Care Services: Abuse of Learning Disabled

Lord Rix Excerpts

Thursday 13th December 2012 Lords Chamber

Asked By

[Lord Rix]

To ask Her Majesty’s Government what steps they are taking to address the abuse suffered by people with a learning disability as illustrated by that which took place at Winterbourne View care home.

[Lord Rix]

My Lords, first, I should apologise for my limited appearances in your Lordship’s House of late but my wife has been in hospital for some time and returns for major heart surgery at the beginning of January. I am sure your Lordships will understand where my priorities lie after some 63 years of marriage.

I am equally certain that all of us present today will have read the government report about Winterbourne View Hospital, Transforming Care, and will have welcomed the sentiments expressed by the Minister of State in his introduction to the report and in his Oral Statement. The report sets out a strong commitment to prevent abuse happening again and stresses in no uncertain terms that clinical commissioning groups and local authorities must develop services so that people can remain in their communities and not be sent away, where they are at greater risk of abuse. As is the way of things, what is written on paper and what happens in practice is often very different. I urge the Government to remember that the policy on local and personalised support has been in place for years—it is the implementation that has failed. I can only hope that this short debate will underline our agreement with many of the Government’s proposals and reinforce their determination to carry them through, in partnership with others.

The serious abuse suffered by people with a learning disability at Winterbourne View Hospital has rightly shocked the nation. The images broadcast in the BBC’s “Panorama” programme in 2011 and again in October this year have left us angered and bewildered. They have also left many of us astonished that such brutal treatment of extremely vulnerable people did not bring down the full force of the law on the management and board of directors of Castlebeck Care Ltd—the owners of that so-called hospital. Unhappily in this country, under successive Governments, people at the top of organisations who fail in their duties of oversight and accountability seem to escape scot-free, while those lower down the ladder are held to account for their role in scandals. I look forward to seeing proposals in the spring on what the Government intend to do to strengthen the accountability of managers and directors in both public and private providers.

To underline this whole sorry saga, let me tell your Lordships about Simon, whose experiences were written about in Mencap and the Challenging Behaviour Foundation's Out of Sight campaign report. Simon has a learning disability and behaviour that challenges. He spent 15 long months at Winterbourne View, far from his family and the community that he grew up in. During that time he was hit, pushed, abused and tormented. Prior to Winterbourne, Simon had received support locally and lived close to his family. When Simon needed a few more hours of care and support, social services refused. Things got worse for Simon and he was sent to an assessment unit. From there he was sectioned under the Mental Health Act and then sent far away to Winterbourne View. His parents describe the torment of being helpless to prevent this, sidelined by uncaring authorities which did not listen to them or to Simon. With the Care Quality Commission failing to see the signs of poor practice, it took a whistleblower and “Panorama” to expose what was happening. Simon’s story and that of his family brings into sharp focus our failing as a society to care for and support those who are most vulnerable.

Winterbourne View Hospital was a 24-bed institution run by Castlebeck Care Ltd. It was registered as a treatment, assessment and rehabilitation centre for people with learning disabilities. What it became was a place where people remained for significant periods of time, sometimes years, well beyond the time they should have been there for the supposed purposes of assessment and treatment. In that time they were subjected to emotional, verbal and physical abuse.

There are over 1,500 people with a learning disability in assessment and treatment centres, and 3,400 in total in in-patient services. This is far too many. It should rarely be necessary to admit a person to an assessment and treatment unit. In most cases what the person needs is good assessment and support in the place where they are living. However, people are ending up in places such as Winterbourne View because either support services in their local areas are not available or the skills and expertise to support people locally is lacking.

The late and much missed Professor Jim Mansell called these places “dumping grounds” used by commissioners looking for an easy so-called solution for placing some of our most vulnerable people with high support needs. And we should not forget cost. Each person at Winterbourne attracted funding of around £3,500 a week—money that would have been better spent on local support services that are in all likelihood cheaper.

What of the scale of the problem? We might be tempted to think that Winterbourne is an isolated incident, but this is not the case. Following the “Panorama” programme, the Care Quality Commission carried out unannounced inspections of all similar units and a number of social care residential services across the country. Its report in June of this year showed that half of the services investigated were not only failing to meet essential standards around care and welfare but also failing to meet standards around protecting people from abuse. This was a deeply concerning finding, meaning that essential safeguards were seriously lacking in many institutions, placing vulnerable people at risk.

Of course, it comes as no surprise to organisations such as Mencap—of which I must declare an interest as president—and the Challenging Behaviour Foundation. We have been campaigning tirelessly on this issue and our joint report Out of Sight must remain firmly on the Minister’s desk in coming years to remind him of the task ahead.

The action plan in the government report commits to a timetable to review all current placements and, by June 2014, to move all those inappropriately placed to community-based provision. While clear timescales are to be welcomed, the future of vulnerable people in remote institutions seems now to hang on the words “inappropriately placed”. Who will determine this? Will the person with a learning disability and their family have a say? I fear very much that the tendency of professionals, commissioners and public authorities to protect the status quo will win over. We must be bolder. These units must close and no more should be permitted to open by the Care Quality Commission.

I turn now to the Care Quality Commission. The regulator, when inspecting Winterbourne View, failed to spot the abuse that was taking place. Furthermore, its inaction when contacted by a whistleblower was totally unacceptable. However, it has since reacted quickly and purposefully to the scandal, carrying out a comprehensive programme of unannounced inspections. We may not see it often, but the CQC does have teeth. For example, it can refuse to register public and private providers who wish to develop new services that go against national policy and put people at high risk of abuse. The CQC can also deregister high-risk existing services. I want to see the Care Quality Commission using its powers to stop another institution like Winterbourne View ever being established.

Your Lordships may recall that back in the 1980s all the talk, and subsequent action, was about care in the community and the closure of long-stay subnormality hospitals—yet here we are, some 30 years later, still finding that care in the community does not exist for many of those in need of care. Instead, they are transported sometimes hundreds of miles away from their homes and left to rot in what is, in effect, a small, long-stay subnormality hospital. How can central and local government allow this non-care in the community to happen—and at such cost to the taxpayer, too?

What happened to Simon? He is now back living near his family, and loving life again. He is at the residential care home he was in before he was sent away, but the service has been adapted to meet his needs. This has been done by developing a flat for him adjoining the care home, where he lives with his support team. Simon’s package of care costs half as much as it did at Winterbourne View and I know from Mencap, which is working with his mother, that he feels safe and happy. A solution has been found.

Living safely and happily should be the reality for all those with a learning disability and behaviour that challenges, and we must strive to make it a reality. Then, and only then, will the promise of care in the community be fulfilled.