Care Services: Abuse of Learning Disabled

Baroness Jolly Excerpts

Thursday 13th December 2012 Lords Chamber

[Baroness Jolly]

My Lords, I start by echoing the words of the noble Lord, Lord Touhig, in thanking the noble Lord, Lord Rix, for bringing this important issue to the attention of the House. His personal expertise and wisdom have informed the House for many years, and long may it continue.

It is vital that we make public this failure in care and act swiftly to ensure that vulnerable populations in society are treated with dignity and afforded quality, compassionate treatment. Today, I want to touch on a few distinct aspects of this issue. Systemic and, perhaps, societal issues need to be raised. As evidenced by the 11 individuals prosecuted and sentenced for providing shockingly abusive care, the actions taken by these staff at Winterbourne View were criminal. There is no excuse for this appalling abuse. I am pleased to note that the criminals have been brought to justice and that larger investigations into more than 150 other hospitals have not found similar abuse and neglect. However, where were the safeguards within this hospital to identify failures in care and correct them? Where was the management of this organisation in monitoring abuse and establishing the quality of care?

Culturally, I am concerned that this event reflects a fault in how we value our vulnerable populations—those with mental health problems, the disabled and the elderly. Our respect for these populations is apparent in whom we charge to care for them and we undervalue them when we pay little attention to how their carers are trained and managed. However, we do little to respect the ill treated if we do not change the culture of care to prevent these crimes from happening again.

We were all rightly shocked when the BBC “Panorama” programme uncovered this systematic abuse of patients at Winterbourne View Hospital. Vulnerable patients were bullied, pinned down and tormented, not once or occasionally, but systematically. This would be appalling even if this treatment was limited to one staff member. What escalates the abuse at Winterbourne View to a national scandal was the culture of neglect and ill treatment that was fostered throughout the hospital. Even with this widespread negligent culture, the existing accountability safeguards did not detect the abuse.

I see two areas of concern. First, the patients who received ill treatment in the hospital should not have been in the hospital setting to begin with. The noble Lord, Lord Rix, made that point very clearly. Similar stories of misplacement into the wrong care settings have been found all across England, so greater scrutiny must be called for in the determination and monitoring of treatment plans for the vulnerable. In particular, we should explore every option for them to live close to their families and the people who care for them. The provision of less institutional and more local care can be a great safeguard against abuse.

Secondly, the abuse was found in a private, foreign investment-backed firm. As we move towards a system with greater diversity in how health and social care is provided, will the Minister tell the House what oversight is being put in place to ensure that these new forms of care delivery are fit for purpose and free from repetitions of this kind of abuse? In these settings, good management is key to setting the standard for institutional practices. Clearly, there was a failure to lead and train staff effectively and eliminate unacceptable behaviour. In these new methods of care delivery, with less direct government oversight, how can we ensure that management is effective in setting behaviour standards and being held to account?

There is a cultural issue that I would like to raise around training, appraisal and professional development of care staff. Clearly, there was neglect at many levels of the organisation, but in particular I believe that how we value front-line care workers reflects how we value vulnerable populations. The following example has been used before in your Lordships’ House. A very high-profile department store and grocery chain will not let a new employee on to the shop floor without providing basic training on the job in hand and on the corporate culture—and this takes weeks, not days. It is accepted and common practice that staff at all levels are given close monitoring until a probationary period is over and that they are part of an appraisal scheme. This is not overkill; it is to ensure that employees know what they are doing and that employers know what employees are doing and can take appropriate action if there is a problem.

This brings me to registration. I know that the Government are reluctant to regulate for the registration of care workers but, with a large population in all areas of health and social care, the failure to register looks like a failure to value their work. When we start setting a precedent of lower value for these workers, it shows in their professional behaviour. If this vital cohort of workers were part of a registered body, that would send a signal to any companies that see the health and care business as a cash cow. Care workers do a valuable job. They are a resource to be valued and their training is not a cost—something to come off the bottom line—but an investment.

Finally, I applaud the action plan set forth by my honourable friend Norman Lamb. At the same time as we embrace innovative forms of care delivery, we must complement this flexibility with accountability from all levels of care organisations: owners, boards of directors, managers and care workers. We need to stop patients being inappropriately placed in the hospital as their primary care setting and instead design personalised services enabling them to live in communities closer to their families.

Again, I reiterate: how we value care workers reflects how we value the populations they care for. Universal professional standards for care workers should be developed and implemented to create a culture where their work is professionally valued and appraised. We need to know, too, that they will be registered. By moving quickly to implement these reforms, we can make what was a horrible failure in care into an opportunity to prevent its repeat.