell there it was like a prison.

A person with learning disabilities[98]

78. We heard examples of both good and bad experiences and received evidence on most aspects of life with a learning disability, including:

access to public and other services (e.g. access to healthcare, education, transport, benefits, social care and support);[99]
access to housing and choosing where to live;[100]
access to paid employment;[101]
relationships with friends and family and sexual or other personal relationships;[102]
participation in decision-making, speaking up and making complaints;[103]
playing a part in the local community.[104]

Access to public and other services

When group members can't do something they want to or that is important to them, it is usually not because people don't respect their rights but is usually down to lack of staff or other support or having no transport.

Summary from a submission from a small self advocacy group[105]

79. We received a good deal of evidence from people with learning disabilities about their experiences of accessing, or trying to access, a whole range of services. On further and continuing education opportunities we heard concerns about restricted provision for some groups, and the lack of progression available.[106] As People First Scotland said: "Most people are sick of 'life-skills' type courses and want to study something that gives them a better chance of getting a job." [107] People also told us about problems they had with transport to college and classes, for example:

108

80. We received so much evidence about people's, often negative, experiences of trying to access healthcare, which we consider in Chapter 5. In addition, a number of witnesses drew our attention to the particular difficulties confronting people with learning disabilities in trying to access dentistry services,[109] and in receiving appropriate optical care.[110]

81. A number of witnesses told us about problems in connection with welfare benefits, including problems if they were contemplating starting a job, and, more generally, the lack of easy to understand information and advice available.[111] For example:

112

Access and choice in housing

I feel so angry, I've got no choice. I want to move, I feel like I'm ready to move. If I said anything to the staff here, they'd say, "no chance", they'd say, "no way'".

I said to Mum and Dad I want to leave home. But they said no. They said I can't cook and I can't clean so I can't be on my own. [113]

82. We received evidence about a range of problems here, including lack of choice and control over where people lived and who they lived with,[114] problems over housing benefit, especially where people needed 24 hour support,[115] little security of tenure,[116] and being prevented by staff or family members from moving on to a new place.[117] Some people felt they were inappropriately constrained where they lived: "how many non-disabled people would be punished (not allowed out) if they left a mortgaged or rented home untidy?";[118]others felt more positive about their housing and support experiences:

119

83. We met members of a KeyRing housing network during the course of our inquiry. They told us how important living on their own in the community was to them, they each needed different levels of support to achieve this. KeyRing staff recognised that theirs was not the only good example of housing support, but they were concerned that local authorities sometimes were too cautious in their approach to enabling adults with learning disabilities to live in the community and that limited resources and suitable housing stock were often cited as barriers to allocating suitable support for people with learning disabilities.[120]

Access to paid employment

We don't feel we have the same chances of getting a job as other people. [121]

You leave special schools without any qualifications and without the skills you need to work[122]

84. We received evidence on the difficulties faced by young people when they left school and wanted to get a job: "they do not receive the same opportunities as their non-disabled peers."[123] We heard about the benefit problems people faced if they were fortunate enough to get the chance of a paid job. These problems meant people might have to choose not to work at all, or only very reduced hours.[124] We were told that it appeared to be even harder to get a job if you had a learning disability in Northern Ireland.[125]

85. Our visit to Lewisham College School of Supported Learning confirmed these concerns. Both staff and learners told us how difficult it was to access paid employment for people with learning disabilities. These difficulties meant that it was nearly impossible to find work for people with moderate to severe learning disabilities.[126]

Relationships with friends and family, sexual or other personal relationships

Our carer says we can't kiss (me and my girlfriend). She says 'we've got to draw the line somewhere'.[127]

86. People told us about their desire for friends and relationships; the difficulties they had in getting out to meet other people (because of lack of support); and the negative attitudes, strictures, lack of opportunities and privacy they confronted, if they wanted to develop close personal relationships or get married. Although we accept the evidence of the Minister for Care Services that the State does not have "a duty to provide people who are lonely with a friend", we are concerned that in some circumstances, the experiences of people with learning disabilities engage their right to respect for private and family life (Article 8 ECHR) and participation in the life of the community, as guaranteed by the UN Disability Rights Convention. [128] For example, witnesses told us:

129

and:

130

87. We welcome the Government's recognition in Valuing People that:

131

88. We recommend that the Department of Health revisit this issue in their redrafted Valuing People Now, in light of the evidence we have received.

Participation in decision-making, speaking up and making complaints

[We are].. often treated like children. [132]

89. We asked people how easy it was for them to be involved in making decisions about their lives. Some of our witnesses felt that they did have a say in decisions made: these were largely people who were involved in self-advocacy groups, whose experience had given them more confidence to speak up for themselves.[133] Others thought it was hard to have a say, because not enough responsibility was given to them. Other witnesses told us that far from being enabled to make complaints about their treatment, people with learning disabilities could be excluded from day to day decisions and choices about how they lived their lives:

134

90. Even those who felt they had a say in decision making themselves felt that "people who have more complex needs often do not because people don't know how to communicate with them".[135] Even if people did have a say it did not necessarily mean that the outcome would be what they wanted:

136

91. Most people said it was hard to make a complaint, because the system was difficult to understand or because they did not have the confidence to do so. A number of witnesses talked of being too nervous to complain or worried about what would happen to them if they did so: "If we complain we will get into trouble."[137] Some people felt there was no point complaining because they would not be listened to. "You can tell someone in authority or a parent, but you are not often taken seriously or believed."[138]

Participation in the local community

92. A number of witnesses told us that they thought that the lack of support they received was inadequate to allow them to play any part in their local community.[139] We return to this topic in Chapter 8.

Families and carers

We are unable to go far as there are no disabled toilets in which to attend to his needs. So as a family we are all restricted in the participation in the local community. He is unable to meet with friends or socialise and without us taking him for a local walk or a short drive in his van we would be completely isolated.

Mother of an adult with learning disabilities on her family's experiences[140]

93. It is estimated that there are around 6 million family carers in the UK.[141] Mencap's report No Ordinary Life found that 60% of parents of children and adults with profound and multiple learning disabilities spent more than ten hours a day on basic physical care. 78% of families received either no support at all or less than 2 hours per week.[142] Valuing People stressed the important role that family carers play in supporting people with learning disabilities and enabling them to live more fulfilling lives. Valuing People Now records the new commitments by Government to improving the circumstances of family carers but notes that 'life for many family carers remains difficult and further action is needed'.[143]

94. We received evidence from a number of witnesses from carers organisations about their experiences of the denial of human rights to their relatives or themselves.[144] Eve Rank and Richard West, two people with learning disabilities who are themselves carers of other people, said:

145

95. They pointed out that being a carer can have a major impact on the life of the carer and their own ability to lead an ordinary life: 'As carers responsibilities increase, many people do not manage to get much of a life outside of the home, and certainly are unable to partake in ordinary community life.' Unable to work (or only able to work reduced hours) because of their caring responsibilities, family carers are often in a poor position financially.[146] But witnesses told us, that 'carers grants and benefits such as council tax relief go unclaimed' because many people who look after a relative with a learning disability do not think of themselves as a 'carer'.[147]

96. The evidence we received from family carers highlighted the concerns felt by them about many of the issues we identify in this report. There was widespread concern about tightening eligibility criteria and the 'postcode lottery' in the provision of support and services; about the introduction of charging for services provided through adult social care, which could mean that families could sometimes no longer afford to continue their use of them; about services focussing on crisis intervention rather than improving people's everyday lives; and about problems with obtaining a Disabled Facilities Grant in order to get adaptations so that an adult with complex needs could have access to a toilet and shower.[148] We heard of family carers who felt that they were invisible to services until there was a crisis at home and of parents being forced to provide all the personal care needed by their relative when they were hospital inpatients, because of the hospital's reluctance to pay for the additional support required.[149] Witnesses told us of the frustrations they experienced in trying to get adequate help for their relative and the difficulties they faced in trying to keep in touch with them if they were moved away from their home community into out of area placements.[150] They pointed out that: 'many families ... act as powerful, long-term advocates for their sons/daughters, but receive little help themselves.'[151] They highlighted the fact that if family carers are not adequately supported it will impact on the lives of their disabled sons and daughters and, that if their relative got ill and they got too old to care for them, it would cost public services a lot of money.[152]

97. Although comments are sometimes made about families holding back their relatives with learning disabilities or being 'over-protective', the evidence we received suggested that 'for most people, most of the time, their families are their greatest and most reliable allies.'[153] As the Foundation for People with Learning Disabilities pointed out:

154

98. Many witnesses expressed concern about continuing poor treatment, isolation and social exclusion and that the experiences of people with learning disabilities in the United Kingdom illustrated a lack of respect for the human rights of adults with learning disabilities.[155] We are concerned that the experiences communicated to us by adults with learning disabilities, their families and supporters appear to reflect the findings of the last National Survey, that adults with learning disabilities are more likely than other people to suffer from social exclusion, poverty and isolation.

99. Not every aspect of the lives of adults with learning disabilities fell within the scope of this inquiry. Indeed, some of the evidence we received did not relate to human rights concerns. However, witnesses consistently told us that there were a number of common themes in the treatment of adults with learning disabilities which cut across a range of issues and which were undermining respect for their dignity and human rights:

the gap between the Government's policy on the treatment of adults with learning disabilities and the life experiences of many of our witnesses;
the difficulties experienced by people with learning disabilities in trying to access services and support; and
the continuing impact of negative attitudes, assumptions and stereotypes around people with a learning disability.

100. We consider how these themes undermine the ability of adults with learning disabilities to secure respect for their human rights; and whether a human rights based approach could lead to change for the better.

The gap between policy and practice

The white paper Valuing People was full of excellent recommendations, many of which have either been paid lip service, or have been ignored completely. There is a feeling amongst professionals that it was a lot of rhetoric without legislative reach to ensure that its recommendations would be put into practice. There is still a huge gap between what was recommended and what actually happens.

An NHS Clinical Psychologist in Learning Disability Services[156]

101. Many witnesses expressed their support for Valuing People, and for the existing legal framework, including the Human Rights Act and the Disability Equality Duty, but regretted that it has not made much difference on the ground. For example:

Human rights law and disability discrimination law present opportunities to challenge discrimination and inequality, but this has mostly taken place on a piece-meal, case-by-case basis. The lack of respect for the human rights of people with a learning disability is rooted, in large part, in a lack of funding for the services and support which are needed to ensure that they have the same opportunities and choices and a lack of political will to deliver the improvements which the policy framework appears to promise.[

157

and

Valuing People

158

102. In its evidence, the Department of Health accepted the conclusion of The Story So Far that "mainstream policy and delivery areas such as employment, housing and education have still not effectively taken on the Valuing People agenda".[159] The National Co-Director for Learning Disabilities told us that the primary reason there was a gulf between the Government's policy and what was happening to people with learning disabilities was the lack of "levers" for the implementation of the policy:

160

103. The Minister for Care Services accepted that, although significant progress had been made, work was still necessary to implement the policy effectively.[161] He confirmed that, until now, he had experienced problems promoting the rights of people with learning disabilities, even within his own Department:

162

104. We are concerned by the evidence that the framework for improving the lives of adults with learning disabilities does not appear to have had much impact in Government departments other than the Department of Health or the wider public sector; and that the impact of Valuing People on the experiences of adults with learning disabilities in their dealings with local authorities and individual service providers has been so patchy.

105. We were dismayed to hear the Minister for Care Services describe the National Director for Learning Disabilities as a "lone-ranger" on mainstreaming learning disabilities, rights and policy even within the Department of Health. We are extremely concerned that the Department, which has responsibility for cross-Government policy on learning disability, has failed to take seriously access to mainstream services for adults with learning disabilities, despite the existence of its statutory duties under the Disability Discrimination Act (as amended), the Disability Equality Duty and the Human Rights Act.

106. The Minister for Care Services told us that the Government was taking a number of steps to close the gap between rhetoric and reality. He told us that, for the next Comprehensive Spending Review period, the Government had not only agreed the money, but also agreed the performance assessment framework.[163] He said that current funding arrangements had to change, with funding moving away from the NHS to local authorities. He told us that Valuing People Now would remind people that:

164

107. The Minister told us that Valuing People Now would involve Government using the levers that were available at a national level to secure better services locally.

108. We welcome the Government's recognition that further work needs to be done to implement policy effectively, so as to support the rights of adults with learning disabilities as individuals. We also welcome the Minister's frank acknowledgement that more pressure needs to be placed on both central and local Government to deliver the policy of Valuing People.

109. In The Story So Far, the National Co-Director explained that some local authorities were happy to treat the policy in Valuing People as "optional."[165] We are concerned that the National Co-Director for Learning Disabilities and the Government have been searching for "levers" to implement a policy designed to ensure that adults with learning disabilities can live their lives in a way which promotes dignity and respect for their rights. We are particularly concerned that the National Co-Director did not appear to consider that public authorities' duties under the Human Rights Act would hold much sway. We reiterate our concern that the Department of Health and other Government departments should be proactive in promoting a positive approach to the Human Rights Act and to the Disability Equality Duty. We see the value of using these obligations to support or explain a particular policy choice as a 'lever' for implementation. However, this should not undermine the binding nature of these duties.

Inability to access services and support

110. Many witnesses told us that they believed that the inability of people with learning disabilities to access appropriate services and support was indicative of a fundamental lack of respect for their human rights. In particular, witnesses told us about:

local authority restrictions on eligibility for support by social services, within the Fair Access to Care criteria (discussed below);

poor care management and planning; particularly on transition into adulthood (i.e. when responsibility for support moves from children's services to adult services within local authority social services departments);[167]
out of area provision of support, away from families and communities, for people with complex and profound learning disabilities;[168]
difficulties co-ordinating support across local authority boundaries;[169] and
reluctance on the part of some of local and health authorities, supporters and families to enable individuals to take risks in their daily lives.[170]

Is it all about the money?

The White Paper Valuing People talks about the importance of community presence and participation, but £1.75 per week to spend is not enough to enable anyone to do that.

Parent and carer of an adult with a learning disability.[171]

If the Government is serious about stopping human rights abuses against people with learning difficulties, then it will simply cost money. If society decides that ultimately it does not care enough about people with learning difficulties to spend money on us, then society exists as a society where people are left out, marginalised and abused in our midst.

Andrew Lee, Director of People First (Self-Advocacy)[172]

111. A significant number of witnesses told us that funding for services and support was the key reason that Valuing People was not being implemented effectively. Dame Jo Williams, Mencap, told us that more information was required on the need for services and funding, which they hoped to feed into the Comprehensive Spending Review:

The evidence that we have to date is that the increase in the population of people with learning disabilities is about one per cent per annum. The current investment is not keeping pace with that…We are hearing about cuts in services which are affecting people's lives.[

173

112. The evidence we have received on this issue focused principally on access to social and community care services provided by local authorities. Witnesses raised two issues of concern:

tightening local authority eligibility criteria undermining Valuing People and putting the rights of people with learning disabilities and their carers at risk; and
inadequate provision for people who could benefit disproportionately from a low level of support, because of the prioritisation of people with more complex support needs.

113. We asked the National Co-Director for Learning Disabilities how the tightening of local authority eligibility criteria would impact on people with learning disabilities and the implementation of Valuing People. He told us:

Valuing People

174

114. When making assessments of need and decisions about service provision, councils must act in accordance with Fair Access to Care Guidance, issued by the Secretary of State. In setting eligibility criteria, councils must take account of their resources, local expectations and costs and agreements with the NHS. They should also consult users and others. Councils are advised in Fair Access to Care that they "should have regard to" their legal obligations under the Sex Discrimination Act 1975, the Disability Discrimination Act, 1995, the Human Rights Act 1998, and the Race Relations (Amendment) Act 2000.

115. Recent figures released by the Commission for Social Care Inspection show that the proportion of councils planning only to support people with substantial or critical needs was likely to rise from 53% to 62%, before the end of 2007.[175]

116. Difficult questions about allocation of resources may be involved when deciding whether to provide support in specific cases. However, we consider these questions must be answered within the context of the legal obligations of local authorities and other public authorities, to respect the dignity and rights of service users. Local authorities must act in accordance with the Disability Equality Duty.[176]

117. We previously considered the positive duties of public authorities under the Human Rights Act in our recent report, The Human Rights of Older People in Healthcare.[177] The Government has since rejected our recommendation that it should legislate to make explicit that all public authorities, including councils, are under a positive duty to take active steps to protect and respect human rights, where the ECHR imposes a positive obligation so to do. The Government said that such a positive obligation was unnecessary, in the light of the duties of the Equality and Human Rights Commission to encourage public authorities to comply with the Human Rights Act.[178] We are deeply concerned about the Government's negative response to our recommendations on the need for an express positive human rights duty for public authorities. The creation of a positive duty to respect human rights would help kick-start a change of attitude to the role of the Human Rights Act and to rights more generally. We doubt that, at least in the short term, oversight by the Equality and Human Rights Commission will encourage individual authorities to take a more proactive approach. On the other hand, witnesses to this inquiry, including the Minister for Care Services and the Minister for Disabled People, stressed their view that the potential impact of the Disability Equality Duty will be to change fundamentally the way that public authorities look at disability rights. We remain persuaded that the same is true of positive duties and the Human Rights Act. We reiterate our recommendation that the Government consider the introduction of an express positive duty on public authorities to promote respect for human rights, where the European Convention on Human Rights imposes a positive obligation on the State.

118. The Minister for Care Services told us he was not persuaded that we were getting the best use of investment in services for adults with learning disabilities.[179]

119. The National Co-Director for Learning Disabilities told us that increasing respect for the rights of adults with learning disabilities was not principally an issue of expenditure.[180] He explained that a more positive approach to the rights of people with learning disabilities could be achieved by changing attitudes towards learning disability (we consider this issue below). We asked a number of our witnesses about how to make improvements, if no more additional resources were available. Suggestions ranged from increasing awareness of the Disability Equality Duty and the Human Rights Act,[181] through better control over care planning and management, to more individualised support with greater flexibility.[182]

120. We asked the Minister about tightening eligibility criteria and the balance which councils were required to strike between cheaper support for those with low support needs and more expensive intervention when their needs became critical. In the latest Comprehensive Spending Review, the Government committed to a process of consultation on a Green Paper on the long-term funding of social care.[183] Valuing People Now proposes the transfer of responsibility for learning disabilities from Primary Care Trusts ("PCTs") to local authorities. Associated budgets will also be transferred. Only specialist learning disability healthcare commissioning will remain with PCTs.[184] Shortly after giving evidence to us, the Minister for Care Services published Putting People First, a proposal for individual, or personalised, budgets for the care and support of elderly and younger disabled people, including adults with learning disabilities.[185] This programme has a ring-fenced budget of £520 million which will be distributed between 150 councils in England, over three years.

121. The recent initiatives by Government to grapple with funding in social care, particularly in relation to learning disabilities, seem like a step in the right direction, although they were announced at a late stage in our inquiry, after we had finished taking evidence. We heard some positive support for the introduction of individual budgets, but have also heard concerns about the adequacy of those budgets and the need for separate funding for independent, effective brokerage.[186] We strongly recommend that guidance to local councils should remind them that decisions about funding must be taken in a way which is compatible with the Disability Equality Duty and the Human Rights Act. We recommend that the Government rewrite its Guidance, including Fair Access to Care, to ensure it provides clear, straightforward and accessible examples of a human rights based approach, explains how social care funding decisions could lead to a breach of Convention rights and sets out how to comply proactively with the Disability Equality Duty.

Negative attitudes, assumptions and stereotypes about people with a learning disability

Some people take the mick out of me and I used to get bullied, but I know people know about my learning disabilities … my girlfriend does not have a learning disability. She gets treated fairly more than me because I have a learning disability. People laugh at her when she is with me, but she just says "he is the same as any one else".

A person with learning disabilities[187]

When we are born, our parents are given negative views about our chances in life. They are encouraged to mourn the fact that they have abnormal children, and their disappointment stays with us throughout our lives.

Andrew Lee, Director, People First (Self-Advocacy)[188]

122. Witnesses told us that providers of mainstream services and people on the street often had negative attitudes, assumptions and stereotypes about people with learning disabilities which made it difficult for people with learning disabilities to gain respect for their human rights. These attitudes and assumptions could lead directly to the denial of individual rights, for example through bullying or hate crime, or they could underlie decisions by others which marginalised people with learning disabilities and undermined their ability to speak up for their rights. Mencap told us:

Despite welcome changes both to the law and to social attitudes, people with a learning disability are still subject to prejudice and misunderstanding and to assumptions that they have little to contribute to society. The experience of prejudice may also discourage people with a learning disability from attempting to play a full role in their community and contribute to their isolation and exclusion.[

189

123. Negative attitudes and assumptions can be a particularly significant problem for certain groups, such as people with complex and profound learning disabilities. For example, the PMLD (Profound and Multiple Learning Disabilities) Network told us:

190

124. Other witnesses confirmed the difficulties they encountered as a result of negative attitudes on the part of professionals and service providers. For example, in seeking access to healthcare (which we consider below, in Chapter 5):

191

125. They also told us how negative attitudes could cause difficulties in the wider community:

192

and

193

and

194

126. Andrew Lee, Director, People First (Self-Advocacy) told us:

195

127. We agree with our witnesses that one of the most distressing and worrying things about the investigation by the Healthcare Commission and CSCI into the treatment of people with learning disabilities in Cornwall was that "many of the staff did not believe and understand that what they were doing was wrong". This episode provides a most harrowing example of how a lack of awareness of the rights of people with learning disabilities can have a devastating effect, leading to situations where the right to be treated with respect for private life is ignored (Article 8 ECHR), and the rights to life and to be free from inhuman and degrading treatment are endangered (Articles 2 and 3 ECHR).

128. Some witnesses told us that training for professionals and others on learning disability by people with learning disabilities would be needed to change the situation. For example:

196

129. The National Co-Director for Learning Disabilities told us that changing attitudes would involve promoting the rights of people with learning disabilities:

197

130. The British Institute of Human Rights said that the promotion of a human rights based approach could improve the treatment of people with learning disabilities, not only by empowering people with learning disabilities but by promoting change within service providers:

198

131. We welcome the recognition by the National Co-Director for Learning Disabilities of the importance of educating people, and particularly service providers, to see people with learning disabilities as people with human rights which need to be respected. He told us:

199

132. We welcome the recognition of both the Minister for Care Services and the Minister for Disabled People, that while the Government has a responsibility to ensure public authorities meet their duties to respect the rights of adults with learning disabilities under the Disability Discrimination Act and the Human Rights Act, a move away from negative attitudes and assumptions is required:

200

133. We agree that taking a human rights based approach to service provision could contribute to reversing negative attitudes, assumptions and stereotypes. We again stress that the Department of Health and the Office for Disability Issues should take a lead in creating a positive approach to the implementation of both the Human Rights Act 1998 and the Disability Equality Duty. However, "taking a human rights based approach" means more than using the appropriate language in policy documents or in statements to parliamentary committees. A proactive and practical approach to the implementation of individual rights for people with learning disabilities is needed to replace the existing culture, which has allowed society to "dehumanise" people with learning disabilities for centuries.

Helen continued to be distressed and her confusion increased. She was sent to a psychiatric ward, where she behaved in ways very unusual for her, pacing and groaning in pain. As Helen's behaviour worsened she was sectioned under the Mental Health Act. Helen's family tried to explain ... they believed that the pain … was the most likely explanation for her change in behaviour. Doctors informed her family that Helen was "just doing this for attention".

Mencap Case Study[201]

134. The evidence that we have received in this inquiry strongly suggests we are failing adults with learning disabilities, by failing to afford adequate respect for their human rights. In the following chapters, we focus on four areas which we consider provide the starkest illustrations of adults with learning disabilities being treated without dignity and respect for their human rights:

The treatment of adults in health and residential care settings, an area that has already had a significant amount of public attention in the light of high profile cases (Chapter 5);
The experience of parents with learning disabilities (Chapter 6);
The treatment of adults with learning disabilities in the criminal justice system (Chapter 7); and
Barriers to an ordinary life confronting adults with learning disabilities (Chapter 8).

97 Q 1. Back

98 Annex 2, para 5. Back

99 Ev 48, 50, 52, 66, 68, 82, 408. Back

100 Ev 55, 84, 92, 110, 116. Back

101 Ev 326, 379, 391, 410. Back

102 Ev 50, 56, 242, 256. Back

103 Ev 116, 219, 238-239, 241, 411. Back

104 We have summarised some of the evidence we received from people with learning disabilities, their families and supporters in Annex 2; See also Ev 56. Back

105 Annex 2, para 6. Back

106 Ev 53, 94, 222, 299, 304, 310, 377. Back

107 Ev 327. Back

108 Ev 122. Back