Care Services: Abuse of Learning Disabled

Baroness Browning Excerpts

Thursday 13th December 2012 Lords Chamber

[Baroness Browning]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Kidron, and to have this opportunity to congratulate her on her maiden speech. She has been acclaimed both nationally and internationally as a film-maker, and we must add our congratulations on her choice of subject matter in her maiden speech. We look forward to future contributions from her as the years go by.

I begin by supporting and joining the call from my noble friend Lady Jolly on two points—first, on the registration and structure of care workers in health and social care. I must say to my noble friend on the Front Bench that there is a real body of steam behind this. I know that my noble friend Lord Howe has said that he will keep an open mind on this, but I say to my noble friend that this is not going to go away and the sooner we get on with it, the better. Also, I join my noble friend Lady Jolly on the question of accountability of those upstream owners of private homes and hospitals. Again, complex though this issue may be, I hope that the Government will address it as a matter of urgency.

As my noble friend Lord Touhig—if I may call him that—said, a third of the patients at Winterbourne View had a diagnosis of autism. I am genuinely filled with despair that, after the high profile of the Bournewood case some years ago now, we are still looking at people with a diagnosis of autism being held in a hospital, and the views of parents and carers being dismissed by so-called professionals. I thought we had moved on from there and I am going to ask my noble friend to carry forward a suggestion I made when we had the Statement earlier in the week about the Mental Capacity Act, which I will come to in a moment.

First, I will say something very briefly about autism and challenging behaviour. There is no doubt that there are people with an autistic diagnosis who have comorbidities—they may be learning-disabled or have specifically diagnosed mental illnesses—and they are complex cases. In another place over many years I raised again and again the difficulty for psychiatrists who are dealing—particularly but not exclusively—with adult patients who present with very challenging and disturbing behaviour. However, sometimes when they are seen by psychiatrists with an understanding of and expertise in autism, it is possible to unscramble what appear as perhaps rather obvious mental health symptoms, when in fact those symptoms have an autistic base.

Autism is not a mental illness and very often the challenging behaviour that is presented does not have a psychotic base to it at all. People who work with adults with autism who are challenging will know that, with the right package of support and particularly with the right expertise of the people working with them, all too often you can identify the triggers that create that autistic behaviour. Why? It is actually rather simple: it is because the autistic mind works differently from the way other people think, and rationalisation is a very complex area. I have known of many—and I do mean many—autistic adults who have been held in some form of detention; some voluntarily, some not. When they have been placed in an appropriate setting with professionals who understand what those triggers are and why their often challenging behaviour presents in a certain way, with the right package of support they have been able to live and be supported in the community rather than locked up.

I say to my noble friend, we really cannot keep going round and round in circles, coming back to these high-profile cases where we seem to have learned nothing. I was involved in the Bournewood case with patient P, who was detained in a mental institution, and it was only when his carers went through not just all the courts in this country but to the European Court and got a judgment there that he was allowed to be released—and I use that word deliberately—from his institution when all the expert advice was that he should remain there. We have to do something. This is about fundamental human rights for a group of people who are unable to make the case for themselves. We, as politicians and in this House, have a duty to ensure that the structure is out there for those who represent them—whether they be parents or carers or people professionally appointed as advocates on their behalf—and that those human rights are at the forefront of what happens to them.

As always, I congratulate my noble friend Lord Rix. His work in this field is an exemplar for us all. Today I have written to the chairman of the Joint Committee on Human Rights, Dr Hywel Francis MP, because I have had grave concerns for some time that the Mental Capacity Act, on which I sat on both the pre-legislative scrutiny and the Bill committees in another place, is not in practice supporting the people whom Parliament intended it to support.

I say again to my noble friend that the Care Quality Commission needs to be more rigorous—we hope that we will have learnt lessons from this tragic case—and that the Mental Capacity Act is not doing what it should in terms of parents, carers and, in particular, patients. I also suggest that the deprivation of liberty safeguards are too narrowly defined by the courts and that the whole framework needs to be reviewed, taking account of the way in which the courts implement the framework.

I hope that my noble friend will understand the call not just for the Joint Committee on Human Rights but for the Government themselves to completely review the implementation of the Mental Capacity Act—an Act I thoroughly support. We will not get to the bottom of some of the problems that we are discussing today unless we are prepared to do that.