People with Learning Difficulties and Autism: Detention in Secure Settings

Lord Crisp Excerpts

Thursday 28th October 2021 Grand Committee

[Lord Crisp (CB)]

My Lords, I, too, congratulate my noble friend Lady Hollins on getting this debate. I want to spend a moment on those congratulations. At a time of Covid, climate change and geopolitical tensions, it is really important that we do not neglect some of the smaller-scale issues. This issue affects 2,000-plus people and their families, but it is not millions, and it is not the billions who live on this earth. In that sense, it is small scale, but for these families this is massive and all-embracing. I also note that Covid has affected people differently and has been a healthy reminder of the inequalities in our society, and this is a massive and rather hidden inequality. So I congratulate my noble friend on the way she opened the debate, spreading out all the issues that are involved.

I want to say a few words about the current situation and focus on the plan, the non-existent plan. We are talking here about 2,000-plus people, 210 of whom are children who have learning disabilities and/or autism. I have been out of touch with this sector for some time, but I sense from the briefings that I have been getting that all we are doing is warehousing these people. They do not need to be there. They are admitted because there is nowhere else for them to go, and they cannot leave because there is nowhere else for them to go. Meanwhile, while there, they deteriorate. It is a dangerous environment for many, and goodness knows what it does for the children and their education, socialisation and development.

I know that similar things are happening to acute adult mental health admissions because I have done a recent review on that, and people are stuck in adult in-patient units, but the difference is that we are talking about people being in this situation for 5.4 years on average. They go in now and come out, possibly in 2027, or, looking backwards, they would be coming out into today’s world from the very different world of 2015, or, as a child, growing from 11 or 12 to 16 or 17 through the early years of adolescence. We can all imagine the personal tragedies behind these bald figures.

So what is the plan? I mean “what is the plan?” and not “what is the policy document?” My noble friend Lady Bull made the terribly important point that this is small enough to count. They can all go on somebody’s list and somebody can tick them off when they are moved out of hospital.

I have had a lot of great briefings from organisations, great descriptions of the problem and great advice. We know what good looks like. There are lots of overlapping recommendations. There is a lot of discussion of inspection and holding to account, but I do not see anything about personal responsibility and who is responsible for delivering the change.

I joined the NHS in 1986 from a background in industry and charitable sector as—in those days’ language—the unit general manager of a mental handicap unit and I am familiar with this sort of problem because in those days we had a target to remove children from mental handicap hospitals. I make these comments as a manager.

Public sector planning can just mean a document all carefully worked through with timelines, targets and many wise words. A plan is not a document but something that is going to happen, but it does not mean anything if there is not somebody charged with implementing it and for whom there are consequences, frankly, of both success and failure. I was staggered to hear the noble Baroness, Lady Hollins, point out that some of the people who appear to be responsible for implementing this do not know how many people they are responsible for in this situation.

We need money to sort some of this out, I am sure, but a person is the most important first step. Money can be wasted, and a responsible person can fight for the money. Of course, quality and safety are also vital; this is not just about getting people out of one bad situation in hospital or inpatient unit and putting them in another bad situation in the community.

I will not labour what happened 35 years ago—but it happened. There was both money and responsibility and it happened. I remember quite a lot of pressure coming down the system to me as a unit general manager to make sure that it happened. At that stage, no more children were living in hospitals. It may not be quite like for like for where we are today, but it is tragic to hear how far backwards we have gone in 35 years.

Therefore, my questions for the Minister are of course: what is the plan and who will be responsible for delivering it? Will whoever is personally responsible also be impacted by their failure or success in achieving the plan? Let me add that this is just the sort of small-scale thing where ministerial leadership can make a massive difference. If a Minister took an interest and wanted to make it happen, they could really make it happen. I know it is not the Minister’s brief, but will he raise this with his ministerial colleague, the Minister for Care? My simple point is: who is going to get a grip on this?