Care Services: Abuse of Learning Disabled

Lord Hunt of Kings Heath Excerpts

Thursday 13th December 2012 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, first, I pay tribute to the noble Lord, Lord Rix, who for so long has been a champion of people with learning disabilities. I always remember the late Lord Carter, who was the Chief Whip a few years ago, advising me that the noble Lord, Lord Rix, always gets his way in the House. That was certainly my experience as a Health Minister and my advice to the noble Baroness, Lady Northover, is to reflect very strongly on the points that he raised. I also very much welcome the maiden speech of the noble Baroness, Lady Kidron, which was excellent. We look forward to her contributing to our debates in the future.

The noble Lord, Lord Rix, made a number of very powerful points about the shocking events at Winterbourne View. He started by drawing attention to the contrast between policy and implementation. I suggest that that gap is what lies behind the unease clearly felt by many noble Lords today. We have had the welcome news from the Government that all current hospital placements are to be reviewed by next June and that everyone there who is inappropriately placed will move to community-based support as quickly as possible, and no later than June 2014. I would have thought that any assessment is likely to mean that many people will need to move to locally-based community care. Like the noble Baroness, I ask whether this is a realistic timetable in the circumstances in which health and social care finds itself at the moment.

We are going to expect a lot of commissioners, yet commissioning has led many people down. It is these commissioners who have been prepared to pay for people with learning disabilities to go miles and miles away from home and who have then forgotten about them. Does the noble Baroness, Lady Northover, really think that the commissioners are in a position to do what is required?

I would also refer to the changes in the National Health Service. I do not think that the primary care trusts can say that they dealt with this matter with any distinction but, my goodness me, what are clinical commissioning groups going to do? Can we be assured either that this is going to be done at a national level—or at least through the local offices of the national Commissioning Board—or, if it is to be done by clinical commissioning groups, that they will have the people with expertise? I am sceptical because there is no sign yet that clinical commissioning groups have people with enough seniority or expertise to do this kind of commissioning.

The noble Baroness, Lady Browning, made an important point about the owners and directors of these private institutions and their responsibilities. I have received a brief from Castlebeck, the people concerned with Winterbourne View, which details the actions it has taken and says that a new board of directors is in place. It also says that the shareholders who owned Castlebeck at the time of Winterbourne View have never drawn a return at any time and have now lost all their investment. However, there are still some serious questions about owner responsibilities. I refer noble Lords to the serious case review, which stated:

“Castlebeck Ltd appears to have made decisions about profitability, including shareholder returns, over and above decisions about the effective and humane delivery of assessment, treatment and rehabilitation”.

The review’s authors also say that,

“the corporate responsibility of Castlebeck Ltd remains to be addressed at the highest level”.

I would be grateful if the noble Baroness could say a little more about how the Government intend to do that. At the very least, will the Government require private companies to name the owners and members of the boards and details of their financial structure before they can be licensed and registered to provide publicly-funded care?

I will not labour the point on the regulation of health and social care workers. This will be the third time this week that the issue has arisen. There was also the Statement on Monday and the debate on nursing launched by the noble Baroness, Lady Emerton, only two days ago. However, persuasive arguments are being put forward for the regulation of these workers. On Wednesday, the noble Earl, Lord Howe, relied on the kind of voluntary registration that he proposed during the passage of the Health and Social Care Act. He also made it clear that the Independent Safeguarding Authority can take action to bar care workers from working in regulated activity. The point is that there are many circumstances where such workers may not have been brought to the attention of the Independent Safeguarding Authority, but may have been dismissed by, perhaps, the National Health Service or an institution and can simply go on to work in another place. We have examples of where that happens. The noble Earl also said—this is in relation to the NHS but it is just as relevant to Winterbourne View—that nurses,

“who are themselves subject to professional regulation … should not be asked to undertake a task for which they are not trained”.—[Official Report, 11/12/12; col. GC 295.]

He also said that healthcare assistants come under the supervision of those nurses. That ignores the strength of the employer as opposed to those healthcare workers and nurses. I accept that regulated nurses clearly have responsibilities, but to blame them for delegating responsibilities to healthcare assistants is wrong and unfair.

My noble friend Lord Touhig made some good points about hate crime and the challenge of care in the community. I want to end on that point. Care in the community has been the policy of successive Governments for more than 30 years. We now have a situation where money is very tight, particularly in local government, but also in the health service. The National Audit Office today signalled some of the pressures in the system. I ask the Minister this question. Do Ministers really understand what is happening on the ground? I do not think they do. They are living, not in a dream world, but one which has no link with the reality, the pressures and the strains. I end, as I started, with doubts about how on earth this change can be made within 18 months when the whole system is under such acute pressure.