People with Learning Disabilities

Baroness Blackwood of North Oxford Excerpts

Thursday 6th June 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Baroness, Lady Thornton, for securing this serious and timely debate and I am very grateful to noble Lords for their informed contributions on a very sensitive matter. The care and treatment of people with learning disabilities and autistic people has rightly come under intense public scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society. Today’s debate provides an important opportunity to reflect on this crucial issue.

Nobody who watched the BBC’s “Panorama” programme on Whorlton Hall could have been anything but deeply shocked and disturbed by the abuse it exposed. The actions revealed by the programme, the abuse of vulnerable people in a setting where they should have been safe and well cared for, was truly appalling. We are very clear that people with learning disabilities and autistic people have the right to feel safe in their environment and to be treated with dignity and respect. As the noble Baroness, Lady Thornton, rightly said, Durham Constabulary is investigating and has so far arrested and questioned 10 members of staff about offences relating to abuse and neglect. We cannot comment on matters that might prejudice that process, but 16 members of staff have also been suspended and all patients have now been transferred out of the hospital and it is closed to new admissions. In addition, my right honourable friend the Secretary of State for Health and Social Care has asked the CQC to look in detail at its inspection and regulatory approach to Whorlton Hall to ensure that lessons are learned from what has happened in this case and in other cases that have gone before it. The CQC has commissioned independent reviews. The first is looking into how the organisation dealt with concerns raised by an inspector in a draft report prepared in 2015, as has already been mentioned; the second is a wider review of what could have been done differently or better in its regulation and inspection of Whorlton Hall between 2015 and 2019. The findings and recommendations of both reviews will be published. It is clear that opportunities to intervene were missed, and we must be open and transparent in getting to the bottom of why this happened.

The noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, mentioned the Children’s Commissioner’s report. She has also investigated the treatment of children with learning disabilities or autism in in-patient mental health hospitals. Her recently published report showed how too many children are still being admitted into secure hospitals, often a long way from their home, when they should be in their community, as well as being subject to restraint and seclusion. I will return to that in a moment. She warns that the current system of support is letting down some of the most vulnerable children in the country. We will consider her report extremely carefully.

I want to turn to points made by the noble Baroness, Lady Thornton, regarding private providers. Around half of the provision of specialist in-patient care is in the independent sector. This is carefully looked at by regulators and by the Government. At the moment, there is no evidence of a systemic difference between the quality of care and that of the NHS or voluntary providers. The care is NHS-commissioned and is subject to the same commissioner oversight, contractual provisions and regulation by the CQC. The same safeguards under the Mental Health Act also apply to protect the rights of patients. However, we keep this matter under careful review and will continue to do so.

I now turn to the important question that was raised about restrictive interventions, given the prominence they have been given in recent reports. It is important that we see a decrease in the use of such interventions. Data collection is not robust enough for us to make comparisons between years to see whether the use of restraint is rising, but it provides enough certainty for us to know that it is still used too much. We must minimise it and, where it is used, ensure that it is done safely and effectively, in line with the Positive and Proactive Care guidelines. Understandably, there is public concern about the use of restraint, prolonged seclusion and the segregation of people with mental health problems, a learning disability or autism.

In response to the case of Bethany, a young autistic woman who was held in seclusion at a hospital for far too long, my right honourable friend the Secretary of State for Health and Social Care has commissioned the CQC to undertake an in-depth thematic review of restrictive practices in health and care settings. The CQC published its interim findings and recommendations on 21 May and the Government have accepted them in full. The care of every hospital patient in long-term seclusion or segregation will be reviewed, and patients will have access to specialist independent advocates to support them and their families, as has been mentioned.

The model of care for autistic people and those with learning disabilities must be fit for purpose. We will convene an expert group to develop a new care model, taking the very best practice as the foundation. We will also strengthen the safeguards, working with the CQC to develop new regulatory arrangements for hospitals that use segregation. In addition, we will develop a new awareness-raising campaign, as has already been mentioned, so that no one will be “out of sight, out of mind”, as has too often been the case. We want to end inappropriate out-of-area placements and ensure that people are cared for as close to home as possible. Where out-of-area placements are essential, as they sometimes are for very specialist care, commissioners will need to visit children every six weeks and adults every eight weeks on site. I hope that that will improve the situation and reassure the House.

The noble Baroness, Lady Thornton, asked why the CQC registered new facilities that do not offer an appropriate model of care. The CQC has a set of stringent rules for registering the right support. It only registers a new learning disability service that meets the service model for building the right support. However, I am sure that, given the circumstances that have arisen, this will be looked at very carefully. The noble Lord, Lord Hunt, was right: given the situations that have arisen, there needs to be a holistic and systemic response.

Many of the actions that have been taken and which we have been debating began in 2014-15, and it is important that we see the progress that has been made since then. The Learning Disabilities Mortality Review Programme—the world’s only national programme looking into why people with learning disabilities die—was set up relatively recently. It has made some progress and has recommended specific steps to improve our response to those with learning disabilities in the community to ensure that they have a better quality of life. The noble Baroness, Lady Thornton, made that exact point when she talked about improved community support. That is why annual GP health checks for people with learning disabilities to help reduce recognised health inequalities is a commitment in the long-term plan, and it is why, over the next five years, national learning disability improvement standards will be implemented and will apply to all services funded by the NHS. That is one of the systemic requirements that will help to drive improvements through the system—something that I think has been missing from the response until now.

Furthermore, NHS England and NHS Digital are working to include a digital flag in the records of people with a learning disability or autism so that information can be shared across health and care records and organisations. In the NHS Long Term Plan we have committed to implement this by 2023-24. It is another systemic response that should create a significant improvement. In addition, people with a learning disability or autism, or those with the most complex needs, will have a designated keyworker. These will initially be provided to children and young people who are in-patients or at risk of being admitted to hospital. All these improvements should make a significant difference, as will the review of the autism strategy, which is well overdue.

The noble Baroness, Lady Lane-Fox, is absolutely right that augmented rather than artificial intelligence—people plus tech—has the potential to completely transform the health of this nation. I thank her for an inspirational contribution. She will be pleased to hear that we have now completed rolling out wi-fi across the GP network and that we are well on the way with the secondary care system. She is right about skills being essential to driving digital transformation across the system, and that is why we set up the NHS Digital Academy. However, we recognise that more needs to be done. Investment was one of the core elements of the Patient Capital Review. We want to drive that forward and I would very much like to hear the noble Baroness’s proposals for it.

On the Transforming Care programme, although hospital might be the right environment for a small number of people with learning disabilities or autistic people at a given point in time, everyone should have the opportunity to live in the community. When people need in-patient support, it should be for the shortest time possible, of the highest quality and delivered in the safest settings where people are free from harm and abuse. The goal of the Transforming Care programme is to reduce the number of in-patients. We have reduced the number by 22%, and we are still fully committed to reducing it by at least 35% as soon as possible during 2019-20, as set out in the NHS Long Term Plan. That remains a commitment. Local areas will be expected to use some of the growing investment in primary care and community care services to meet that commitment.

I would like to respond to the point that was made about the number of child in-patients having doubled. In part this was because, we believe, commissioners did not correctly record children in the NHS Digital figures before 2015. We are checking the data and will respond later.

The noble Lord, Lord Hunt, was absolutely right about self-training, and that is why we have consulted on proposals to introduce mandatory training. Our plans to introduce mandatory training for all relevant health and care staff will go a long way to ensuring that more people receive the safe, compassionate and informed care that they are entitled to.

We will of course continue to work with all partners across government and across the health and social care system to consider any recommendations that can improve care for people with learning disabilities and to address the shameful inequalities that they experience. Every person has a right to effective, compassionate and dignified care. If you have a learning disability, these expectations should be no different.