In-patient Abuse: Autistic People and People with Learning Disabilities

Jim Shannon Excerpts

Tuesday 18th April 2023 Commons Chamber

[Barbara Keeley]

I thank the right hon. and learned Gentleman for his intervention. That is very much the sentiment I will be expressing in this debate tonight, but I would go further and say we cannot just accept continual targets. I will remind Members that the original target was to reduce to zero the number of people in inappropriate in-patient units, and I shall say that that is the target we should get back to.

As I said, I would like to begin with the experiences of two young autistic women who were detained in in-patient units commissioned by the NHS. Their stories were told recently in a powerful Channel 4 “Dispatches” programme, on which they and their families spoke with immense bravery about the abuses they faced. I encourage all Members to watch it.

Amy is a 22-year-old autistic woman who was, until recently, detained at the Breightmet Centre for Autism in Bolton, run by ASC Healthcare. The unit is supposed to provide care tailored to the needs of autistic people that would not be available on a general psychiatric ward. While she was detained at the Breightmet Centre, Amy said that her eating disorder actually worsened and that “it’s all about punishment”, not treatment. Amy reported that not a day went by when staff members did not use restraint and that the threat of violence was used to make patients conform. She said:

“They’ve chucked me about…they will nip you, they have pulled my hair out, they will push your wrists down. When I tell them it hurts they do it more”.

After staff at Breightmet were told that Amy had spoken out in the Channel 4 documentary, they took her phone away from her. When she got it back, she sent photos of dark bruises covering her arms.

Amy was moved to a different hospital and the Care Quality Commission has taken further enforcement action against the Breightmet Centre, stating that

“if there is not rapid, widespread improvement”

it

“will start the process of preventing the provider from operating the service.”

The CQC reports there are still 12 patients at the Breightmet Centre, and I am deeply concerned that they may be having similar experiences to the abuse suffered by Amy. It should not have taken a TV programme for the CQC to take action, because the Breightmet Centre has been placed in and out of special measures since 2019. Amy had to return there even after the CQC rated it as inadequate in 2022—it was rated not safe, effective, caring or well-led.

Danielle is another young autistic woman who told her story to the Channel 4 “Dispatches” programme. Like many autistic people admitted to in-patient units, Danielle has spent not weeks or months but years detained. In one unit she was 320 miles away from her family. Her mother Andrea reported that Danielle had lost half her life—13 years—spent in hospital in-patient units. While she was held at the Littlebrook Hospital in Dartford, Danielle was placed in solitary confinement for 551 days—more than 18 months. She was locked in a room with just a mattress on the floor and drugged heavily. According to the UN’s special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, confinement lasting for more than 15 days and lacking meaningful engagement constitutes torture. Danielle endured that for 551 days, a punishment not even inflicted on violent criminals. Yet Kent and Medway NHS and Social Care Partnership Trust paid to impose that treatment on a young woman whose only offence was to be autistic in a society that does not understand or support that diagnosis.

Solitary confinement in those units is so commonplace that data on the practice is collected and published by NHS England and broken down by the kind of restraint used, from chemical injection to prone physical restraint and seclusion. From those datasets we can see that more autistic people and people with learning disabilities are held in solitary confinement now than three years ago. That is a failure of care, and people such as Danielle are paying the price.

Danielle’s story gets even worse. Her mother Andrea told the “Dispatches” programme that during her stay at Littlebrook Hospital, Danielle was taken by staff members to areas away from cameras. She was then molested and raped. That is no isolated incident. Further investigation by the “Dispatches” team found that 18 reports of sexual assault and 24 reports of rape at Littlebrook Hospital were made to the police between 2020 and 2023. No charges have been brought in any of those cases to date, including Danielle’s case. The programme later showed Danielle on a ward in a general hospital being surgically fed through a tube, because she is now refusing to eat. Danielle’s mother said:

“After 13 years of trauma and neglect, she can’t see an end to it, so she’s been starving herself. She just wants this to stop.”

As the Minister hears these stories and listens to the words of those parents speaking out, I wonder whether she really believes that the right support is being given to autistic people. I hope that she can pledge action to help Danielle. I understand that Danielle needs housing so that she can move back to the community with support. Will the Minister look at her case, to avoid Danielle being shifted from facility to facility? Her life seems to be at risk. I have discussed the case with the family’s MP, the hon. Member for Maidstone and The Weald (Mrs Grant).

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Worsley and Eccles South (Barbara Keeley) on bringing this subject forward. She has outlined two tragic and poignant cases, and I commend her on the respectful way that she has done so. In Northern Ireland, the Muckamore inquiry recently brought to light the abuse of people in care. I had a mother in my office whose heart broke when it happened to her child. Some 2,045 people are detained in in-patient settings, and a lot of families only want the best for their loved ones. Does the hon. Lady agree this problem does not just pertain to the individual but affects the entire family circle? That is the wider aspect that we need to look at.

[Barbara Keeley]

I very much agree. What the hon. Gentleman says is true; I have seen many reports from Muckamore and I know that there are similar issues. It is desperate for the parents and the families because they rightly sought help for their children, but they ended up being abused and their lives are ebbing away—particularly those with eating disorders, who are not getting the support that they need.

The truth is that the abuses experienced by these two young women have been mirrored in similar scandals across the country. There was a toxic culture of abuse at the Edenfield Centre, revealed by BBC “Panorama” last September. There were the preventable deaths of three adults with learning disabilities held at Cawston Park hospital, who were subjected to torture and neglect, including the appallingly named “crucifix restraint”. At Cygnet Yew Trees hospital, staff members were arrested after reports that they kicked, slapped and dragged around the autistic women and women with learning disabilities being held there. Before that was the BBC “Panorama” exposé of the scandal at Whorlton Hall, which I cannot discuss in any detail due to ongoing legal cases.

All those reports were preceded by the scandal at Winterbourne View, revealed by BBC “Panorama” in 2011. Members will remember the scale of the outcry when that programme was broadcast. There was a feeling then that something might change. I remind the Minister that the coalition Government actually committed to closing all inappropriate in-patient beds for autistic people and people with learning disabilities by 2014.

At one time, reports and investigations into the scandals gave rise to the hope of change, but despite the relentless efforts of journalists, charities and activists, the criticisms reported in the CQC’s inquiry into Winterbourne View all that time ago are as true today as they were 12 years ago: there is a

“systemic failure to protect people or to investigate allegations of abuse”.

Each of the scandals I have outlined across the decade, from the events at Winterbourne View to those at the Edenfield Centre, shows striking similarities. I encourage Members and the Minister to read the safeguarding adults review on Whorlton Hall and to decide whether anything has changed since the inquiry into Winterbourne View, despite all the promises of action.

More recently, we seem to have entered a phase of total apathy. Each scandal that hits national TV or the press results in a more muted and defensive response from the Government. As calls to address repeated failed targets grow more desperate, less and less appears to be happening to rectify the situation.

In February, NHS England quietly published a report analysing 1,770 individual reviews of the care of autistic people and people with learning disabilities, including children, who were detained in in-patient services. The report was commissioned following the tragic deaths of Joanna, Jon and Ben at Cawston Park. It found evidence of high levels of restrictive practice, that people’s medication was not always reviewed in a timely way and that more than half the people were being detained a long way from home. Most concerningly, the report found that 41% of people did not need to be in hospital at all. NHS England stated that many people could not be discharged because there was no adequate care provision in the community and because staff did not always have the training necessary to support people’s transfer from hospital. These findings are a deplorable indictment of the Government’s failure to act.

We are now 13 years on from the inquiry into Winterbourne View and not a single Government target to reduce the use of in-patient beds has been met, as referred to by the right hon. and learned Member for South Swindon (Sir Robert Buckland) in his earlier intervention. After the coalition Government’s ambition to close all in-patient beds by 2014, a succession of watered-down targets have been announced over the years, none of which has been met. As the right hon. and learned Member said, the goal is now to close 50% of in-patient beds by March next year, but it looks impossible for the Government to meet even that much-delayed target. The latest data indicates that bed numbers will reduce not by half but by around only a quarter in 2023, compared with the 2015 benchmark.

Over the last three years, even the meagre progress made earlier has stagnated. The number of autistic people and people with learning disabilities in mental health hospitals has actually increased since the publication of the Government’s Building the Right Support action plan last July, which was meant to drive cross-Government action.

There is also a problem with the data itself, whereby data for past months is retrospectively amended, sometimes by quite large margins. That makes it difficult to understand with any accuracy how many people are being detained. Getting the data right really matters. When the risk of abuse is as high as the evidence suggests, it is a dereliction of duty to have so much variation in data collection. How are the Government supposed to measure progress when the targets keep shifting?

A similar story can be told when it comes to financial investment in the Building the Right Support agenda. The Government’s own review from last summer stated that

“the limited ability to analyse financial data…to provide a national perspective is a significant barrier to the effective oversight and management of the BtRS programme overall.”

An answer to my written parliamentary question confirmed that the Department of Health and Social Care did not hold data on how much money had been spent on developing community services for autistic people and people with learning disabilities, either since 2015 or since the Winterbourne View scandal in 2011. The data that was provided instead of the data I asked for showed that investment in community services had actually fallen between 2021-22 and 2022-23, from £62 million to £51 million, and that funding for discharging long-stay patients has remained frozen, despite the fact we now have rocketing inflation, meaning soaring costs to providers. That financial picture is clearly unacceptable.

In her response, the Minister may want to point to the draft Mental Health Bill. While the draft Bill includes some provisions to address the detention of autistic people and people with learning disabilities, concerns have been raised by charities that the Bill must be significantly strengthened if it is to achieve its aims. There are also concerns that the Bill will take years to come into force and will not end the scandal on its own, without urgent investment in both social care and mental health services.

In the meantime, last year’s Building the Right Support action plan is woefully inadequate. Not only was it published a full 11 years after Winterbourne View, but it is vacuous, it is unambitious and it has been derided by organisations working in the sector. I believe that to call it an action plan is absurd. Instead of a fully funded strategy for caring for people at home rather than in hospital, the Government have established the Building the Right Support delivery board, which is responsible for monitoring the commitments in the Building the Right Support action plan. After so many years of allowing mistreatment to continue, it seems pathetic that the best system of accountability the Government can come up with is a delivery board that I have discovered has met for only six hours in the 22 months since it was established.

We know from more than a decade of reports and evidence that investment in social care, in community support and in the workforce is critical to reducing the number of autistic people and people with learning disabilities who are detained in inappropriate in-patient settings. However, the Government have just announced that they are halving the already pitiful £500 million budget for the social care workforce for the next three years. I believe that that will have a severe impact on a workforce who are already overstretched and are operating with a vacancy rate of 11%. I ask the Minister what assessment her Department has made of the repercussions that the cut to the social care workforce budget will have on the quality of care.

I could go on listing the repeated failures of successive Conservative Governments to do anything about the matter. The fact is that well over 2,000 autistic people and people with learning disabilities are still being held in inappropriate in-patient units. Approximately one in 12 are being held in units rated inadequate by the CQC. Some 40% have been there for more than 10 years. Fewer than ever have a planned date of discharge. Many people are being detained far from home. The risk of abuse is shockingly high, as we saw in the cases highlighted by Channel 4’s “Dispatches” programme, yet at every turn Government Ministers have lacked any humility. Nor have they made any apology for their abject failure to get a grip on this national scandal.

I hope the response this evening will be different. Will the Government now finally stop choosing to ignore the issue? Will the Minister instead offer assurances that her Department will take urgent action to end the inappropriate detention of autistic people and of people with learning disabilities, which is destroying the lives of so many people detained and their families?