Winterbourne View Hospital and the Transforming Care Programme

Liz Kendall Excerpts

Thursday 10th June 2021 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms McVey. I thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for securing this extremely important debate, marking the 10th anniversary of the Winterbourne View scandal. I want to say at the start that the repeated and abject failure to move people with learning disabilities and autism out of long-stay institutions and into the community, following what we saw at Winterbourne View, is the worst political and institutional failure I have seen in my 25-year experience of working in health and social care as a Member of Parliament and before I became an MP. It is essential that we understand the underlying reasons for this failure and what we will do differently so that we can put it right in future. That is what I really want to focus on.

Many hon. Members have spoken about the horrors that the BBC’s “Panorama” programme exposed at Winterbourne View in May 2011, with patients repeatedly abused, pinned down, slapped, soaked with water, trapped under chairs, threatened and taunted by staff. The incidents included a member of staff slapping a resident across the cheek and—forgive me, Ms McVey—saying:

“Do you want a scrap? Do you want a fight? Go on and I will bite your bloody face off.”

A member of staff claimed a resident “loved pain”, and then said to the resident:

“Simone, come here and I’ll punch your face.”

Staff gave a patient cold showers as a punishment, leaving her outside in near-zero temperature, pouring mouthwash in her eyes. Patients were shown screaming and shaking, one trying to jump out of a second-floor window to escape the torment but just being mocked by members of staff.

Straight after the programme was aired, the then Minister commissioned an in-depth review into what happened, the results of which were published on 10 December 2012—a day I remember extremely clearly, as the Government statement to Parliament was the very first time I had spoken at the Dispatch Box as a Member of Parliament and a new shadow Minister. The new Minister of State promised that all patients, 3,400 in total, would have their placements reviewed by June 2013, and that everyone who was there inappropriately would be moved into the community no later than June 2014. This was followed by the Government’s transforming care programme, which aimed to close up to half of in-patient beds by June 2014.

June 2014 arrived; the Government had failed to deliver. There were still 2,615 people in in-patient units, including 148 children. Sir Stephen Bubb was commissioned to do another review, which was published in November 2014. As a result, NHS England announced a three-year closure programme called building the right support. This had a slightly reduced target of reducing the number of in-patient beds by between 35% and 50% by March 2019. March 2019 arrived; the target was once again missed. The Government had missed even the more modest target of a 35% reduction. Instead of trying to really get to grips with the cause of the failure, the target was downgraded again, from between 35% and 50% to just 35%. Surprise, surprise: a year later and even the downgraded target was missed.

The grim reality is that there are still 2,040 people with learning disabilities and autism in in-patient units, including 215 children. The average length of stay is over five and a half years, and 355 people have been in these units for at least 10 years. Unbelievably, after everything that has happened, there has been little if any change in the number of people being admitted into in-patient units each month, when, as many hon. Members have said, one of the key priorities must be preventing people from going into hospital in the first place.

Far from closing large-scale units, the Government are opening new ones. Last year, a new 123-bed medium-secure unit, including 45 beds for people with learning disabilities and autism, was opened by Mersey Care NHS Foundation Trust. Mersey Care also got planning permission to build an additional 40-bed unit, going against the Government’s own recommendations. Report after report has shown continuing unacceptable treatment in these long-stay institutions. In one month this year—just one month—3,390 restrictive interventions were used, by which we mean physically restricting people or restricting them with chemicals—drugging or isolating them. In reality, that is a massive underestimate because, scandalously, we have data for only 31 of 56 NHS providers, and for one of 16 private providers. I have one question that I hope the Minister will answer: why is providing that data every month not a requirement for every provider in this country and will she consider making it available a requirement of Care Quality Commission registration?

The latest target set out in the NHS long-term plan is to deliver a 50% reduction in in-patient beds by March 2024, but unless we are clear about why the Government have failed to achieve anywhere near that over the past decade and what we are going to do differently, we cannot have confidence that things will change.

It is my view that the first reason for that failure is simply that this has not been a political priority. I am singling out not the current Minister but Ministers over a decade who have failed to grip the issue, failed to make it one of the repeated, unmissable priorities for the Department of Health and the NHS, and failed to secure the funding that the NHS and local authorities need to shift the focus of services fundamentally towards prevention and co-ordinate support not just between the NHS and local authorities but with housing and other community services. Will the Government consider the recommendation of the Joint Committee on Human Rights to set up

“a Number 10 unit, with cabinet level leadership… to ensure reform is driven forward”?

If we do not change that, we will not have that leadership in place.

Secondly, there are institutional failings. It is just too easy for services to keep doing the same thing—commissioning large-hospital services—rather than the difficult work of individual, personalised support in the community or at home. We do not have the financial incentives in place, or the accountability mechanisms, to do things differently. Mencap says that in my own region, the east midlands provider collaborative, which commissions these services, includes some of the very private providers that have been shown to have poor records of care. How is that allowed and who is responsible?

Thirdly, and I really believe this is the key to change, we have failed to put families at the heart of the process and not just to listen to their views but put them in the driving seat of change. There are many ways to do that, but I know, and I have seen, that one of the most powerful ways to get that change is personal care budgets given to families and developed in partnership with the services. The average cost of a weekly stay in an in-patient unit run by the NHS is £3,000. If we gave families greater control over that money, I bet they could find a better way to spend it on care for the people they love.

Last but by no means least, one reason why people with learning disabilities and autism and their families believe change never happens is that they feel they just do not matter, are not important enough, and are out of sight and out of mind. As Members here know, what has happened in those in-patient units is part of a much wider pattern of unacceptable inequalities in access to services and in health outcomes for people with learning disabilities and autism. For example, women die 18 years earlier than the average and there are much worse health outcomes in a range of areas.

I am afraid that with covid-19, and despite initial claims they were at no greater risk, people with learning disabilities and autism have death rates six times higher than those for the rest of the general population. Changing that requires concerted action across the board. We need to change how we train health and care professionals, and ensure absolute clarity at every level about who is responsible for change and how they will be held to account. The trouble is that this is everybody’s and nobody’s problem. That is why we cannot get change.

I say all that to be constructive. The Minister knows that I want to solve problems, not just criticise. I would be happy to meet with her and the families and providers, as well as her officials, to see whether we can put in place a more effective plan of action. I ask her one thing: can she tell me what the Government and NHS England now propose that is different from the proposals of 10 years ago, five years ago or one year ago? From what I have read, there is no difference. The trouble with that is that we will get the same result. That is not good enough for people with learning disabilities and autism and their families.