People with Learning Disabilities

Lord Hunt of Kings Heath Excerpts

Thursday 6th June 2019 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, as I shall refer to some workforce issues, I refer noble Lords to my membership of the General Medical Council. I am grateful to my noble friend for instituting this debate. The questions she has posed are very significant. As she said, the “Panorama” programme depicted shocking events. The depressing thing, of course, is that it follows not only Winterbourne View but a series of reports published in the last few years identifying the scale of the problems. My noble friend went through some of them; I will mention three.

One is the Children’s Commissioner for England report of 2019, published only two weeks ago, which found that there are 250 autistic children or children with a learning disability in mental health hospitals in England, who on average had spent six months there. Many, she said, are far away from their homes, friends and families. One in four had not had their care plan reviewed in the last six months. Despite the fact that restraint and seclusion should be only a last resort, many staff in mental health hospitals spoke as if they were routine matters. Last year the CQC was asked to carry out a review into the use of restraint and seclusion in mental health hospitals. It really was a shocking situation: 31 of the 39 people found in long-term segregation whose cases investigators assessed were on the autism spectrum; some were on wards that did not have the appropriate environment for autistic people; many staff lacked training; in the cases of two-thirds of the people the CQC assessed, staff had stopped trying to reintegrate them into the main ward; and a third of the people it assessed were experiencing a delayed discharge because there was not a plan for appropriate care in the community. The National Autistic Society has laid bare many of the problems that these reports have identified.

There was also the very interesting National Audit Office report in 2017, which raised a number of complex challenges that the various partners involved in supporting people with learning disabilities face in making the system work much more effectively and delivering what my noble friend has asked for: appropriate care in the community. It identified that the flow of patients into mental health hospitals was not working effectively and that, shockingly, in December 2016, 28% of such patients had still never had a care and treatment review. Fundamentally to the financing of this, money was not being released from mental health hospitals quickly enough to help pay for the kind of community support we need to see.

We also know, from a report published two days ago by Health Education England, that the learning disability nursing headcount could hit critical levels in the next five years—some would say it has hit those levels already—with vacancies upwards of 30%. In addition to some of the issues we have in recruiting nurses—including bursaries, et cetera—I believe there is a huge crisis in the learning disability field and, so far, no real, tangible means of trying to deal with it.

I know government Ministers are and have been committed to doing something about it, as my noble friend says. We are not short of reassurances that Ministers have given to this House and the other place, and I do not doubt Ministers’ sincerity. It was only on 21 May that the Secretary of State announced a number of initiatives on,

“the model of care for autistic people and people with learning disabilities”,

and the appointment of,

“specialist, independent advocates who will … work with families … join up services … work to move people to the least restrictive care and then out into the community … a new working group for learning disabilities and autism, bringing together experts, clinicians, parents and carers to develop a new model of care … a new awareness campaign, to encourage staff, families and friends to come forward if they have concerns about care”.

I could not disagree with any of that; I am sure it is welcome. The question is: where is the beef? What is going to make this really happen? Is this just a continuation of, frankly, a system of scandals that have been with us for decades?

I could not help going back just over 50 years to Geoffrey Howe’s report into Ely Hospital in Wales, which was the start of a series of inquiries into hospital care for people with learning and mental health disabilities. It led the movement towards more community care. At the time, it caused great shock that our fellow country men and women could be treated so badly in institutions ostensibly established to care for and support them. I make the connection between what was exposed so recently by “Panorama” and what was found by Geoffrey Howe just over 50 years ago in Ely Hospital. I do not think that we, collectively, can be proud of what has happened. Of course improvements have been made, but an awful lot more needs to be done. Ministers often make the glib statement, “We want to make sure this can never happen again”. The Government have been wise not to make that statement in relation to people with learning disabilities. At the moment, I do not believe there is anything to guarantee that it will not happen again.

It is clear, for a start, that there does not seem to be any national leadership. In the end, who is in charge of making a new service work effectively? I cannot see anybody one can identify as being in charge unless it is Ministers, but Ministers do not—or say they do not—have the levers to make the system work effectively. It is clear that commissioners are not up to the task. The lack of interest that many commissioners take in those people, once they have been allocated to these places, is so striking. Given that many of the people in those places come from long distances away, it is almost impossible for their home commissioners to monitor what is going on.

The current system is simply not capable of stopping this. Ministers must appoint someone centrally with the powers to dictate what will happen. Unless we do that we will simply come back here year after year with yet another scandal. The measures taken so far are sensible, but will not cut the cake.