People with Learning Difficulties and Autism: Detention in Secure Settings
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I thank the noble Baroness for securing this important and heart-wrenching debate, and for leading the work on the independent reviews of people with a learning disability and autistic people in long-term segregation. I also thank the oversight panel that works with the noble Baroness on this vital issue for its report and recommendations, which the Government wholeheartedly welcomed and responded to in July this year.
Some of the stories we heard were heartbreaking. I am extremely concerned to hear about the number of people who remain in long-term segregation and, in too many instances, the unacceptably poor care to which they are subject. As the noble Baroness rightly says, no one should be detained where they do not need to be and where they can live a full life in the community but, sadly, we know that this is still happening and, frankly, it is not good enough. The Government are committed to taking action, both for those already detained who can and must be discharged, and to prevent people who do not need to be admitted from being so in future. We must move away from responding to crises to ensuring that the right care and supporting legal framework are in place from the very beginning of someone’s life.
We are determined to reduce the number of people with a learning disability and autistic people in mental health hospitals, which is why we are investing more than £90 million of additional funding in 2021-22 in community services and support for discharges. The Government are also undertaking wider action, which I will set out as I address the important points raised in this debate. I aim to address as many of noble Lords’ points as possible today.
The noble Baroness, Lady Hollins, started the debate by talking about housing. There is clear evidence that the right housing arrangements can deliver improved outcomes and meet people’s preference to remain in their own home. We agree, as the noble Baroness said, that the right housing for people with learning disabilities and autism is not always available, or available as quickly as we would like. In England, we are providing funding to build specialised housing through the Care and Support Specialised Housing Fund—CASSH—for older people and adults with learning and physical disabilities or mental ill health. We have provided £71 million for the fund in 2021-22.
Also in England, we fund the disabled facilities grants to support eligible people, including people with learning disabilities and sensory impairments, in adapting their homes to make them safe and suitable for their individual needs, subject to a means test, eligibility criteria and their needs assessment; £573 million has been provided for this in 2021-22. Housing is one of the six priority work streams of the Building the Right Support delivery board, and will form part of its upcoming action plan.
The noble Baroness, Lady Hollins, and the noble Lord, Lord Addington, mentioned training and expert staff. We accept that the right workforce is critical in enabling the highest standards of care and support for people with learning disabilities and autistic people. Skilled staff, leadership and creativity can be key in supporting someone towards discharge. For those in long-term segregation, the launch of a senior intervenors pilot is vital. Senior intervenors are being recruited, and we hope that they will help to remove barriers and bring creativity to planning and moving people towards discharge. The role will bring with it the necessary expertise and experience to assist in overcoming some of the barriers to progress.
More generally, we have provided £1.4 million of funding for the development and trialling of Oliver McGowan mandatory training to improve awareness and understanding of learning disability and autism for health and social care staff. Hundreds of staff have already been trained through the trials. The Government recently announced at least £500 million over three years to fund social care professionalisation initiatives to improve workforce well-being and other issues, especially for those who work with patients with autism and learning disabilities.
As we set out in Right to be Heard:
“Our vision is that in future all professionals will, before starting their career or through continuing professional development, undertake training which covers a ‘common core curriculum’ for learning disability and autism so that we can be confident that there is consistency across education and training curricula.”
The Government are currently working with Health Education England, the Medical Schools Council, regulators and medical schools to establish the best approach to developing a core curriculum. In addition, to improve patient services supporting autistic people, we are investing £1.5 million to develop training for staff in adult in-patient mental health centres. I know that the noble Lord said that there are much wider issues around mental health, but it also includes supporting autistic people, in line with tier 3 of the core capabilities framework.
As part of the Oliver McGowan mandatory training in learning disability and autism programme, we are working with a number of people, backed by that £1.4 million investment. Subject to evaluation, this should be available to all of the 2.8 million health and social care staff on autism and learning disability. As I said, the workforce is one of our six priorities. Also, as part of the new national autism strategy, we are taking a number of steps to improve the understanding of autism among educational professionals, as well as the training that we have already announced.
There are a number of incredibly important reports and recommendations, especially those by the Joint Committee on Human Rights, the Health and Social Care Committee and the CQC oversight panel. The Building the Right Support delivery board has been established to drive further and faster progress on the exact issues that a number of noble Lords raised today. We are considering how to bring these recommendations together as part of the Building the Right Support action plan; this will require a cross-government, cross-system effort, as many noble Lords have said.
We also want to ensure better reporting on the number of people being detained. The Government are fully committed to reducing restrictive practices and poor care for people with learning disability and autistic people. Reporting on our progress on the use of these restrictive practices is an important part of that, which is why the Mental Health Units (Use of Force) Act statutory guidance, on which we recently consulted, set the reporting requirements for restrictive practices under the Act. That guidance makes reference to the mandatory requirement to report this information, in line with current NHS England and NHS Improvement requirements. We will publish the final guidance, reflecting feedback from the public consultation, later this year.
The noble Baroness will be aware of existing reporting data which is also already published. NHS Digital publishes its annual Mental Health Bulletin, a monthly public dashboard about the use of restrictive interventions and assuring transformation data about the number of people with a learning disability and autism in in-patient settings.
The noble Baroness, Lady Hollins, and perhaps one or two other noble Lords, also raised the issue of changing the rules so that care workers can enter the skilled worker immigration scheme. We should all acknowledge the valuable role that immigrants play in our economy. Within the social care workforce, nurses, occupational therapists and social workers are eligible for the health and care visa. The new health and care visa will make it cheaper, quicker and easier for eligible social care professionals from around the world to come to work in the UK. We hope to attract the best talent from around the world.
The noble Lord, Lord Addington, asked whether we have training for staff to de-escalate and minimise restrictive practice. NHS England and NHS Improvement have commissioned the rollout of the HOPE(S) model, a national training model to be delivered through NHS-led provider collaboratives to reduce the use of restrictive practices and long-term segregation and to develop positive cultures. The HOPE(S) model will follow a human rights-based approach, be person-centred and be informed by experiences of trauma. A number of noble Lords raised the issue of trauma and we think it is important that we address it. I would welcome feedback from noble Lords across the Committee who take an interest in this issue to make sure that we are on the right path.
I want to dwell on the senior intervener role, which is being trialled in response to the recommendation of the noble Baroness, Lady Hollins, for the introduction of an additional senior person to support local services to plan discharge, guide where there is challenge and agree actions to facilitate a reduction in restrictions. It is important that we do this planning and that we are planning for discharge as the ultimate goal. The project builds on the positive evaluation of the pilot of children and young people’s senior interveners. The ultimate goal of senior interveners is to establish and oversee this robust programme, making sure that we are all working towards discharge from long-term segregation and hospital.
I was asked by a number of noble Lords, especially the noble Baroness, Lady Hollins, about independent case reviews. We have accepted the recommendation made by the noble Baroness, Lady Hollins, and the oversight panel to resume independent case reviews for those in long-term segregation. We are working with NHS England and the CQC to ensure that IC(E)TRs will be restored as soon as possible. It is important that the reviews that take place are high quality and that we have the right panel of experts in place. We are trying to work on this as fast as possible in the context of the Covid-19 pandemic.
A number of noble Lords asked about Winterbourne View and targets. We have a clear target in the NHS long-term plan of a 50% reduction by 2023-24 and are taking action across several fronts to achieve this. There have been more than 10,000 discharges since March 2015 and a 28% net reduction in in-patient numbers. We accept that this does not meet the target of a 35% reduction previously set out in March 2020, but we hope to continue and to make real progress.
The noble Lord, Lord Touhig, talked about mental health issues and Mental Health Act reform. Reform of the Mental Health Act is important and a White Paper was published in January 2021. We have consulted publicly on the proposals, and we published a response in July 2021.
I will try to answer the other questions. The noble Baroness, Lady Bull, and the noble Lord, Lord Touhig, talked about limiting the scope of detaining people with learning disabilities or autistic people. The proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and make every local area understand and monitor the risk of crisis at individual level.
I would like to say more about commissioners, if I may, but, if I have not answered noble Lords’ questions in the time allotted, I hope that they will write to me, so that I can give them all a more thorough response.
I end by thanking the noble Baroness, Lady Hollins, for this important debate. I think all noble Lords agree that all parts of the system must play their part and take action, so that no one is detained when they do not need to be. Hospitals must always have a therapeutic purpose and detain people only for as long as is absolutely necessary. We hope that the actions we have set out today for both the long and short term—I will write to noble Lords about our significant reforms—demonstrate the range of activity already under way or planned. We hope that this will help to ensure that we prevent people with a learning disability and autistic people being detained when they could live a full life in their community with their friends and family, as every one of us deserves.
Once again, I thank the noble Baroness, Lady Hollins, for securing this debate. I look forward to working with her in future.