Winterbourne View Hospital and the Transforming Care Programme

Debate between Esther McVey and Baroness Keeley

Thursday 10th June 2021 Westminster Hall

[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.

Oral Answers to Questions

Debate between Esther McVey and Baroness Keeley

Monday 3rd November 2014 Commons Chamber

[Esther McVey]

I will indeed meet my hon. Friend. I congratulate him on all the work he is doing, not just on job fairs in general but in supporting people over 50. He has developed something unique to help people have fuller working lives. I would be delighted to take forward what he is doing. In fact, I have looked at it, the Department now has a hold of it, and we are going to spread it right across the country.

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

In earlier questions on the bedroom tax, it was not mentioned that this unfair charge hits 60,000 unpaid family carers, many of whom are not able to move from adapted homes. They cannot move into work, they cannot take extra hours and they need those additional rooms, which are essential for getting enough sleep to enable them to carry on caring. Is it not about time that we accepted that they should be exempt from the bedroom tax?

Oral Answers to Questions

Debate between Esther McVey and Baroness Keeley

Monday 13th January 2014 Commons Chamber

[Esther McVey]

The hon. Lady is right to bring this matter to the House, and such situations are always difficult, but the room would be allocated to whoever was the main carer of the child. In this instance, that is the mother and that is who we would be looking to. We would not be supporting two sets of rooms in two separate houses, as we are trying to get this housing policy right.

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

May I bring the Minister back to the issue of unpaid family carers of sick and disabled people? She recently admitted in a response to my question that 50,000 or 60,000 of those carers were affected by the bedroom tax. More than 1 million of those carers have given up work to care, and they have nowhere to go to find the money. She has talked about live-in carers, but it is not about that. Will she answer about the 50,000 or 60,000 carers? Will she admit that it was a mistake not to exempt them from the bedroom tax?

[Esther McVey]

What we did is not name absolutely everybody who could have part of the discretionary housing payment. We have allowed discretion for those people who might need it the most, hence it is called “discretionary”, hence it has been trebled and hence we are supporting these people. Obviously, if somebody on housing benefit, or their partner, needs an overnight carer on a regular basis, they would have their spare room subsidy; they would be exempt from this.

Oral Answers to Questions

Debate between Esther McVey and Baroness Keeley

Monday 18th November 2013 Commons Chamber

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

13. What progress he has made on delivering his target of 160,000 Youth Contract wage incentives by April 2015; and if he will make a statement.

[The Minister of State, Department for Work and Pensions (Esther McVey)]

There were more than 21,000 wage incentive job starts up to May 2013. The next wage incentive statistics are due to be released early in the new year.

--- Later in debate ---

[Esther McVey]

I am quite sure that what the hon. Gentleman was reading out was a piece of fiction and I would like to give him the correct figures. The Youth Contract is made up of many component parts. One is wage incentives, and there is a wage incentive for apprenticeships, and another is for work experience. Of the 113,000 people who went on work experience, 50% have a job, and 21,000 have wage incentives, and that figure is rising by 4,000 a month. Youth unemployment has fallen for 17 consecutive months. In the hon. Gentleman’s constituency, it has fallen 35% in the last year. Perhaps he wants to congratulate us on that.

[Barbara Keeley]

I do not congratulate the Government on the level of youth unemployment in my constituency; there are 900 unemployed young people in my constituency and almost 1 million nationally. The system of wage incentives is clearly not working, because the numbers are appallingly low for constituencies such as mine. Is not it time that Ministers stopped being in denial and started doing something radical to help young people back to work?

[Esther McVey]

I would just like to mention Labour’s record: a 40% increase in youth unemployment. What we have done, as I have said, has seen youth unemployment fall for 17 consecutive months. It is now lower than it was at the general election.

Oral Answers to Questions

Debate between Esther McVey and Baroness Keeley

Thursday 20th June 2013 Commons Chamber

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

5. What progress she has made on ensuring equality for disabled people.

[The Parliamentary Under-Secretary of State for Work and Pensions (Esther McVey)]

Our disability strategy, Fulfilling Potential, has been developed with disabled people. Through that we are removing the barriers that prevent disabled people from taking a full part in society. Recent indicators show that disabled people are seeing improvements in key outcomes and reduced inequalities between them and non-disabled people. We will drive that progress further when we publish a full detailed plan next month.

[Barbara Keeley]

The Government have refused to do cumulative impact assessments on their welfare changes, but these were done recently by Demos and Scope for the report, “Destination Unknown”. They found that thousands of disabled people will be hit by four, five or six different cuts to their welfare benefits simultaneously. Does the Minister think the Government have their priorities right when disabled people will be hit by a loss of £28.3 billion of support, while millionaires are enjoying a tax cut?

[Esther McVey]

The hon. Lady raises this point time and again and I have answered it. We do equality assessments on every policy change. A key reform that we have brought in for public sector duty is to ensure that equality is embedded from concept to development to delivery, right the way through. Cumulative impact assessments are not taking place because we have taken advice that they could not give a proper measurement as these changes in policy are being introduced gradually and those would therefore be inaccurate assessments. But we are doing independent assessment throughout to ensure that we are getting these policy changes right.

Oral Answers to Questions

Debate between Esther McVey and Baroness Keeley

Monday 28th January 2013 Commons Chamber

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

13. What estimate she has made of the number of unpaid carers who will lose carer’s allowance as a result of the benefit cap.

[The Parliamentary Under-Secretary of State for Work and Pensions (Esther McVey)]

No one loses carer’s allowance as a result of the benefit cap for, as the hon. Lady may know, the cap is applied to overall household income.

[Barbara Keeley]

What advice would the Minister give to the 5,000 carers who, as the Government’s impact assessment states, will lose an average of £105 a week through the operation of the benefit cap? Is she suggesting that they give up caring, look for work and ask social services to find a care placement for the person they care for? Why have the Government not thought of exempting carers, who do a wonderful job, from the benefit cap in recognition of their unpaid caring work?

[Esther McVey]

I would not seek to tell anybody what they should do. We seek to work closely with people to enable and support them as best we can. We are doing that by trebling the discretionary payment to help people into work, because if they are on working tax credits, they will be exempt from the benefit cap.

Welfare Reform (Disabled People and Carers)

Debate between Esther McVey and Baroness Keeley

Tuesday 18th December 2012 Westminster Hall

[Barbara Keeley]

The Minister is right to comment on carers, but does she see how deeply unfair it is to apply the benefit cap to them? They will lose £105 a week. This stuff about households and the way in which they are defined is just nonsense; 5,000 carers should not lose out.

[Esther McVey]

I will explain to the hon. Lady why the changes have to be brought about. At the moment, there are 1 million spare bedrooms, 250,000 households living in overcrowded conditions and 1.8 million households on the waiting list, so we have a size criterion in the private sector, and we must get this right. We have to support people. We have to work with what we have, and we will introduce the changes because we have to get this right—it has not been right, and the previous Government left it to get into this predicament.

[Barbara Keeley]

rose—

[Esther McVey]

I will not give way.

Work must always pay more than benefits, and that is why we are introducing the cap on the amount of benefits that working-age people can receive. It is not reasonable or fair that people out of work can get an income from benefits that is greater than the average weekly wage for working households. We understand, however, that disabled people face extra costs, and that is why we are exempting from the cap households receiving DLA, PIP or the support component of the employment and support allowance.

It is fair that the benefits system should support people in public housing in the same way as it does those in private housing, but we have made changes to the housing benefit regulations, in recognition of the fact that some people need an additional room for an overnight carer who lives elsewhere. We have also listened to concerns about disabled people living in significantly adapted accommodation, and have announced additional discretionary housing payment funding of £30 million for 2013-14, to cover both that group and foster carers.

Instead of simply cutting money from everyone, we chose the more difficult but principled option of modernising the benefit and focusing support where it is needed most. PIP will be awarded on the basis of fair, consistent and objective assessments, and such assessments are not in place at the moment. The assessments have taken two years to develop. We consulted with disabled people and made key changes as we received their feedback.

Although they are different assessments that will work in different ways, we have learned from the experiences of the work capability assessment—something that the Opposition brought in—and we had to introduce Professor Harrington, who produced recommendations that we are still working through, to get this right. That will enable us more accurately and consistently to ensure that support is targeted at those who face the greatest barriers to leading independent lives. More than a fifth of PIP recipients will get both of the highest rates, worth £134.40 a week, compared with only 16% of those who are on DLA at the moment.