Winterbourne View Hospital and the Transforming Care Programme

Esther McVey Excerpts

Thursday 10th June 2021 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate.

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

I beg to move,

That this House has considered the 10th anniversary of the investigation into the Winterbourne View Hospital and the Transforming Care Programme.  

It is a pleasure to speak in this debate with you in the Chair, Ms McVey. I thank the Backbench Business Committee for allocating time for this important debate.

The debate is being held to mark the 10th anniversary of the BBC “Panorama” programme that revealed the scandalous treatment of autistic people and people with learning disabilities in Winterbourne View Hospital. One of the experts on the programme said that Winterbourne View was

“run by a group of bullies for their own entertainment.”

It should shame everyone involved in the healthcare system that it took a team of journalists to uncover those abuses, when complaints from whistleblower Terry Bryan were ignored by the management of Castlebeck, which ran the hospital, and by the regulator, the Care Quality Commission.

I recently re-watched the programme—a decade on, the abuse shown is still shocking. At the time, it was rightly described as “torture”. One resident was showered while fully clothed, and had mouthwash poured in her eyes. On the same day, she had jugs of cold water poured over her head and was kept outside in March until she was shivering. Another resident was asked by a member of staff whether they wanted the staff member to

“get a cheese grater and grate their face off”’.

Residents were slapped and held down under chairs. They had their hair pulled and were pinned down while medication was forced into their mouths. One resident was so distressed by that treatment that she tried to throw herself out of a second-floor window and was then mocked by staff.

That behaviour was the end result of a system that did not see residents as people. Rather than the person-centred support that we would rightly expect in any hospital, a closed culture developed where abuse became normalised. Such abuse should not have been left to be uncovered by a journalist and secret filming. A whistleblower, Terry Bryan, had taken his concerns to the management of Castlebeck, then to the local safeguarding board, then to the Royal College of Nursing and then to the Care Quality Commission on three separate occasions. It was only when all that led to no action that he approached the BBC.

Ultimately, 11 members of staff at Winterbourne View pleaded guilty to neglect or abuse, and six of them ended up spending time in jail. However, Winterbourne View was not just a failure of one hospital or a few staff—although it certainly was that. The people in that hospital were let down by the entire system: from a provider that did not pay enough to attract or retain dedicated or qualified staff and did not supervise or manage them, to a regulator that failed to listen to the concerns of a whistleblower and to commissioners who were happy to put people in that hospital and then fail to monitor the placement or follow up with discharge plans.

Since 2011, residents in other in-patient units have been subject to similar abuse. As recently as 2019, another BBC “Panorama” programme uncovered similar treatment at Whorlton Hall in County Durham. Staff there were filmed verbally and physically abusing residents.

If the residents of Winterbourne View were let down by a system that simply did not place enough value on them to intervene, everyone who has faced abuse in those units since 2011 has been let down by a string of Governments, who have failed to take the action necessary to stop the abuse happening.

The only way we can ensure that there is no abusive treatment in those units is to move autistic people and people with learning disabilities into the community, where they can be given appropriate support to live independently. In 2011, following those shocking revelations, the Government seemed to recognise that, and David Cameron pledged to close all inappropriate in-patient units by 2014—but that was only the first in a long line of broken promises. By 2014, there were still thousands of people detained in those inappropriate institutions.

In 2015, NHS England pledged to reduce the number of people in assessment and treatment units by between 35% and 50% by 2019, but that target was missed, with the number falling only 5%. NHS England then pushed the target back a year, but that was also missed. By April 2020, the number of people in in-patient units had fallen only 15% in five years.

The NHS long-term plan then committed to reducing the number in units by 50% of the 2015 level by 2024, but on the current trajectory that will be yet another target the Government do not get close to meeting. A decade after the abuse at Winterbourne View was uncovered, more than 2,000 people are still detained in inappropriate institutions. As today’s learning disability mortality review shows, people with learning disabilities who end up in mental health units are nearly five times more likely to die young than their peers. The mistreatment people experience in those units stays with them for life, even after they are discharged. On average, people in such units have been detained in some form of hospital placement for more than five years.

What progress we have seen has been painfully slow. We still see hundreds of people admitted to in-patient units every year, and the number of children detained has risen by a third since 2015. We normally talk of admission to hospital being for care or for treatment, but neither of those words is appropriate here, and far too many people admitted to such a unit will have stories of poor treatment and abuse by staff.

Dan was left scarred by poor treatment in in-patient units, which led to him trying to overdose on pills when he was discharged, and then being detained in hospital for another 18 months. Kayleigh was moved from Winterbourne View to another hospital. Within weeks, she had been pushed and hit, and had made more serious accusations against the staff. Ryan was first detained when he was 17. Over the years, he has been isolated and held in long-term segregation. He has been heavily medicated with drugs so powerful that their side effects meant he had to have 18 teeth removed.

Hospital reports show that Ryan has experienced broken bones, and other injuries that sometimes were treated only after a week had passed. Ryan was supposed to be discharged three years ago. He has had an independent case review, which flagged urgent issues with his care. Over the past year, his family have seen their visits restricted and there have been covid-19 outbreaks on his ward. Despite media attention and legal support, Ryan’s discharge plan stalled repeatedly. While things are now looking up for him, hundreds of other people have not been so lucky, and it should not need TV crews and lawyers to get people basic dignity and proper care and support.

People end up in these totally inappropriate units because the funding is not available to support them in the community. One Winterbourne View resident, Dan, had previously been supported at home by a small specialist provider. When it asked for funding for two more hours a day of support so it could manage the triggers that set off Dan’s challenging behaviour, it was turned down. Dan’s family were then told they had no choice but to allow him to be moved to an assessment and treatment unit. That removed him from his home and from his support network. In the unit, Dan was forcibly restrained and ultimately ended up in Winterbourne View. That abusive care cost the Government £3,500 a week—far more than the extra couple of support hours he needed to remain at home.

Clearly, that was not inevitable. After the BBC’s “Panorama” programme, Dan’s family were supported to move him back home. A suitable property was found in his home village and the care staff who had worked with him before he was admitted to Winterbourne View were rehired. Nearly a decade later, he is still living independently in his own home. Unfortunately, such success stories are far too rare.

A similar story is that of a young autistic woman, Bethany, which I have raised many times in the House. She ended up in in-patient units because her local authority said it needed

“a break from paying for her support”.

By sending her to an assessment and treatment unit, it could shift the burden of funding to the NHS. That is the root cause of the Government’s failure to address this scandal over the last decade. If people are moved out of an in-patient unit, they need to be moved somewhere they will be supported. Under our current system, that kind of community support is funded by local authorities, which have had £9 billion taken out of their social care budgets over the past 10 years. Supporting a person with learning disabilities who might have complex needs is not cheap when compared with many other social care packages, so it is not surprising that cash-strapped local authorities have tried to pass the buck on funding to the NHS.

In the 1980s and 1990s, when the long-term psychiatric hospitals were closed, there was a system of dowries whereby the funding moved with the person as they were discharged to a local authority. That discouraged the kind of siloed thinking that sees a person’s human rights denied because a local authority cannot afford to fund the care they need. The Government could have reinstated those dowries. They could have given local authorities far more funding to ensure that they can support autistic people and people with learning disabilities properly in the community. They could have matched the ambition of their rhetoric with the resources that are needed.

Instead, we currently have a £62 million funding pot spread over three years to support people to be discharged. High-quality community support for people moved out of those units can cost as much as £100,000 a year, but even that is much less expensive than placements in private hospitals, which can cost six times as much. That means that the Government’s funding settlement is probably only enough to discharge 200 of the 2,000 people currently trapped in in-patient units. Because the funding only runs for three years, there is a real risk that when the funding runs out, those people will be readmitted to an in-patient unit.

We are not talking about huge sums of money when compared with the expenditure the Government have taken on over the last year. In 2019, the Labour party proposed spending £355 million a year on dedicated and targeted support, which would have been sufficient to move everyone currently in an in-patient unit into their community.

At the same time as discharging the 2,000 people currently detained, we also need to ensure that nobody else is admitted to those units, and we may need legislative measures to ensure that that happens. Underpinning any changes must be the reform of our adult social care system. We are still awaiting the details of that long-promised reform, but perhaps the Minister can tell us more today. Perhaps she can tell us whether the Government’s reform will increase funding so that local authorities can afford to support everyone who needs help to live independently in their community, including autistic people and people with learning disabilities. If it will not, one of the largest issues in our social care system will be left unaddressed.

It is a decade since BBC “Panorama” revealed the appalling treatment of the residents of Winterbourne View. As a society, we could and should have taken that as a cue to say, “Never again,” and to ensure that all autistic people and people with learning disabilities were given the support they needed to live independently in their own communities. Instead, we have had a decade of broken promises and broken targets. Rather than putting in place an ambitious programme of change, the Government have repeatedly promised reform while simultaneously cutting the funding for the very local services that would deliver that reform.

Autistic people and people with learning disabilities trapped in those inappropriate institutions cannot afford to wait any longer. Rather than more empty promises, they need legal changes to end the use of detention. Alongside that, we must see a radical programme of investment in community social care services to support them to live independently in bespoke accommodation, with care packages designed around their needs. We need a new commissioner, independent of Government, to oversee the process of moving people out of those institutions and hold the Government to account if they fail to make the progress that is needed.

After a decade of failure, I hope today the Minister can give autistic people and people with learning disabilities and their families the reassurance that they need and deserve, because it is long past time that we fixed this problem. However slow the progress, there is no excuse for not making sure all the people detained in institutions are safe. That needs to happen now—today. The two most important changes are the proper oversight of community provision, which is centred round choice and personalisation. We need bespoke packages of accommodation and care, not institutions. People can live happily and independently with an environment and support made for them.

[Esther McVey (in the Chair)]

I remind Members that we will be going to the Front Benchers no later than 4.25 pm, and we would also like to hear Barbara Keeley wind up within that time limit.

--- Later in debate ---

[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to speak under your chairmanship, Ms McVey. I join other hon. Members in this Westminster Hall debate by thanking the hon. Member for Worsley and Eccles South (Barbara Keeley) for leading it. The note that I passed to you, Ms McVey, was to apologise and to hope that you had received notification beforehand that I was running from the main Chamber to speak here. I very much hope that that was the case, but I apologise both to you and to the hon. Lady.

I begin by paying tribute to our former friend and colleague, the late Dame Cheryl Gillan, who chaired the all-party parliamentary group on autism and was a long-standing advocate for the 700,000 autistic adults and children and their 3 million family members and carers. I now chair that all-party parliamentary group, but I very much wish that I was sitting here, as I would tend to be in these debates, watching Dame Cheryl and listening to her advocate so finely for all of that community. She will be remembered for her passion, drive and kindness.

For more than a decade, Dame Cheryl worked tirelessly to ensure that Government and Parliament took more account of autistic people and the need to improve the support for them. She began her campaign for an autism Act in England in 2008 to tackle the lack of support for autistic people and to improve the understanding of autism. That landmark law—I think it is quite remarkable that she got it delivered—remains the only legislation aimed at supporting one particular group of disabled people. I am deeply saddened that Dame Cheryl passed away before getting to see the new autism strategy, which is set to be published shortly—I hope imminently. I hope that she would have been very proud of what gets delivered.

Following the passing of the Autism Act 2009, Dame Cheryl campaigned hard on so many of the crucial issues. Even during her illness, she fought hard to take on these issues, ranging from diagnosis to waiting times, teacher training, employment and, importantly, the subject that we are talking about today—health, mental health, and those who feel imprisoned by the system. It is a topic on which so much more needs to be done and, in Dame Cheryl’s memory, I very much hope that it will be.

As other hon. Members have said, it is 10 years since the appalling abuse and neglect of some of the residents of the Winterbourne View home were exposed. There were shocking levels of violence, degrading treatment and taunting. It was a scandal that led to widespread acknowledgement that a significant number of people with autism and with learning disabilities, or with both, were stuck inappropriately in in-patient settings. However, the latest monthly data show that 2,040 autistic people and people with learning disabilities are still in in-patient mental health hospitals, of whom 1,150 are autistic.

That means that since 2015, the number and proportion of identified autistic people in in-patient facilities has actually increased, from 38% to 56%. A lack of appropriate community support and issues with legislation have meant that a growing number of autistic people are ending up in mental health hospitals against their will and that of their families. Once a person has been admitted to an in-patient unit, they will stay there for an average of 5.6 years, and they will be on average over 60 miles from their home.

The National Autistic Society, which provides the secretariat for the all-party parliamentary group on autism, has continued to hear of alarming cases of over-medication, seclusion and unnecessary restraint. That is completely unacceptable in 2021. Autism is not a mental health condition, and hospital is not the right place for the vast majority of autistic people. Hospital wards can be noisy, bright and unpredictable. Without reasonable adjustments to the environment, and without the support of professionals who understand autism and how to adapt these people’s care, wards can be completely overwhelming for them.

For autistic people who are particularly sensitive to sound, light or touch, the experience of being in an in-patient setting can dramatically increase their level of distress and lead to further restrictions, making it even harder to be moved into the community. It becomes a perpetual cycle, unless something breaks that cycle. Even then, there is a challenge in finding the right type of mental health and social care services in the community for autistic people to move into. It is not right that thousands of autistic people are developing avoidable mental health conditions because they cannot access the support they need early on. To end the travesty, there must be commitment and significant investment in better social care and mental health services that work for autistic people.

I am the last Back-Bench speaker, so I will add my list, too, for the Minister for Care. I have worked with her over the years and know that she is absolutely dedicated to this cause. Without wishing to keep her at the ministerial level at which she is, we need consistency in ministerial position to follow this through. I understand that she is setting up a report group to ensure that all those responsible for delivering outcomes do act. I absolutely support the call from my right hon. Friend the Member for Forest of Dean (Mr Harper) that milestones need to be set. I had written that down before he said it, but I had not written down that they should be published. He is right. They should be published not just for us as Members of Parliament to hold the Government to account, but for the Government to hold to account those in the report group who have to deliver, so that there is no hiding place when it comes to what should be done by when. If there is a failure to meet individual timescales, more pressure and perhaps more resource can be added. The Minister will have all our support in holding their feet to the fire.

When will mental health legislation be amended? It will need to be amended. Indeed, it is not just an issue of moving the community from inappropriate settings into appropriate settings. Do we actually have those appropriate settings? Do those milestones include not just the transition but the provision that must be there? I will end there, because we want to hear from the shadow Minister and the Minister, but I very much support all the calls made by Dame Cheryl’s former colleagues that more must be done.

[Esther McVey (in the Chair)]

I thank the hon. Member for Bexhill and Battle (Huw Merriman) for acknowledging Dame Cheryl Gillan and all the work she did in the world of autism. I know we all share that view.

I will now call the Front-Bench speakers, mindful that we do want to hear from Barbara Keeley at the end to close the debate.