Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Norman Lamb (North Norfolk) (LD)
(Urgent Question): To ask the Minister if she will make a statement on the treatment of people with learning disabilities and complex needs at Whorlton Hall.
The Minister for Care (Caroline Dinenage)
Many of us here today, and many of those listening and watching this urgent question, will have seen the very disturbing footage shown on the “Panorama” TV programme last night. It was footage detailing the incredibly traumatic experiences of vulnerable people with learning disabilities and autism at Whorlton Hall—somewhere they should have been safe, somewhere they should have been cared for. The actions revealed by the programme are simply appalling—there is no other word to describe them—and I condemn any abuse of this kind completely and utterly.
I want to begin by saying that I can only imagine the impact of those experiences on the people themselves, and the lasting damage and trauma that it will have caused to them and their lives. It must also have been incredibly distressing for their families, watching what has been happening to their loved ones, unable to step in and unable to do anything to help them. It is utterly, utterly tragic. On behalf of the health and care system, I am deeply sorry that this has happened.
As hon. Members will be aware, unfortunately, this is not an isolated incident; we have heard reports like this before. That is why there have been a number of reports published even this week on the care of people with learning disabilities and autistic people in in-patient settings. All those reports have been commissioned directly or indirectly by the Government, and all of them have found very clear evidence of care that has fallen way below the standard we expect and the standards that people absolutely deserve.
The allegations of abuse at Whorlton Hall were shared with my Department, NHS England, the Care Quality Commission and the provider ahead of the programme airing yesterday. Immediate steps were taken to ensure the safety of patients, including ensuring that safe staffing levels were maintained following the suspension of a significant number of staff by the provider. A Whorlton Hall incident co-ordination group was established, involving NHS England; NHS Improvement; Cygnet, as the owner; the CQC’s regional head of inspection; the local clinical commissioning group; and the local authority.
Durham constabulary opened a criminal investigation earlier this month, and the CQC and NHS England are supporting its enquiries. While that investigation is ongoing, I cannot comment on the specific incidents or individuals depicted, as Members will understand. The evidence presented, including but not limited to the “Panorama” footage, must be thoroughly examined, and where those investigations find that allegations of abuse are substantiated, action will be taken.
One thing we can all be clear on is that what was shown last night was not care, nor was it in any way caring—suffice it to say that I am clear in my mind the nature of what was occurring at Whorlton Hall.
There are three questions that we need to consider urgently. First, was the activity in Whorlton Hall criminal? The police investigation is looking into that. Secondly, is the regulatory and inspection framework working for these types of services? We want to know why, after whistleblowing concerns had been raised, was the outrageous culture and behaviour at Whorlton Hall not identified? What went wrong? We will be working to understand in detail the timeline of events, the actions taken and where things might have been addressed earlier. Thirdly, was the oversight of commissioners fit for purpose? Where were the CQC and NHS England in this?
More broadly, there is a range of questions about whether these types of institutions and these types of in-patient settings are ever an appropriate place to keep vulnerable people for any extended length of time and why community provision is not sufficient. Work is continuing on all those subjects as well. We know the problems that exist in the system and we are utterly determined address them.
Norman Lamb
I thank the Minister for that response. Last night’s “Panorama” was deeply shocking and particularly distressing for any family who have a loved one in an institution and are worried about their safety. We saw people with learning disabilities and autism mocked, intimidated, taunted and provoked, and care workers admitting to deliberately hurting patients—behaviour appropriately described as psychological torture. The individuals responsible must be held to account, but so must the provider that allowed this dreadful culture to persist. Will there now be an investigation by the Health and Safety Executive into the possibility of criminal prosecution against the provider?
The truth is that, seven years on from Winterbourne View, the system continues to sanction a model of care that is outdated and wrong. If people are contained in institutions a long way from home, awful things will happen behind closed doors. Will the Secretary of State now take personal responsibility for closing down institutions that provide the wrong model of care? Why does the CQC continue to register new institutions that offer inappropriate institutional care? Does the CQC need new powers? What lessons must we learn from the fact that the CQC rated this place as good? Is this another case of whistleblowers not being listened to? How much was Cygnet charging the NHS per week for this awful abuse and neglect?
This horror comes in the same week as a damning CQC report on segregation, an equally scathing report by the Children’s Commissioner on children being wrongly placed in institutions where force is routinely used and the LeDeR—learning disabilities mortality review—report confirming the extent to which people with learning disabilities and autism are fatally failed by the system. Does the Minister accept that we are tolerating widespread human rights abuses? Is it true that the Government moved forward the publication of the CQC report to pre-empt the “Panorama” report? What families want is not another review; they want action to protect their loved ones.
Will the Government take action to end the endemic use of restraint—including face-down restraint against adults and children—five years after I issued guidance to that end? When will the Government tell us what will replace the transforming care programme? It ended in March and we are still waiting—there is hardly a sense of urgency. Finally, will there now be substantial investment in the development of community facilities, so that people with learning disabilities and autism have the chance of a good life that the rest of us take for granted?
Caroline Dinenage
These exchanges reflect the views that I am certain we all hold, and I thank the right hon. Gentleman for raising all those questions. The culture and behaviour shown on yesterday’s television programme are absolutely abhorrent and we must stamp them out. More broadly, it is clear from the reports published earlier this week, which the right hon. Gentleman refers to, that we need to do much more to improve the quality of care in mental health wards for anyone with a learning disability or autism. I want to reassure the House that we absolutely recognise that, and steps are being taken to address it.
Societies are rightly judged on the way we treat our most vulnerable citizens. This is not just about reviewing a few individual cases in which things went wrong; it is about a system across health, education, social care and criminal justice—it all needs to change. Today, people will rightly be very angry about what has happened and what was shown on last night’s television programme, and they will want answers. They will also rightly be very angry that, eight years after Winterbourne View, we have another scandalous case in which vulnerable people with learning disabilities or autism are on the receiving end. They will rightly ask what action has been taken and what more we need to do.
As the right hon. Gentleman will know, six months ago the Secretary of State commissioned the CQC report on segregation, seclusion and restrictive practices. It was published earlier this week simply because the original publication due date of 31 May is during a recess, and he will know that the Department has come in for enormous criticism in the past for publishing reports when Parliament is in recess, post elections or when the House is not sitting and for publishing late. We wanted to avoid all those things. That is why the date was brought forward. The publication was ready and we took the view to publish it. The publication of the LeDeR report was a matter for NHS England, of course, it being an independent document.
The action we announced in response to the CQC report on Tuesday confirms how seriously we take this issue. We are adamant that no stone should be left unturned in identifying problems, poor practice and care that falls short of what we would expect for our own family members. That said, this is not about segregation or seclusion or failings at specific hospitals, but about the need for far better oversight more generally. Where it is essential that somebody be supported at a distance from their home, we will make sure that those arrangements are supervised. We will not tolerate having people out of sight and out of mind. Where someone with a learning disability or an autistic person has to be an in-patient out of area, they will now be visited on site every six weeks if they are a child and every eight weeks if they are an adult.
The host clinical commissioning group will also be given new responsibilities to oversee and monitor the quality of care provided in their area. This is an issue not just for the regulator, but for those who commission the care. We must be clear that improving the quality of specialist in-patient care is critical, but we are committed to preventing people from entering crisis and having to be admitted to in-patient care in the first place, and that is what the transforming care programme is about. This programme has not finished. As was highlighted in the NHS long-term plan, the transforming care programme and the building the right support plan continue, and we are renewing and redoubling efforts to reduce the number of people in an in-patient setting by 35%. So far, it is down 22% from 2015, but that endeavour continues. The right hon. Gentleman highlights the report from the Children’s Commissioner on Monday. We take the issues they spoke about very seriously.
The right hon. Gentleman asked lots of questions, many of which I think were answered in the three questions I highlighted earlier—the questions that we will be addressing over the coming weeks: criminal liability, oversight and commissioning. Where there have been failings, these will be addressed. Autistic children often have a range of needs or supports that must be joined up, which is why we are reviewing our entire autism strategy and will extend it to include children. As part of the NHS long-term plan, there will be a concerted effort to implement arrangements to ensure that those at the highest risk of admission to a specialist hospital get the help they need, and we will ensure that every area has a dynamic support register in place.
We think that staff in these settings must be much better trained in awareness of learning disabilities and autism, which is why we conducted a thorough inquiry and public consultation on training for learning disabilities and autism. In the coming months, we will set out our response to that consultation and proposals to introduce mandatory training for all health and care staff. We will continue to bring those in-patient numbers down and take every step to take the best practice in health and care and make it the norm everywhere. We will root out toxic cultures and behaviours of the type we saw last night so very painfully on our television screens, but I am fully aware that there is no room for complacency.
Several hon. Members rose—
Sir Desmond Swayne (New Forest West) (Con)
What happens at the Care Quality Commission’s headquarters when a story such as this emerges? Are the inspectors who so recently rated the facility summoned in for a meeting without coffee, or perhaps with the rough end of a pineapple?
Caroline Dinenage
The Care Quality Commission is taking the situation incredibly seriously. Some massive concerns were raised last night, and Paul Lelliott from the CQC apologised and said that the matter would be very thoroughly addressed and investigated by its team.
Barbara Keeley (Worsley and Eccles South) (Lab)
I appreciate the Minister’s response, but the Secretary of State really should be here to deal with this. The abuse shown on the BBC “Panorama” programme last night was appalling, and it should never have been allowed to happen. The fact that it is eight years since the Winterbourne View scandal and nothing has changed should be a source of shame for the Government. Rather than warm words—the Government seem to be getting good at warm words these days, but little else—will the Minister take personal responsibility and tell us what she is doing to ensure that this never happens again?
The abuse that was shown was tantamount to psychological torture, with residents sworn at, threatened and intimidated. Other residents were violently restrained or deliberately hurt by care staff. As the Minister has mentioned, other cases—such as Mendip House and Thors Park—show that this is not an isolated incident; it is part of a pattern of cruel and callous behaviour in such institutions. There is only one sure way to end this abuse, and that is to close down the institutions and move people into supported placements in the community.
Many of the people who were abused at Whorlton Hall were hundreds of miles from their families. Does the Minister recognise that cutting people off from their support networks allows such abuse to carry on without anyone noticing? Labour has pledged £350 million extra per year to ensure that people can move from such institutions and be supported in the community instead. Will the Minister match that commitment?
In 2011, the Government pledged to end the use of units such as Whorlton Hall. Eight years later, however, there are still more than 2,200 people detained in inappropriate institutions. More recent targets, which were less ambitious, were also missed. After years of broken promises, autistic people, people with learning disabilities and their families cannot trust the Government to deliver on their promises. Is it not time the Government brought in an independent commissioner to oversee the closure of such units?
Caroline Dinenage
I do not agree with the hon. Lady that what I have said today is about warm words; it is about action. The CQC report that came out on Tuesday was commissioned by our Secretary of State to really shine a light on the matter. We are shining a light on some of the most distressing information so that we can address it—so that we cannot brush it under the carpet and speak warm words about it. Not only did we accept all the CQC’s recommendations, but we made more recommendations of our own that we intend to put into practice.
In answer to some of the hon. Lady’s questions, I am very clear that as far as possible, people should be treated in a community setting. If they have to go into an in-patient setting, they should be as close to home as possible and they should be there for the shortest possible time, with a very clear route out and plan for their future. To help to deliver that, we have committed £4.5 billion to community funding as part of the NHS long-term plan, and I expect a good proportion of that money to be spent on investing in the community settings that we need.
Caroline Dinenage
The hon. Lady is saying from a sedentary position that we should close settings, but we are talking about very vulnerable people who have complex needs and require special care, and we need to make sure that there are sufficient services in the community to support them. It would be a complete dereliction of our duty and responsibility to take people out of one setting that is not working for them and put them into another setting that will be as bad, or worse.
Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
I thank the Minister for her robust efforts to get to grips with the matter. I have heard from my constituents overnight that they have no confidence in the CQC if it thought it could get away with assessing Whorlton Hall as good. If it takes an undercover investigator to highlight a message that whistleblowers are not getting through, why are the Government not taking immediate action properly to investigate every single in-patient centre so that the Minister can look us all in the eye and say, “I know which places are safe and which are not”?
Caroline Dinenage
My hon. Friend is absolutely right to raise that point. I think the CQC itself admitted to this. In fact, some of its social media engagement over the past 24 hours has been unprecedented in its level of frankness and openness, and in the way in which it has shown a desire to change and make this situation better. It has been very disturbing for everybody concerned, and it is true that NHS England has started enhanced oversight and scrutiny of this particular group’s other learning disability and autism settings to try to ensure that we are not going to uncover any more stories of such horror.
Helen Goodman (Bishop Auckland) (Lab)
What was revealed on “Panorama” last night was truly horrific. This was public service broadcasting at its best, but it should not have taken the BBC to uncover the case; the CQC got this totally wrong. However, whatever the failings of the CQC, ultimate responsibility must lie with those who own and manage these homes and make money out of them. I am therefore extremely concerned to hear that the Minister has put Cygnet on the body that is to look into this matter. There is a clear conflict of interest because Cygnet may end up needing to be prosecuted. Finally, the Government need to fund these services properly. It is no good having people who are not qualified and not properly paid working with the most vulnerable people in society.
Caroline Dinenage
Let me clarify what I said, because I think the hon. Lady might have slightly got the wrong end of the stick. I did not say that Cygnet was being put on a group that is investigating this situation. I said that a group was established to deal with the immediate problem as soon as the issue came to light. That immediate problem was the safety of the individuals living in this particular setting and the conduct of those whose behaviour had been so outrageous. At that point, we were told that 21 people had been suspended. The safety of the individuals living in the setting was therefore our immediate concern, as well as finding alternative places for many of them to go. At that point, there was an incident co-ordination group that included Cygnet because it is the owner, but that group was set up to deal with the immediate situation that needed to be dealt with very promptly.
John Howell (Henley) (Con)
The NHS has been using a system of ambulatory care, particularly to deal with elderly patients by treating them in their home, plus a hospital visit. Why has this not been rolled out quicker to those with learning disabilities and autism?
Caroline Dinenage
That is what we are looking towards, which is why the Government are putting so much more money—£4.5 billion of the extra investment in the NHS—into the sorts of community services that we need to make exactly that a reality. There are cases where people do end up in an in-patient setting, often because services have failed and their situation has almost reached crisis point. The transforming care and building the right support system that I spoke about earlier is all about ensuring that we get people out of those settings as quickly as possible and into the right kind of support in the community.
Dr Sarah Wollaston (Totnes) (Change UK)
Too many people are ending up in terrible institutional care hundreds of miles from home for the want of much more appropriate community care, including social care. The Minister has spoken about not wanting to delay the publication of reports, but she will know that the delay to the social care Green Paper has been unaccountably prolonged. Will she bring forward the social care Green Paper, because this issue lies at the root of inappropriate admissions?
Caroline Dinenage
The hon. Lady knows that I listen very carefully to what she says. I completely share her frustration about the delays to the social care Green Paper, but I do not think that we should ever be held back from making progress on all the things that are wrong in society that we care very deeply about because we are awaiting the publication of such documents. We will therefore be pushing forward with all the work on a lot of the issues that I have spoken about today as a matter of great urgency.
Bob Blackman (Harrow East) (Con)
Mencap has called for a cross-Department ministerial working group to review the system, and a taskforce made up of people with real-life experience of dealing with people with learning disabilities and autism. Will my hon. Friend confirm that she will set up both such groups so that we can get some action in helping people who are suffering?
Caroline Dinenage
There is already a cross-departmental working group on disability, and quite rightly, this could be part of its work. In addition, as part of the response to the CQC report published on Tuesday, the Secretary of State has committed to set up a group made up of academics and experts, including experts by experience, to look at exactly that.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I chair the Westminster Commission on Autism. The Minister will know that people on social media are asking why it took a television programme to reveal this. Can we learn the lessons quickly? I make no party political point—these crises have happened under other Governments, but we have to learn the lessons and reappraise the whole sector. Some people have said this morning that we should keep these children and adults close to home, in their communities, and that is right. We should also look at something that has really worked, which is the Children’s Commissioner, especially with someone like Anne Longfield in the role. That has been an enormous success, and perhaps we need a commissioner for autism, who would give a voice and a personality to this kind of crisis.
Caroline Dinenage
I greatly respect all the work that the hon. Gentleman does with autistic people, and I know he is passionate about this. He is right. We have committed to review the autism strategy. The Autism Act 2009 is the only condition-specific piece of legislation in British law, and we want to ensure that it continues to be fit for purpose. The consultation on the autism strategy review has just closed, and we will look carefully at everything that comes out of it.
Tom Pursglove (Corby) (Con)
What protection is in place for those who come forward to shine a light on allegations relating to such grave care? What is the Minister’s message to people who have concerns?
Caroline Dinenage
I am grateful to my hon. Friend for raising that, because it is the whistleblowers who have brought these concerns to everyone’s attention. It is deeply regrettable that whistleblowers brought this to people’s attention before, and it was investigated, but this abuse was not rooted out and stopped. We need more protection for whistleblowers. We have accepted some of the CQC’s recommendations on encouraging whistleblowers to come forward, and we are always looking at more ways to offer protection and encourage them to do so. It is always wrong when deeply disturbing practices have to be brought to light by those who shine a light on them.
Mr Steve Reed (Croydon North) (Lab/Co-op)
Children with autism and learning disabilities are still being pinned face-down on the floor, tied to beds or locked up in seclusion rooms. The Government promised five years ago to publish guidance to prevent that kind of abuse, but they still have not done it. After Whorlton Hall, we desperately need a date. When will the Government publish that guidance?
Caroline Dinenage
The Secretary of State commissioned a report on exactly that—segregation and restrictive practice. It was published on Tuesday, and we have accepted all the recommendations. We are working very hard on this. There will be guidance, but it is more important than that. As shown in the TV programme last night, there was training and guidance on the restrictive practices to be implemented, but it was ignored, and restraint was recorded incorrectly. This is a much bigger issue than the one the hon. Gentleman highlights.
Rachel Maclean (Redditch) (Con)
I see more and more families in my surgery with loved ones who suffer from autism or learning difficulties being failed by the system. Will the Minister give an assurance to my constituents and their families that there will be a genuine focus in the NHS long-term plan on these vulnerable people?
Caroline Dinenage
I thank my hon. Friend for that question; she is right to raise it. Autism and learning disability are both mentioned as clinical priorities in the NHS long-term plan. That is absolutely right, and we must relentlessly continue that focus.