People with Learning Disabilities (Abuse)

Fiona Mactaggart Excerpts

Monday 3rd September 2012 Commons Chamber

[Mr Clarke]

I am pleased that the Member in whose constituency Winterbourne View was—I know he has worked very hard on the issue—has intervened, and I am sure that the House will take careful note of what he has said.

Among the abuses that “Panorama” thought important were the following: patients were forced to have showers while fully clothed; mouthwash was poured into a patient’s eyes; a patient had a bucket of cold water poured over her and was forced to sit outside in the cold; patients were dragged along the floor; a patient was repeatedly punched; and a patient was driven to attempt suicide, and was subsequently mocked. That establishes that vulnerable people were tortured for the amusement of men and women guilty of an inhuman and monstrous series of crimes.

[Fiona Mactaggart (Slough) (Lab)]

The thing that struck me about the Winterbourne View case was that the individual incidents of torture meted out to the people who were being assessed there—my right hon. Friend is right to describe it as torture—was the same torture as was meted out to residents in a care home on the border of my constituency, which, like Winterbourne View, had many residents whose families were miles and miles away. Is my right hon. Friend, like me, shocked to learn that the Department of Health has no central register of out-of-area placements of people with learning disabilities? Will he, in the course of his remarks, ask the Minister if he will ensure that we have national figures about where people are sent, miles away from their families who want to protect them, into institutions such as Winterbourne View?

[Mr Clarke]

I am grateful to my hon. Friend. On these matters she shows a great humanitarian understanding, and the very point that she raises was raised with me today by families who came down to London from all over the UK because of this debate. My hon. Friend should know that she has considerable support.

The harrowing examples that are given, and there are many more, of depraved activity that some will inflict on the most vulnerable among us are almost impossible to comprehend. My hon. Friend outlines some of the reasons for that. The courts will deal with those responsible, and that is how it should be. Families of the victims may find solace when the guilty are sentenced, but what of those who seek no vengeance? What of those who take the view that such abuse should never have happened and want to know why it did happen? It is fair to say that we all want to know who was responsible for presiding over this human crisis. How far and how wide does culpability spread?

We cannot erase the evidence of abuse, where and when it happened. We cannot undo the pain, the suffering and humiliating experience endured by people with learning disabilities, and we most certainly cannot leave it to the monolithic bureaucratic machine to ensure that such abuses never occur again. We have completely and unmistakably failed to protect adults in many aspects of their character where we see that their mental capacity is that of a child.

Winterbourne View was operated by a company called Castlebeck Care Ltd, which charged the public purse an average of £3,500 per patient per week for the services that it provided. For that amount of money, a person could stay in the Ritz hotel. For that amount of money, Castlebeck Care Ltd saw a turnover of £3.7 million per year from Winterbourne View. We should know what that money was spent on. We do not know, but the Department of Health should be able to solicit this information and put it into the public domain—again, a point that the parents whom I met today made loudly and clearly. It is only then that a proper, informed judgment can be made of whether the reason for being of those who are providing such services is the pursuit of profit or patient care.

As I said, I met today families who related their own experience. What they told me is that questions and challenges must be addressed to local councils and local health authorities, which have a crucial role. The Improving Health and Lives organisation published a report written by Professor Emerson of Lancaster university, which analysed the Care Quality Commission’s investigations into 150 care providers. Professor Emerson established that only one in seven patients were being supported in an environment that was fully compliant with statutory regulations. He also established that units operated directly by the NHS were more likely to be compliant than those that were out to make a profit. Half the units investigated did not meet those important statutory levels of care.

The Care Quality Commission knew exactly what was going on. Reading through the material, it is impossible not to conclude that its inaction was simply shocking. It presided over the shambolic and chaotic delivery of vital care services. It was appalling when not even lip service was paid to the adherence to statutory regulations or the basic minimum levels of care. Prior to the abuses at Winterbourne View, there were months and months when the commission carried out no inspections at all. Its self-described “light-touch regulation” is part of the reason these abuses occurred. Winterbourne View was inspected only once every two years in the absence of any complaints. Clearly, that is profoundly unacceptable. The commission was also affected by the coalition Government’s civil service recruitment freeze, which resulted in it having fewer inspectors than it clearly required.

Inspectors must increase the pressure in care units that are underperforming. Inspections must occur more regularly and without warning. There must be stiffer penalties for care providers for non-compliance with their statutory obligations. The commission must be relentless when it comes to investigating care providers that cause concern. Of course, as we all know, Winterbourne View was closed down, but how many people know that Castlebeck Care Ltd had two other units closed down as a result of serious concerns about the level of care? The “Panorama” documentary not only exposed Winterbourne View; it laid bare the unbelievable ineptitude of the commission, which was utterly incapable of taking action in all three units before the scandal was exposed. In my view, the new mantra should be, “Inspections will occur anywhere at any time and without prior notice.”

--- Later in debate ---

[Paul Burstow]

My hon. Friend makes an important point and anticipates what I am about to say. The Department’s guidance is clear. People should be supported to live in the community, wherever possible, and only in strictly limited cases should assessment and treatment centres be used. Nowhere in policy or guidance is there justification for long-stay assessment and treatment hospitals. Indeed, the CQC found length of stay ranging from anything between six weeks and 17 years, with five to seven years not uncommon.

The hon. Member for Slough (Fiona Mactaggart) raised the issue of data during her intervention on the right hon. Member for Coatbridge, Chryston and Bellshill. I agree that we need to improve data collection so that we have a clearer picture of what is going on. The painstaking work of the serious case review, Department of Health officials and others to create a clear picture of the system begs questions about the adequacy of data collection for many years.

[Fiona Mactaggart]

I wrote to the hon. Gentleman last week—although, having been a Minister, I suspect that he has not seen my letter—asking him to conduct an audit of out-of-area placements of vulnerable people and to publish the figures on people who are placed a long way away from home. Will he commit tonight to do that?

[Paul Burstow]

What I will rightly do—having been a Minister, the hon. Lady will understand this—is give her the justice of reading her letter and considering properly what she has asked. There is merit in what she has said. There is certainly merit in ensuring that those who commission such services are collecting that information so that they have a clear picture of those who are being placed out of area.

I am more interested in the more fundamental question of the appropriateness of something that is outside of policy becoming a practice and being established as an ongoing practice. My point is that we need to look critically at the system that has allowed out-of-area placement to grow to the extent that it has, which has allowed such abuse to go unnoticed in some places for too long. There is no place for such long-stay institutions detaining vulnerable people far away from home.

Providers, commissioners, regulators and individual professionals all have a responsibility—a duty of care to those on whose behalf they commission services. Last year, in the wake of Winterbourne View, the CQC conducted 150 inspections of other services for people with learning disabilities. It adopted new ways of working involving experts both by profession and experience. Although the CQC found no other cases of abuse like those exposed at Winterbourne View, it is disturbing that half of the services that the CQC inspected revealed evidence of poor quality care that was failing to meet essential care and safeguarding standards. Everyone who is involved across the NHS and social care has a vital part to play in driving up standards.

As I have said, the Department’s guidance has been and remains clear. The interim report sets out clearly the elements of the model of care that we expect to see commissioned. However, that is not always happening on the ground. Those commissioning, or in too many cases, spot purchasing, long-stay assessment and treatment services need to look carefully at what they are doing. Indeed, I can tell the right hon. Member for Coatbridge, Chryston and Bellshill that the chief executive of the NHS Commissioning Board and the Department’s director-general of social care wrote to chief executives and chairs of all NHS bodies and local authorities to highlight the interim report and reinforce their responsibility to improve commissioning.

When I published the interim report in June, I set out five objectives for improving services for people with learning disabilities and behaviour that challenges. Those objectives underpin the 14 national actions set out in the report to improve care and support for people with learning disabilities or autism and behaviours that challenge. Those actions include promoting open access for families and visitors and ensuring that people are involved in reviewing the care that they receive; encouraging the CQC to carry out unannounced inspections at any time of the day and week; working with the CQC and the Department for Education to promote best practice and positive behavioural support and ensure that physical restraint is only ever a last resort, and certainly not a tool of choice as it clearly was at Winterbourne View; improving integration between the NHS and social care by setting up health and wellbeing boards to agree joined-up ways of improving services; and getting a range of national organisations, including the Association of Directors of Adult Social Services, the Royal College of General Practitioners and other royal colleges, the NHS Confederation and the NHS Commissioning Board, to sign up to a concordant setting out the actions that each will be committed to taking forward to deliver the right care for people with learning disabilities and challenging behaviour.

One final action that I commend to the House is our work with the NHS Commissioning Board to improve the use of NHS contracts. When we read the serious case review, it is shocking to see how few NHS organisations used NHS contracts to contract their services. They used Castlebeck’s own contract, which was a poor document. The serious case review is just part of what we need to examine. There is also the NHS review of commissioning that was conducted by the South West strategic health authority, which sets out a number of other actions that are being taken to address failings.

I made it clear when we published the interim report that I would very much welcome feedback on it to ensure that the final report, and the action plan that we will publish alongside it, would be as robust as possible and deliver what Members of all parties wanted. I therefore welcome the report by Mencap and the Challenging Behaviour Foundation. As part of our response, we will consider the role of commissioners and how we can support them in the new health and care system.

In addition to the work that my Department is doing directly in response to Winterbourne View, we are taking a number of other steps to improve the care and support system. For example, we are introducing the first ever code of conduct and national minimum training standards for health care and adult social care support workers. That goes to a point that was made in interventions. That work is being taken forward by Skills for Care and Skills for Health and will ensure, for the first time, that employers and people who provide care understand their responsibilities and roles in delivering high-quality and acceptable care to people who need it.

In July, when we published the White Paper on care and support, we set out plans for measures to increase the availability of appropriately skilled care workers, including by expanding the number of care apprenticeships. The White Paper also made the case for strengthening safeguarding, which is what this debate is fundamentally all about. That is a key priority for the Government.

We are committed to preventing, and reducing the risk of, significant harm to adults in vulnerable situations, while supporting individuals to maintain control over their own lives and to make informed choices without coercion. That is why the draft Care and Support Bill sets out a new statutory framework for adult safeguarding to address some of the defects that have been identified, and key responsibilities for local authorities and their partners in the NHS and the police. It will ensure that safeguarding adults boards exist everywhere in England. The Bill will place all that on a statutory footing for the first time.

I am grateful to the right hon. Member for Coatbridge, Chryston and Bellshill for securing the debate. In learning the lessons from Winterbourne View, I am determined to ensure that the voices of people with learning disabilities and of families are right at the heart of what we do.

The National Forum of People with Learning Disabilities and the National Valuing Families Forum sit on the programme board that I chair, which will oversee progress on the action plan. Both have key roles to play locally and nationally in driving change.

Let me end by making it clear that the Government’s approach to people with learning disabilities is grounded in fundamental principles of human rights, independence, inclusion and choice. There can be no excuses. There is no tolerance of those who abuse disabled people.

The right hon. Gentleman has done the House a service by bringing these matters to it tonight. I look forward to coming back to the House later this year with the final report setting out the actions that the Government will take to stamp out abuse.

Question put and agreed to.