Assessment and Treatment Units: Vulnerable People

Baroness Keeley Excerpts

Tuesday 6th November 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the long-term seclusion and deaths of autistic people and people with learning disabilities in assessment and treatment units.

[The Minister for Care (Caroline Dinenage)]

I want to address the care that the NHS and social care system gives to some of the most vulnerable in our society. The millions of people who work in the NHS and social care do so every day with compassion and commitment to care for us all, but sometimes the system gets in the way, and when we see that, it is our task and our duty to change it. That is the case with the care given to people with some of the most significant and complex needs, such as those with learning disabilities and autism who are in-patients in assessment and treatment units and other mental health in-patient settings across the country. The care received by some of the people with the most significant needs quite simply is unacceptable.

With respect to in-patient care in assessment and treatment units and other in-patient settings, I absolutely share Members’ concerns about reported deaths, and I want to restate my Department’s commitment to reducing the number of preventable deaths among people with a learning disability. NHS England is ensuring that relevant investigatory processes have been followed in respect of each and every one of the cases it has responsibility for, and it is seeking assurance from all relevant clinical commissioning groups that they too have ensured appropriate investigation. As it stands, there is no indication that any of the deaths were untoward or that due process was not followed in every single case, but we are double-checking each and every one.

The hon. Member for Worsley and Eccles South (Barbara Keeley) mentioned seclusion. Like everyone in the House, I have been incredibly moved by reports of the care for Bethany and by the dignity of her dad, Jeremy, who has described the daily battle he has fought to get her the best possible care. It is completely unacceptable for seclusion to be used in this way. Restrictive practices must only ever be used as a last resort, and we must strive to totally eliminate them. With that in mind, the Secretary of State has instituted a serious incident review in Bethany’s case, and we will act to ensure that she gets the best possible care for her.

However, this is not just about individual cases; it is about the system. Three years ago, the Government committed to reducing the number of people with learning disabilities or autism detained in mental health hospitals by at least a third. The latest information we have shows that the number is down by around 20%, but that is not nearly enough. Today, 2,315 people with a learning disability and/or autism in England are held in mental health hospitals. I want to see that number drastically reduced, and in the first instance I want us to meet the target of reduction by a third. I want to see everyone who can be cared for with their family living as normal a life as possible.

The Secretary of State has instituted a wide-ranging review into the inappropriate use of prolonged seclusion and long-term segregation as restrictive practices. He has asked the Care Quality Commission to initiate that review immediately, and it will be undertaken in two stages. Furthermore, he has asked the NHS to address this issue in the long-term plan that it is writing for the future of the NHS, and I know that NHS leadership shares our passion to get this right. We will also address the role of local authorities in the social care Green Paper, and both of those will be published before Christmas.

[Mr Speaker]

Order. I remind the House that this question must finish no later than 1.45 pm, and if people have not got in by then, I am afraid that it is too bad.

[Barbara Keeley]

I want to put on record my disappointment that the Secretary of State tried to shoehorn an issue of this severity into an NHS policy announcement yesterday, and my thanks to you, Mr Speaker, for allowing this urgent question.

The treatment of people with autism and learning disabilities in assessment and treatment units is nothing short of a national scandal. Six years ago, these units were described by the then chief executive of NHS England and the chief executive of the Care Quality Commission as a model of care that has

“no place in the 21st century”.

Seven years after the Winterbourne View scandal, the Government have not rid the country of these units or substantially cut their use. Indeed, as the Minister said, there are still 2,315 people in assessment and treatment units, including 230 children, and the number of under-18s has been increasing.

A Sky News investigation last week revealed that, since 2015, at least 40 people with a learning disability or autism have died while in assessment and treatment units, and nine of those who died were aged 35 or under. Some of the country’s most vulnerable people are being exposed to physical abuse in institutions that the chief inspector of mental health services described as being

“in danger of developing the same characteristics that Winterbourne View did.”

Can the Minister tell us why the NHS is still sanctioning the use of settings that expose thousands of vulnerable people to abuse, at a cost of half a billion pounds, despite the Government pledging to close them?

The transforming care programme has manifestly failed. What are the Government going to do to ensure funding is available for cash-strapped local councils to pay for community placements with care support for autistic people and people with a learning disability? The Times has revealed that the private companies running these units are making millions of pounds out of detaining vulnerable people in unsafe facilities, in one case funnelling £25 million into a secret bank account in Belize. Can the Minister tell us what the Government are doing to immediately stop private companies that have a vested interest in keeping people with learning disabilities in these Bedlam-like conditions from doing that?

On Saturday, as the Minister has outlined, the Secretary of State ordered the Care Quality Commission to undertake a thematic review of assessment and treatment units, and he has ordered a serious incident review in the case of one young autistic woman, Bethany. Reviews are not urgent action, there are very many Bethanys trapped in seclusion, and 40 people have died in these units. Will the Minister tell us the timetable for the completion and publication of the CQC review and what urgent action can be taken to free all the young people and adults trapped in these appalling conditions?

[Caroline Dinenage]

Hon. Members will be very aware of and concerned about the report published this week by University College London. As the hon. Lady said, the report, which was commissioned by the NHS, draws attention to how people with learning disabilities die on average 15 to 20 years sooner than the general population, often for reasons that are not an inevitable consequence of any underlying medical condition. I was reassured that this report shows that programmes and opportunities that Government are putting in place to improve outcomes for people with learning disabilities and autism are addressing some of the concerns. However, I share very strongly her views and the views of this report that there is still much further to go and that now is the time to take action.

As hon. Members will know, the LeDeR report—the learning disabilities mortality review—is looking into the deaths of all people with a learning disability. It published its second annual report in May and in their response in September the Government accepted all the recommendations and included detailed actions for implementing them. NHS England has also committed that the long-term plan for the NHS will include learning disability and autism as one of the four clinical priorities. The long-term plan will also set out the future of the transforming care programme, which the hon. Lady raised.

Government policy on restrictive practices, including seclusion, is to reduce their use. Where such interventions have to be used, they must be a last resort and the intervention should always be represented as the least restrictive option to meet immediate needs. Incidents of restrictive intervention are recorded in the mental health services dataset and this data is published. The Mental Health Act code of practice highlights the particularly adverse impact of seclusion on children and young people. It advises careful assessment and periodic reviews.

I want to turn to the Care Quality Commission review into the inappropriate use of prolonged seclusion and long-term segregation. The first stage of the review will focus on settings that relate most closely to Bethany’s circumstances, focusing on people of all ages receiving care on NHS and independent sector wards for people with learning disabilities and/or autism and on child and adolescent mental health wards. That will start immediately and this stage will report in May next year. It is very important that service users, their families and people with lived experience are able to contribute to that. The second stage will report in the winter and will examine other settings in which segregation and prolonged seclusion are used. That stage will include NHS and independent sector mental health rehabilitation wards and low secure mental health wards for people of all ages, as well as residential care homes designated for the care of people with learning difficulties and/or autism. As I have said, individuals who have been subject to segregation and/or long-term seclusion and their families and carers will be invited to provide evidence, including through interviews. The Care Quality Commission will make recommendations at the end of both stages, which will seek to eliminate system-wide inappropriate use of prolonged seclusion and long-term segregation, and ensure that vulnerable adults and children supported by health and social care are accorded the best possible care.

I should point out that not all the numbers that the hon. Lady spoke about are in separately identified assessment and treatment units. The data reports there being 2,315 in-patients with a learning disability and/or autism in mental health in-patient settings as of September, but some 360 of them were in in-patient settings described as for people with acute learning disabilities

It is important that commissioners should be able to access very high-quality, value-for-money care in their local area, whichever organisation provides it. We recognise the concern that people have expressed about what happens in the transforming care process, but I see it very much as a process and not as an event that will continue. The NHS has transferred more than £50 million to ensure that the right care is put in place in respect of community support, so that people are better cared for when they are out in the community.