Transforming Care Programme

Paula Sherriff Excerpts

Thursday 5th July 2018 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

Let me start by congratulating and thanking the right hon. Member for North Norfolk (Norman Lamb) for securing this debate and the Backbench Business Committee for granting the time on this very important issue. As the motion today notes, the transforming care programme was created with the stated intention of improving quality of care and quality of life for children and adults with a learning disability or autism who display challenging behaviours.

As we have heard from Members today, people with learning disabilities too often suffer from neglect, abuse, poor care and even premature death. Unfortunately, as the right hon. Gentleman set out, the transforming care programme simply is not delivering the promised improvements in their lives. Instead, too many are wrongly admitted to assessment and treatment units, in which they remain trapped, rather than living independently where they can be with their families and friends and, of course, the support network that comes with them. The community services that should be part of that support network are themselves underfunded and simply do not have the capacity that is needed. As it stands, the transforming care programme is unlikely even to come close to the ambitions rightly set out in the “Building the Right Support” strategy by March 2019, when it is due to conclude. Let us take, for example, the target to decommission 900 learning disability beds in conventional hospitals. The Minister admitted just this week, in an answer to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), that the Government have not even come close to meeting the halfway point to that target.

Seven years after Winterbourne View and more than two years on from the start of “Building the Right Support” strategy, there has been a startling lack of progress in key areas. There has been little reduction in the number of people in in-patient units and in the number of admissions. Indeed, the most recent data, from May 2018, shows that there are 2,400 people with a learning disability and/or autism in in-patient units, which is an increase since the last monthly data was released. It should be of great concern that the number of children in in-patient units has also increased. The latest NHS Digital data shows there are 250 children in these units, more than double the number of children—110—who were reported as being in in-patient units in March 2015. There are 465 young people aged between 18 and 24 in in-patient units, and this age group makes up a significant proportion of the whole transforming care in-patient cohort. This data suggests that the transition from child to adult services is the point at which people with learning disabilities are particularly at risk of admission, as Dame Christine Lenehan pointed out in her review last year.

As we have already heard this afternoon, the average length of stay in in-patient units has stayed largely the same, at approximately 5.4 years. Similarly, in answers to my hon. Friends Ministers have admitted that discharges into the community actually went down in the last year, and quite significantly so for those with learning disabilities. It is clear that transforming care is not delivering the promised outcomes at this time. Unfortunately, this failure fits the wider picture of neglect for people with learning disabilities and the services on which they rely.

The recent learning disabilities mortality review came seven years after Winterbourne View and nearly three years since the death of Connor Sparrowhawk, which in part prompted it. Its findings show the scant regard with which people with learning disabilities are treated.

[Mark Tami (Alyn and Deeside) (Lab)]

The fact that the risk of people with learning disabilities dying before the age of 50 is 58 times higher than the rest of the population is scandalous in itself.

[Paula Sherriff]

My hon. Friend makes a very valid point. Everybody here this afternoon could not fail to be shocked and horrified by the case outlined by my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) regarding her young constituent, Matthew, and the quality of care that he received on an in-patient unit.

Some 1,311 cases were passed for review between July 2016 and November 2017, but only 103—that is 8%—have finished so far. The report cited a lack of local capacity to review cases, inadequate training for people completing mortality reviews and insufficient staff capacity to complete a mortality review. Will the Minister update the House on when the remaining cases will be finalised and what the Department is doing to ensure that these barriers are tackled? In 13% of cases reviewed, the person’s health had been adversely affected by delays in care or treatment, gaps in service provision, organisational dysfunction, neglect or abuse.

Just how many more deaths must occur before the Government tackle the unjust treatment of people with learning disabilities? Dr Ryan, Connor Sparrowhawk’s mother, was also damning in her assessment. She said that too many agencies had shown “systematic disregard” for some people with learning disabilities and she felt that certain people “simply don’t count” in the eyes of the authorities. We must do better, and we must show that every single life matters. But our fear is that, without some fundamental changes in the Government’s approach, the problem is set to get worse, not better.

Take the NHS workforce, for example. The latest figures from Health Education England show that the number of learning disability nurses working in the NHS has gone down by a third over five years. HEE data from March 2017 shows that learning disability nursing had the highest proportion of vacancies, at 16.3%, compared with all other fields of nursing. Will the Minister tell us how the Government plan to tackle this?

It is bad enough that the failures of transforming care have left too many people inappropriately in hospital settings, but the lack of trained staff when they are there makes that failure all the more stark.

[Dame Cheryl Gillan]

I am with the hon. Lady in her criticisms, and in wanting some constructive developments and improvements, but I would not want her to stay at the Dispatch Box and paint a picture that is completely negative. There are some inspirational stories about people coming out of these settings and institutions after being dealt with by a caring team, who have put a particular emphasis on communications and turned lives around. Some of the case studies published by Dimensions show that that really is one of the ways forward, and that is what we should seek. It is possible to take an aggressive individual out of an in-patient setting and give them the quality of life and meaning to life that we would all want and expect.

[Paula Sherriff]

I thank the right hon. Lady for her intervention. I absolutely agree. There are some incredible examples around the country of excellent work that is being done, but that makes it all the more important that we share that good practice so that it is disseminated more widely. Particularly on this very special day of the NHS’s 70th anniversary, I pay tribute to all those people who are involved in being innovative, and not just doing exactly what they have to and no more.

It is bad enough that the failure of transforming care has left too many people inappropriately in hospital settings, but the lack of trained staff when they are there makes that failure all the more stark. It is also a matter of great concern that the Government are not including people with learning disabilities, or working-age people with disabilities, in the social care Green Paper, but are instead having a “parallel workstream”. Once again, the care needs of people with learning disabilities seem to have been put in second place.

If this catalogue of failure were not enough, the issue around sleep-ins threatens to make it even worse. It has been woefully mishandled thus far. Having admitted that earlier guidance on pay was misleading both for providers and commissioners, Ministers are now playing for time rather than finding a solution, ignoring warnings from care providers, charities, and the Local Government Association. The consequences for people with learning disabilities and autism could be disastrous. Some 70% of learning disability providers have warned that they will no longer be viable. It could drastically reduce the number of providers available to provide community services. For people with learning disabilities, autism or challenging behaviour who are personal budget-holders in receipt of funding from local authorities to pay care staff themselves, this crisis could lead to difficulty in paying their personal back-pay bill and, in turn, having to reduce their level of support to cover costs.

Let me be clear, as a former healthcare worker and trade unionist, that the care workers affected should receive historic back pay for national minimum wage sleep-in shifts rather than paying the price for underfunding of social care. Given the state of the sector, without imminent investment we run the risk of a systemic failure that could leave thousands of people without the care that they desperately need. That is why we continue to call for the Government to reveal the full scale of financial liability and to increase funding for social care so that care providers can continue to deliver services to vulnerable people in need of care and workers can receive the pay to which they are entitled.

A Labour Government would provide care workers with paid travel time, access to training, and an option to choose regular hours. That, of course, comes in the context of proper investment, increasing social care budgets by £8 billion over the next Parliament, including an additional £1 billion for the first year to ease the Tory social care crisis. We have made our alternative crystal clear. Our policy will include all people with care needs, with the aim of ensuring that they can live independently and, most crucially, with dignity.

The question that the Minister must now answer is whether and how this Government can work towards that goal. Will there be a successor programme to transforming care? How will the shift to early intervention, prevention and community care be prioritised and properly resourced, given that what we have now is clearly not sufficient? In the end, this is a question of how we value human lives.