Baroness Hollins
My Lords, I declare an interest as a psychiatrist who has spent much of the last 30 years working with people with learning disabilities who have similar needs to those of the subjects of the shocking “Panorama” programme. I am also the carer of an adult man who has a learning disability and whose behaviour at times challenges those who support him. I have also been a policy adviser on learning disability to the Department of Health on two occasions.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the safety and quality of care of those with learning disabilities are of the highest importance. We will discuss the terms of reference for the serious case review with South Gloucestershire Council. We want to ensure that the terms of reference for all of the reviews by the local authority, the strategic health authorities and the Care Quality Commission will give us the evidence that we need to answer the serious questions raised by the events at Winterbourne View. We have asked Mark Goldring, the chief executive of Mencap, to work closely with us in reviewing the evidence.
Baroness Hollins
My Lords, I thank the Minister for his response. The national picture needs to be thought about. This matter is not happening just in south Gloucestershire. I understand that there may be as many as 150 private hospitals. I consider that to be unacceptable given the three decades of work to close NHS long-stay hospitals, which was finally achieved just two years ago. Will the Minister consider reversing the decision to end the employment of the national director for learning disabilities, who, as a policy adviser to the department, could have responsibility for overseeing the implementation of government guidance? The Mansell report gives guidance on how to manage and support people with learning disabilities and challenging behaviour in the community, rather than exporting them a long way from home to private hospitals.
Earl Howe
My Lords, I am grateful to the noble Baroness. She raises some important issues. I am aware that the chief executive designate of the National Health Service commissioning board and the current chief executive of the National Health Service, David Nicholson, will be looking at the whole question of national clinical directors and leadership in clinical care in the coming months.
The noble Baroness is right about care in the community. That has been the direction of travel under the previous Government, as it is now. She will know that many Winterbourne View residents were sectioned under the Mental Health Act and had challenging behaviour, an area I know she has experience of. I believe that privately provided care can be trusted; if the commissioning is right, if regulation is right and if the arrangements for oversight are right, it is not intrinsically less likely that privately provided care will be delivered at the right levels of quality.
Baroness Thornton
I am seeking assurance from the Minister that there will be a wide-ranging and independent review of this matter, held in public, that will shine a light on what happened at Winterbourne View and allow the wider lessons to be learnt. We need to know whether the CQC’s failure to monitor the treatment of residents was due to the fact that there was a shortage of CQC staff. Does the CQC have sufficient powers to act in this case and, if so, is it using its powers adequately? Could the Minister also comment on the wisdom of placing more regulatory tasks with the CQC, as the Government are proposing in the process of reorganisation? Surely we need to see that the CQC is carrying out its current functions adequately.
Earl Howe
My Lords, first, there is a criminal investigation under way and it would not be appropriate to launch an inquiry, even if we were minded to do so. As the noble Baroness knows, the CQC has launched its own internal investigation. It has admitted that there were failings in its processes. South Gloucestershire Council will lead an independently chaired serious case review, as has been mentioned, involving all agencies, which will look at the lessons to be learnt. The strategic health authorities involved have instigated a serious untoward incident investigation. The department will, after these reviews have been concluded, examine all the evidence and report to Parliament.
We want to understand not only the immediate facts and why things went wrong at Winterbourne View but also whether there are more systemic weaknesses in the arrangements for looking after people with learning disabilities and who exhibit seriously challenging behaviour. It is very easy to make the CQC into a scapegoat. It is difficult to ask of the CQC that it polices every room in every hospital at every hour of the day. We rely on the CQC and have been supportive of it. It does much good work and clearly it will want to review its own processes as part of this.
Baroness Barker
Does the Minister agree that when this abuse was taking place, a number of professionals, including nurses and doctors, must have gone into that establishment and that these professional bodies should start to conduct their own inquiries into what their staff were doing in there at the time? Secondly, a bad provider of care has everything to fear from an unannounced visit, while a good provider of care has nothing to fear. Does the Minister agree that as a temporary measure the CQC could consider conducting only unannounced visits in the foreseeable future?
Earl Howe
My Lords, I am grateful to my noble friend. My understanding is that all patients at Winterbourne View have been regularly reviewed by a multidisciplinary clinical team in the past six months on behalf of the primary care trust that commissioned their care, and most of them in the past three months. I am sure she is right to say that those who have conducted such reviews should examine their processes and my understanding is that that is exactly what will happen.
We have endorsed the CQC’s proposal to launch a programme of risk-based and random unannounced inspections of a sample of the 150 hospitals providing care for people with learning disabilities. They will work in conjunction with local government improvement and development, ADAS, Mencap and with experts with experience of this programme. The spirit of my noble friend’s question is amply addressed in the programme.
Lord Laming
Will the Minister encourage the Government to reinforce messages about managerial accountability wherever vulnerable people are being cared for and about the fact that the greater the degree of vulnerability, the greater that accountability must be held by the managers of the service?
Earl Howe
The noble Lord is quite right. There has clearly been a serious failing in management here. We are looking at that urgently and, no doubt, important lessons will be learnt. All agencies have acted immediately on being alerted to the situation by the “Panorama” team and, as I have mentioned, appropriate inquiries are under way.
Baroness Wall of New Barnet
I agree with the Minister about the response around the Care Quality Commission. When such a result as this comes out, the undermining is quite damaging right across the whole spectrum of its work. In hospital trusts and everywhere else, the CQC’s inspection and report are held in great esteem if they are good and are very worrying if they are not. I wonder whether that is denigrated by this unfortunate incident and this awful opportunity that it has had and missed.
Earl Howe
My Lords, I take the noble Baroness’s point. It is very easy to blame the CQC whereas we should in fact first point the finger at those who perpetrated these awful acts and at the management of the hospital. There are a number of other agents involved besides the regulator. We are committed to developing the role of the Care Quality Commission to make it a more effective regulator of health services in England. Those efforts can be supplemented by the role of HealthWatch, which she will know we proposed in the Bill before the other place to strengthen the arrangements for the patient and public voice. I am sure that there is more that we are able to do, but it is important that we learn the facts first before pointing the finger at the regulator or anybody else.
