People with Learning Disabilities

Baroness Thornton Excerpts

Thursday 6th June 2019 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what action they are taking to address the treatment of people with learning disabilities and complex needs in in-patient units; and what plans they have to provide adequate, alternative community support.

[Baroness Thornton (Lab)]

My Lords, the Minister will be aware that this Question was prompted by the BBC “Panorama” programme shown immediately before the Recess and the statement made by the CQC at the same time. I thank the Library, Mencap, YoungMinds, the Royal College of Speech and Language Therapists, and others for their briefings. I also thank the noble Lords taking part in this short debate.

The “Panorama” programme was shocking. You have to wonder what the owners of Whorlton Hall, Cygnet Health Care and the CQC were doing in previous years; they were certainly not looking in the direction of, or carefully enough at, the care of some of the most vulnerable people in our society. The programme revealed conduct and attitudes almost medieval in their cruelty and ignorance. The fact that it took place somewhere that should have been safe and caring is shaming for all of us. The BBC’s undercover filming appeared to show patients with learning disabilities being mocked, intimidated and restrained. We know that 10 workers have since been arrested and that the health watchdog—the CQC—has launched a review, led by David Noble, into how it handled a 2015 report raising concerns about Whorlton Hall hospital. It beggars belief that although the former Care Quality Commission inspector Barry Stanley-Wilkinson flagged up the potential abuse of patients four years earlier in an as yet unpublished report, it took an undercover programme to reveal what was going on in the home. It is even more unbelievable given that the site had at least 100 visits by official agencies in the year before the abuse was discovered.

Of course, this is not for the first time. Since the 2011 Winterbourne View abuse scandal—also revealed by a BBC “Panorama” programme—Ministers have promised repeatedly to move such people out of unsuitable secure units and into community care, yet the number of adults with autism and learning difficulties locked up in ATUs fell only slightly over the past three years, while the number of children in them has more than doubled. Last year, there were 28,880 restraint incidents in England alone.

The Transforming Care programme has taken many forms since 2012: the initial two-year targets were missed and a new lead was appointed but resigned. After two critical National Audit Office reports, two Public Accounts Committee hearings and various other reports, NHS England and partners wrote Building the Right Support. Eventually, a three-year programme for 2016-19 was announced, with three aims: to develop new community support and services; to improve the quality of care in in-patient settings; and to reduce the number of people with learning disabilities and/or autism in in-patient settings by between 35% and 50% by March 2019. The programme failed to deliver these aims. By March, at the end of the programme, bed numbers had decreased by only 19%. What is the Government’s response so far? It is true that NHS England included that target in its long-term plan. However, that has simply moved the delivery date, with NHSE now aiming to meet the target in five years’ time. That is not good enough.

It is also true that, in the meantime, the Secretary of State commissioned a CQC review of seclusion and restrictive practices in response to numerous media exposures of poor practice. The recent interim report reveals the widespread use of restraint and restrictive practices in in-patient units for people with learning disabilities and/or autism. In May 2019, a damning report from the Children’s Commissioner highlighted the shocking treatment of children in these places and the lack of community support leading to their admission. This very sorry tale reveals a lack of leadership, ability or preparedness on the part of the Government to effect real change for this most vulnerable cohort of our fellow citizens.

The truth is that, seven years on from Winterbourne View, the system continues to sanction an outdated and wrong model of care. If people are contained in institutions a long way from home, awful things seem to happen behind closed doors. Can the Minister tell the House whether the Secretary of State now takes 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 “good”? Is this another case of whistleblowers not being listened to? How much was Cygnet Health Care charging the NHS per week for this awful abuse and neglect?

This horror came in the same week as the damning CQC report on segregation, an equally scathing report by the Children’s Commissioner and the LeDeR—the learning disabilities mortality review—report confirming the extent to which people with learning disabilities and autism are fatally failed by our system. Does the Minister accept that we are tolerating widespread human rights abuses? Surely families want not another review but action to protect their loved ones. Many of the people abused at Whorlton Hall were hundreds of miles from their families. Does the Minister recognise, and will she commit to the fact, that cutting people off from their support networks allows such abuse to carry on without anyone noticing?

The Government’s inadequate response to this matter is deeply shocking. There is agreement among experts in this field, including many health and social care professionals, that robust community support and leadership across government is needed to ensure transformation. Most recently, but still six months ago, Sir Simon Wessely’s report— Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion—was published. It included a number of positive proposals meaning that children and young people would be treated in hospital only when absolutely necessary and clarifying their rights to be involved in—and challenge—decisions about their care. I agree with YoungMinds when it says that it is,

“concerned that essential reforms to improve the quality and type of support for young people with complex needs and mental health conditions could be further delayed or put at risk”.

On its behalf and that of thousands of young people and their families, I have some questions for the Minister. When will we see the Government’s response to the Wessely review recommendations? When will we see a new mental health Bill? When will the Secretary of State for Health and Social Care grasp the nettle and drive forward cross-departmental work and joined-up NHS and social care support? Only proactive and strong leadership from the top will unlock the systemic blockages stopping people from moving out of in-patient settings and back into their communities.

Mencap proposes four actions that should inform the Government’s action programme. First, it proposes increasing cross-departmental leadership, accountability and oversight through a commitment from the Secretary of State for Health and Social Care to convene and lead a new, cross-departmental ministerial group with the Minister for Children and Families and the Minister for Housing, Communities and Local Government. It states that referring the Transforming Care programme to the inter-ministerial group on disability, as the Government previously suggested, is wholly inadequate given the attention that the programme requires, so it will not be effective. Secondly, it proposes a commitment from the Secretary of State to ensure that learning takes place from the independent evaluation of the Transforming Care programme, and that this leads to new and credible implementation plans across health, social care, housing and education. Thirdly, it proposes pooled and ring-fenced funding to build high-quality, specialist support in the community. The buck-passing between health, education and social care has to end, with budgets pooled and focused on getting the right outcome for the person by intervening early so that children get the right support and adults have the right adapted housing and specialist staff support they need. Finally, it proposes co-production with families and individuals with lived experience. The regulator, specialist practitioners and commissioners should drive forward workable solutions, but not without the lived experience of children and adults with a learning disability, as well as of their families.

Finally, I have to raise the question of who owns, runs and profits from these homes. Julie Newcombe, a mother who—as she puts it—“rescued” her son and set up Rightful Lives, said:

“There is a huge conflict of interest within the private sector because heads on beds equals money in the bank, which means profit becomes the ultimate barrier to discharge”.


Last November the Mail on Sunday published an article, “Profiteers of Misery”, lifting the lid on the profits made by private companies that run establishments such as Whorlton Hall. We need to discuss and raise the issue of the conflicts of interest—with which, of course, we are very familiar through our recent consideration of the MCA Act.

Universal Health Services—whose former CEO, I think, is Simon Stevens, now the head of NHS England—is a huge US healthcare firm snapping up British psychiatric services. Its British operations are run by Cygnet Health Care, the owners of Whorlton Hall. Cygnet Health Care boasted in recent accounts of earning revenues from 220 NHS purchasing bodies and almost doubling its profits to £40.4 million in the last year. Will the David Noble inquiry look at the issues this raises—underpaid and inexperienced staff—and ascertain what the occupancy rates were and whether patients were being kept longer than was needed, ultimately to boost the profits of Cygnet and its US parent company, Universal Health Services?