To ask the Secretary of State for Health if she will make a statement, pursuant to her written statement of 6 July, on the timetable for implementing the national recommendations contained in the joint inquiry into the position of learning disabled services at Cornwall Partnership NHS Trust by the Healthcare Commission and the Commission for Social Care Inspection.
Let me begin by apologising, on behalf of the NHS, to the vulnerable people in east Cornwall who have suffered from individual and institutional abuse, and to their families, who have shared their distress.
As I told the House in my written statement on 6 July, the Healthcare Commission and the Commission for Social Care Inspection recently published a report of their investigation into abuse at the Cornwall Partnership NHS Trust. I fully accept the conclusions and recommendations of their report, and have already agreed to the immediate application of special measures.
The failings identified by the two commissions are horrifying. People with learning disabilities are entitled to be treated with the same dignity and respect as every other member of the community. Abuse of those particularly vulnerable people is absolutely unacceptable and I am determined both that matters should be put right in Cornwall and that lessons should be learned nationwide, where necessary.
In 2001, our White Paper “Valuing People” set out the principles of rights, independence, choice and inclusion for people with learning disabilities. Had those principles been followed in practice in Cornwall, then of course the abuse would never have happened.
Action has already been taken in Cornwall. An external team was appointed in October 2005 to start improving services. Disciplinary action was initiated against seven members of staff, five of whom have been dismissed. More than 200 community care assessments have now been completed for everyone using the trust’s services. However, more is still required.
The special measures now being taken include an external independent review of the board’s membership and workings. They also require the external team to remain in place in the trust for a further 12 months to oversee the necessary transformation of the service.
It is not only Cornwall Partnership NHS Trust that needs to take action. The North and East Cornwall primary care trust is shortly to be joined with the West of Cornwall and Central Cornwall PCTs to become the Cornwall and Isles of Scilly PCT. Along with Cornwall county council, those PCTs are responsible, as commissioners of the services involved, for ensuring the highest possible standards of care. They signally failed to do that.
As we said in the White Paper “Our health, our care, our say” in January:
“We expect PCTs to be robust in their management of services that do not deliver the necessary quality. Where there are deficiencies in service quality, PCTs will be required to set out a clear improvement plan”,
“may include tendering for the service where standards fall below those expected.”
Let me make it clear that unless, in the very near future, fundamental improvements are seen in those services in Cornwall, I expect the new PCT and the county council to look to other providers, in line with the White Paper principles, to ensure that they discharge their responsibility to those vulnerable people.
We are also considering the implications for learning disability services across the country. The commissions say in their report:
“While we accept that there may be other pockets of poor practice found elsewhere in the country, this does not excuse poor practice at the trust and, in our view, the extent of unacceptably poor practice in Cornwall is unusual.”
None the less, I strongly welcome and endorse the Healthcare Commission’s decision to conduct a national audit of services for people with learning disabilities. My Department is working with the Healthcare Commission and the Commission for Social Care Inspection in developing that national audit, which will assist in addressing national recommendations; for example, it will check that services are properly registered under the Care Standards Act 2000, where required by law. The audit process will be tested on three sites in September this year and will then be implemented nationally from January 2007.
Let me stress, however, that there is no need to wait for the conclusions of the national audit, necessary though it is. If any service user or their family, any professional or member of the public believes that abuse is going on in any setting elsewhere, they should come forward now. Any allegations will be fully and properly investigated.
I shall be asking strategic health authority chief executives to take immediate action to ensure that NHS bodies that provide services in a housing association, voluntary or charitable sector are registered with CSCI and, if they are not, that they apply for registration immediately.
As I said in my written statement, my Department is already taking other steps to provide additional safeguards for the protection of vulnerable adults. The Safeguarding Vulnerable Groups Bill is currently going through Parliament, and will assist in responding to the national recommendations for safeguarding vulnerable adults. In particular, it will ensure that unsuitable people are not employed by the NHS in future. We have also issued statutory guidance to directors of adult social services, stressing their responsibility for ensuring that local arrangements for safeguarding vulnerable adults are working effectively. We will have further discussions with the Healthcare Commission and CSCI to ensure that, if necessary, regulatory arrangements are strengthened so that that learning disability services are properly inspected everywhere in future.
What happened in Cornwall was shameful and must not be allowed to happen again. But the situation in Cornwall should not be allowed to cast a shadow over the excellent services provided for many adults with learning disabilities by thousands of staff—in the NHS itself, in social care services and in the private and voluntary sectors. Many people and their families are immensely grateful to those staff for the care and support they provide. While thanking those staff for the services they provide, I underline to the House our determination to take the necessary steps, both locally in Cornwall and nationally, on the basis of the reports that have been presented.
I thank the Secretary of State for her statement, and on behalf of my constituents, particularly those affected, I thank her for her apology on behalf of the NHS.
People all over the country, as well as many of my constituents and the House, will be deeply concerned to learn of the unacceptable treatment of individuals with learning disabilities, and to learn that although those abuses were reported, action was not taken by the trust management in response. It is entirely right that we have the opportunity to discuss these matters on the Floor of the House, and I am sorry that the Secretary of State did not choose to do so of her own volition, bearing in mind the seriousness of the findings.
It is important that every effort is made to ensure that the physical, mental and financial abuse of vulnerable adults with learning disabilities, such as has been reported at the Cornwall Partnership NHS Trust, can never be allowed to happen again—in Cornwall or anywhere else in the country. The national recommendations in the report will go only part of the way to achieving that—
Has the Secretary of State assessed how many NHS bodies will be affected by the national recommendations contained in the report? How long will they take to implement? What proportion of those providing services for the learning disabled are currently not in compliance with the recommendations? What are the cost implications of the recommendations for NHS bodies and local authorities? Despite existing budgetary pressures, both Cornwall county council and the primary care trust are facing additional unanticipated expenditure of roughly £2 million each this financial year.
In addition, will the Secretary of State please look again at the inspection system? The Healthcare Commission found terrible levels of abuse in its inquiry, but failed to pick up any of those problems in its two previous inspections of the trust, which covered the same period and which resulted in the trust being awarded three stars and two stars respectively. Does she agree that that points to failings in the inspection system that are not covered in the report’s recommendations? They must be urgently addressed. How could the management failings go unnoticed in those inspections, and why was the widespread abuse and mismanagement not dealt with on those occasions? Although registering with CSCI will ensure that minimum standards are met in relation to homes and domiciliary care, without performance indicators, the treatment of adults with learning disabilities will not be integrated into the strategy—
Order. We have to bear it in mind that the House has other business. I agree that this is an important matter— I would not have agreed to the urgent question otherwise. However, if there are any other supplementary questions, the hon. Lady must write to the Secretary of State.
On the first group of questions that the hon. Lady asked, the Healthcare Commission said that it believed that the situation was unusual—not only in relation to the extent of the outrageous abuse that was taking place, but in the sense that, although the NHS trust claimed to be offering treatment and assessment services, it was actually providing something in the nature of a long-stay residential home that, if it was going to provide services, should have been registered with CSCI. We will not know until we have conducted the national audit whether there are other organisations in that unusual position or others not in compliance with the national recommendations. At this stage, we have no reason whatsoever to think that the situation in Cornwall is replicated in large numbers of organisations in other parts of the country.
The hon. Lady asked why the failings were not picked up earlier in inspections by either the Healthcare Commission or CSCI. That matter is addressed, in part, in the report of the two organisations. In part, there is the rather unusual structure of the trust and the fact that, after the earlier merger of the provider trusts, responsibility for learning disability services was not passed to the social services department of the county council, as it was in most other parts of the country. My hon. Friend the Under-Secretary of State for Health will discuss that matter further with the two commissions.
As for why the management failings went unnoticed and the complaints in 2001 and 2003 were so inadequately dealt with, that comes down to issues about board governance. In line with the Healthcare Commission recommendation, we will now review that matter by means of the external independent review of the board’s operation that we will be commissioning very shortly.
The police are involved in looking at the cases. The cases of 40 vulnerable adults have now been referred to the team responsible for protecting vulnerable adults. The police are part of that team and therefore they will make the necessary investigations. Other cases involving irregularities in the handling of service users’ money have already also been referred to the police. At this stage, obviously, I cannot say whether proceedings will follow, but certainly the police are involved.
I share the Secretary of State’s sense of concern and outrage at the extent of the abuse disclosed at the Cornwall Partnership NHS Trust, particularly given that in so many places across the country—such as Meldreth Manor in my constituency, where Scope is looking after young people with profound learning disabilities—such considerable care and quality of care is given to those with learning disabilities. She responded to a number of questions. The report made some particular recommendations that bear on the national circumstances and were designed not simply to buttress the process of inspection and the audit that is to come next year, to which she referred, but to try to build some of the principles of valuing people into the care that is given to those with learning disabilities. May I just ask a few questions about those?
First, one of the things that are rather disturbing is quite how far away from home people with learning disabilities live, which is on average 74 miles, but in some cases up to 300 miles. What steps can be taken soon to try to reduce how far people with learning disabilities are from home?
Secondly, the debate on the Safeguarding Vulnerable Groups Bill has disclosed that whereas it was originally intended that the IMPACT computer system to enable the exchange of data between agencies would be in place by 2007, it will not be in place in full until 2010. Will the Secretary of State say whether she, or indeed the Home Office, which leads on this, will be able to improve on that, because the delay might have serious implications?
Thirdly, one of the important recommendations in “Valuing People” back in March 2001 was that everyone with a learning disability should have received a
“Health Action Plan by June 2005.”
Will the Secretary of State say whether that has indeed happened? If it has not happened yet, when will it have happened?
Finally, a recommendation in the latest report was that the supported living fund should be paid to individuals and managed locally. The Secretary of State said that she accepted all the recommendations, but that had no timetable attached to it. Will she thus attach a timetable to that important recommendation as well?
The hon. Gentleman raises an important point about the distance that many people with learning disabilities live away from home. That is very much a matter for commissioners. As primary care trusts and social services authorities review services, in accordance with the White Paper principles, they should take that into account. In some cases, there might be good reasons why people are living a considerable distance from home—for instance, so that they can get the services that they need—but clearly being so far away from their home and family is likely to increase their vulnerability to poor services, or even abuse. I would expect commissioners to take that issue into account when considering whether more services need to be provided locally for this particular group of people.
The hon. Gentleman asks about the exchange of data between agencies. I am aware that there are various difficulties in ensuring that the barriers to exchanging data are removed. I will write to him with further details of the progress that we are making on that point.
The hon. Gentleman asks about health action plans for people with learning disabilities. I understand that some areas have put those in place for all people covered by the recommendation. However, that is not the case universally, and, again, it is something that commissioners and health providers need to consider.
The hon. Gentleman referred to the recommendation about the supported living fund. I would add to that the work that we are already doing following the January White Paper on extending individual budgets and direct payments, which is already giving many adults with learning disabilities much more choice about, and control over, where they live, what kind of support services they have, and who provides those services. Those features were almost wholly absent from the experiences of the people in Cornwall. All those issues and others will be considered in more detail by the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who will be leading a high-level group in the Department of Health to ensure that the recommendations are implemented and that we follow up to ensure that this does not happen again.
We must all be concerned when we become aware of widespread institutional abuse. Part of the problem was that the Healthcare Commission realised that it had to involve CSCI. Does the Secretary of State agree that the sooner the two bodies are merged, the better, so that other people will not fall through the gaps in inspection? Does she also agree that it would probably be a good idea to increase the number of unannounced inspections because that could more easily pick up some of these problems? Most importantly, will she ensure that those who are accused of malpractice are not placed in a situation in which they are investigating themselves, because that happens far too frequently?
Finally, it took five families working with the help of Mencap to highlight the situation. What chance does she have of reassuring a single family that its voice will be heard and that we will not be in a similar position in the years and months to come?
We have announced our intention to merge the Healthcare Commission and CSCI by 2008. In the meantime, however, the two organisations are working together much more closely, and we will continue to ensure that they do so in anticipation of the merger and, indeed, even before that takes place. The hon. Lady is quite right about the desirability of unannounced inspections. As the Healthcare Commission and CSCI operate on the principle of better regulation, they have already ensured that their inspections are based on a proper risk assessment, complemented by both random and unannounced inspections to pick up problems.
The hon. Lady referred to the problem, which was particularly prominent in Cornwall, of people investigating complaints about matters for which they were responsible or in which they had colluded. That is completely unacceptable, and it should be standard good practice for the board of any trust that provides services to ensure that complaints are investigated. When they are investigated internally, that should be done by someone who is not implicated in the matters to which the complaint relates. As for ensuring that proper attention is given to complaints even from a single user or family, we have already taken steps to strengthen the NHS complaints procedure. From my own constituency experience, I have been impressed by CSCI’s response to concerns—for example, about the treatment of a vulnerable elderly person—raised by one family, and by the way in which it has looked at the situation in the care home or whatever is the subject of complaint. We certainly need to ensure that the voice of the most vulnerable people in our community is heard by the staff who look after them, by the board responsible for the organisation that employs those staff, by commissioning organisations and by the regulators. As Members of Parliament, we can assist with that process, but we must ensure, too, that the regulatory and complaints system is as it should be, and that is what we are doing.
People both inside and outside the House will be shocked by those appalling events, none more so than people in Cornwall. While there were terrible shortcomings at a local level, the Minister will accept that the inspection regime, which should have guaranteed that those individuals’ interests were well protected, failed. Can she confirm that there will be an immediate step up in unannounced inspections so that that can never happen again for such a long time without it being picked up? Finally, will she reflect on the fact that while appalling events have taken place, nationally and, indeed, in Cornwall, many people caring for individuals with learning disabilities do not treat their patients that way. An enormous amount of good work is done by many people, not least in the NHS in Cornwall, but they may believe that their efforts are unappreciated.
I have made it clear that the Healthcare Commission and CSCI, in particular, have changed their inspection regime, both to ensure that they look at organisations when there is reason to believe that people may be at risk and to use unannounced inspections. In Cornwall, the problem was not an absence of unannounced inspections but the fact that the inspections did not look at what was happening in learning disability services, partly because of a curious arrangement for services provided in what appeared to be a health service establishment. The regulators are looking at that problem. As for the excellent services provided by many staff and organisations in different parts of the country, I entirely concur with the hon. Gentleman and stressed that point earlier.
Further to the Secretary of State’s comments on the good work that is being done, many families in Cornwall who have experienced the care provided by the trust are far more positive about smaller establishments. They are particularly nervous about change, so can the Secretary of State provide reassurance that the needs of those clients and the preferences of their families will be taken into account as we move forward?
The hon. Gentleman raises an important point. In its report the Healthcare Commission stressed that most of the staff to whom it talked were warm, kind and committed to doing their best for the people in their care, but did not have the training, support and the proper systems in place to enable them to do that. Of course, it is a central principle of good care for vulnerable people that they and their families are fully consulted about any changes that may need to be made in the services that are provided. That is part of the purpose of the care assessments that have already taken place.