Care Services: Abuse of Learning Disabled

Baroness Emerton Excerpts

Thursday 13th December 2012 Lords Chamber

[Baroness Emerton]

My Lords, I, too, congratulate the noble Lord, Lord Rix, on initiating this debate, and I congratulate my noble friend Lady Kidron on her outstanding maiden speech. I want to concentrate on the management of change in the situation that we find ourselves in, and perhaps I may take noble Lords back to the beginning of Winterbourne. I was called in with Professor Jim Mansell to look at the footage before it was put out on television and asked why in the late 1970s we had been able satisfactorily to relocate 1,115 and 1,112 patients respectively from two large institutions, all suffering from learning disabilities, after 10 years; and why, in 2011, we find the same things happening now as happened in the late 1970s.

I want to raise the issues that we found. First, what were the principles and what were the things that needed to be looked at? We needed a multi-professional team, a strategy, a programme and research. We had no idea that the project would take so long, but we set about it. I was most fortunate in recruiting the then young Professor Mansell as a psychologist and researcher. It was his first post, other than working at the Kushlick centre, since leaving university, having changed his degree after the Ely inquiry. He was outstanding in the field of care for those with learning disabilities and continued his research right up to his sad death last year. The principles were that patients should return to their district of origin; that they would be individually assessed and diagnosed with their treatment set out; that they would work to a programme; that the staff would be trained to meet that programme; and that accommodation would be suitable to the need. Membership of the project team was large—we had a psychiatrist, a psychologist, a researcher, members of social services and we set up a university department. The principles were clear—that no patient would be discharged without an assessment, training programme, support programme and suitable accommodation.

The barriers were enormous. The psychiatrists at the hospital were totally against it being closed and the patients themselves were not happy about going, because it had been their home for a long time. The relatives became very edgy because they thought that it was a safe haven and that going into the community would be unsafe and the recipients in the community had a little of the “not in my backyard” attitude. Finance was an issue but at the time it was government policy and we were able to get funding. On the question of accommodation, we had to look at all the different types of accommodation that might be available—houses, housing association flats, and very small units.

The patients with less challenging behaviours were the easiest to relocate. Those with more challenging behaviours were more restricted: specialist skills were required to care for them. Fortunately, because we had Professor Mansell, we were able to relocate all of these with the right treatments and staffing levels. The training programmes were for support workers, who were trained but obviously not registered, at that stage, since they had never been registered. We also had trained nurses and social workers and we went through the programme. Resistance was overcome by influence, persuasion and personal visits to local councils, social services and parents themselves, and by going to hear what the patients had to say. We made sure that the team, which worked extremely hard, remained committed to overcoming the barriers.

Near to the closure of the 1,500 bed hospital, most of the patients had been relocated back to the sites from where they had originally come, but some—mostly those with challenging behaviours—remained. We had to persuade those within the counties and the districts: we had seven local London districts as well as Kent and Sussex. It took time to persuade them that it was possible, but Professor Mansell was instrumental in persuading people that even those with the most severe challenging behaviour could be housed in the community. We eventually succeeded in getting them out—the decisions were taken and the assessments went on—and the communities began to accept them and were happy. We found, through visiting them, going round to tea with the residents, that they had settled and that the community had accepted them. The budgets were sorted and the patients were happy. I remember a flat in Camberwell where three elderly gentlemen who had been in hospital for 30 years said what a treat it was to be able to go to a fish and chip shop; they also invited us to tea.

The programme would not have succeeded without the leadership of Jim Mansell and the rest of the team. It would not have succeeded had we not used leadership, influence and persuasion, or if we had not trained the staff. Today, the noble Baroness, Lady Jolly, and other Members have mentioned the need to register support workers. We cannot go on without having that registration of support workers, who are trained to understand the special needs that go with learning disability.

The point of making this reminiscent therapy that I have gone through is that today we face the same barriers and issues, and we have to overcome them. I am grateful that we have been able to see the report from the Government but we need to address these barriers urgently. If we do not, it will be those who suffer from learning disabilities who will be disadvantaged.