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Winterbourne View Care Home

Volume 529: debated on Tuesday 7 June 2011

(Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s decision not to hold an external independent inquiry into the abuse of vulnerable adults at Winterbourne View.

Nobody watching the BBC’s “Panorama” programme last week could have been anything but shocked and appalled by the systematic abuse of residents at Winterbourne View. May I, first, extend my deepest sympathies, and those of all of my colleagues in the Government, to those so horribly mistreated and abused, and to their families and loved ones? For the avoidance of doubt, I should say that we have not ruled out an independent inquiry. A criminal investigation is under way and it is important that we do nothing that could prejudice it.

In the coming weeks, the Care Quality Commission will inspect the other 22 hospitals run by Castlebeck and the reports will then be publicly available on CQC’s website. The CQC is also starting a three-month inspection of the 150 hospitals that care for people with learning disabilities, and this will include unannounced inspections. Where it identifies inadequate care, the CQC will require the necessary improvements to be made immediately. South Gloucestershire council will also lead an independently chaired serious case review. I have asked the Department of Health to draw together the findings of these various investigations and ensure that they are completed in a thorough and timely manner. I can also report that Mark Goldring, the chief executive of Mencap, will bring an independent voice and a depth and breadth of knowledge of the needs of people with learning disabilities to the task of drawing conclusions and learning lessons. Once in possession of the full facts, and once the police investigation has concluded, we will be in a position to decide what further action is required.

Since being made aware of the abuse, our priority has been ensuring the safety of patients at Winterbourne View. Fifteen staff have been suspended by Castlebeck and no further patients will be accepted at Winterbourne View. All residents now have a personal advocate and the CQC is working with all the agencies involved to find suitable alternative placements for them, taking into account their specialist needs and the wishes of their families. I issued a full written ministerial statement on these matters at 9.30 this morning.

It is the right of every individual being cared for by others to be treated with dignity and respect and it is the responsibility of those trusted with their care to provide it: a responsibility that weighs most heavily on those who care for the most vulnerable, including those with learning disabilities. This responsibility rests in four places: with the providers themselves, in this case Castlebeck; with commissioners, both primary care trusts and local authorities; with the regulators, including both the Care Quality Commission and the professional regulators, and the CQC has acknowledged it should have acted sooner and issued an unreserved apology; and, of course, with individuals. No training, guidance or management should be needed to tell people that the behaviour experienced by the residents of Winterbourne View was nothing other than obscene and unacceptable.

In future, our proposed HealthWatch organisations will provide a valuable early warning and will be able to ask the CQC to investigate where concerns exist. We intend to put safeguarding adults boards on a statutory footing, helping local authorities, the NHS and the police to work together to safeguard vulnerable adults. We will do everything in our power to prevent incidents such as those at Winterbourne View from happening again and to ensure that, if they do, the system responds quickly and decisively to protect those at risk.

The Opposition agree entirely with the sentiments expressed by the hon. Gentleman. It was with great shock and sadness that we saw the terrible events happening, before our eyes, on the television screens. To see the abuse of the most vulnerable by those entrusted with their care was truly shocking and sickening. In the wake of this tragedy, however, vital questions must, in our view, be answered fully and impartially.

Although internal investigations conducted by the CQC and South Gloucestershire council, both of which are directly connected with this failure, will be of some value, they are nevertheless insufficient. We are asking for an independent inquiry similar in nature to the well-respected “Healthcare for all” inquiry, which Sir Jonathan Michael carried out in May 2007. The Government could include in that inquiry experts to work alongside Mark Goldring, such as Professor Jim Mansell, who has already conducted two reviews for the Department of Health into the structure of homes for those with learning disabilities, because the issues raised in his reports are still to be resolved, as this tragic case suggests.

We need full and frank answers. Was the CQC’s failure to monitor the treatment of residents due to the lack of resources? Was it due to the shortage of 300 staff, as reported in the Financial Times last week? Does the CQC have adequate powers to act in cases such as that of Winterbourne View and, if so, is it using its powers appropriately? If not, how must the CQC be strengthened to prevent a repeat of this failure and what actions will the Government take to ensure that staff working in social care are better trained and regulated so that events such as those at Winterbourne View can never be repeated?

Last week, the Minister created confusion with his response. On Tuesday, he seemed to imply that there would be an independent review of the case but by Wednesday he seemed to have changed his mind. Does he now think that internal reviews will be sufficient to answer the questions? I hear what he says about sub judice and the police inquiry, but we are not asking for an inquiry into individual culpability. We are asking for an independent inquiry into the failure of the system, for that inquiry to begin immediately and for there to be no delays. We need assurances that there will be a wide-ranging review, held in public, that will shine a light on the terrible events at Winterbourne View. Only an independent inquiry will do.

Of course, we need to ensure a full and thorough inquiry into all these matters, which is being undertaken in the serious case review, which will be chaired independently, and in the work of the CQC. That will go on as the Department brings together all the different reviews and that is why we are very pleased that Mark Goldring will take part in the process.

The hon. Lady suggests that there was confusion last week, but the confusion was only that which she sought to spread. We were very clear from the outset that we wanted to examine all the results from all the different inquiries, and that is what we are doing. We are not ruling out any further inquiries, but we want to ensure that the processes that are in hand are concluded and that we make judgments with the full facts available.

May I welcome my hon. Friend’s announcements to the House this afternoon? Does he agree that although there has quite properly been a lot of focus on the CQC—Dame Jo Williams accepts that there have been quite clear failures in its supervision of the home—there are also some difficult questions to be answered, particularly by the commissioners of the care? What were they doing paying for care that clearly was not to the required standard? Equally importantly, there are some important questions for the professional regulatory bodies to answer. Did no doctor ever go into the home? If they did, what conclusions did they draw? Where were the nursing regulators in this case?

My right hon. Friend poses a number of questions that are at the heart of the various current inquiries. He is right to say that to focus solely on the CQC is to miss the point, as the primary responsibility rests with the provider organisation to recruit, train and supervise the right staff in the first place. He is also absolutely right to ask about the role of the commissioners and the professional regulators. Those are the issues that we are looking at and will examine, and I will come back to the House with answers in due course.

As the CQC has been forced, by Government cuts, to reduce its inspections by no less than 70%, how are the Government going to prevent similar abuses from occurring elsewhere and going uninspected and undiscovered unless someone happens to blow the whistle or offer undercover photographic evidence?

Let me start by addressing the whistleblowing issue. Terry Bryan, the whistleblower in this case, is to be applauded for his tenacity in pursuing it. The Government have been clear about the need to strengthen the arrangements and safeguards for whistleblowers, because that is an essential first way in which we can make sure that the system protects those who are vulnerable. The right hon. Gentleman suggests that the Government have in some way cut the number of inspections, but he should reflect back to 2008 when his Government introduced the current mandate for the CQC and changed the basis on which it would inspect. That is what led to the changed inspection system. Perhaps he should ask some questions about that as well.

Does my hon. Friend agree that the model of large-scale institutionalised provision for people with learning difficulties is now broken and that we should support even more moves towards personalised and supported care close to the families and loved ones of people with learning difficulties?

My hon. Friend makes a very good point. The move towards personalisation and greater supported living is undoubtedly the direction that we wish to move in. That was started by the previous Government and we have been continuing it. We have made a massive transfer of resources from the NHS to local authorities to support that very transfer of responsibility, which is undoubtedly the way to deliver better results for individuals.

Is it not self-evident that if there were a full inquiry we would be able to hear about the owners and the people who make money out of these business ventures—businesses such as Lydian Capital Partners, which owns Winterbourne View, and people such as J. P. McManus and John Magnier, who have rubbed shoulders in royal circles? Is it not ironic that those two billionaire Irishmen, at the same time as the British people are bailing out the Irish economy, are making misery for disabled people by inflicting the damage they have caused and are making money in the process?

In my public statements and in my statement today, I have made it clear that the spotlight needs to be shone just as clearly on the provider organisation in this case, and not just on the CQC. That will be my continued intention as we pursue this matter to its conclusion.

Will the Minister address the question of how long these vulnerable people were filmed being abused, because that simply would not have been tolerated if they were children?

My hon. Friend makes an important point. I do not know the answer to the question of how long the people were filmed before the whistle was blown again by “Panorama”. However, it is an important point that will undoubtedly become clearer as we come on to the details of the inquiry.

I endorse the Minister’s praise for the whistleblower in this horrific case, but may I remind him that he blew the whistle three times to the Care Quality Commission, which did precisely nothing? What are the Government doing to ensure that such a situation can never arise again?

The local authority was notified in the same way, so there are a number of agencies at which we need to look carefully and critically, and that is what the independently chaired serious case review will do. That is what the review by the CQC is about, and we will pull all those reviews together. If there are any gaps in the information that comes from that process, we will make sure that they are filled. However, the key thing is that lessons are learned along the way and changes are made straight away.

Further to what the hon. Member for Hampstead and Kilburn (Glenda Jackson) said, given that the CQC clearly ignored the advice it was given, there should be resignations at the highest level—the buck has to stop somewhere.

I am afraid that I am not going to agree with the hon. Gentleman today that we should call for anyone’s head. I want the heads of that organisation to be relentless in pursuing the questions that hon. Members have asked today and which I have asked since this came to light about why failures occurred—not just the CQC’s acknowledged failure but failures by others in allowing this to go on for the time it did. I am not calling for resignations, but I am calling for action and resolution. Learning should take place, and there should be change as a result of that learning.

The Minister has rightly addressed the issue of whistleblowers. Will he assure us that there will be protection for whistleblowers in future, whether they are relatives or staff, so that they have the confidence to act? In relation to staffing issues, are any of the inquiries making any assessment of whether there is a correlation between shift lengths and pay rates and the poor care in some of those institutions?

Again, those are all matters that need to be properly considered and weighed up in the reviews and that the Department will want to make sure is part of the overall report. When that work concludes, we will report to the House and make sure that the information is available to all hon. Members so that they can assess it and make their own judgments. It is certainly the Government’s intention to strengthen the protections on whistleblowing. We are consulting on how that might be given effect, and I urge the hon. Gentleman to contribute to the consultation.

Does the Minister envisage that putting safeguarding adults boards on a statutory footing would help care home residents, their families and all those concerned; and would bring these incidents to light and, indeed, to a halt sooner in future?

It is essential to establish a statutory basis for safeguarding adults boards, but it is not sufficient, as other issues must be addressed in the review, which is why various aspects of the work are progressing. However, it is right that we should respond quickly to the Law Commission, which recommends that we should put the boards on a statutory basis, and that is what we will do when legislation is introduced.

If, as is often said almost as a cliché, a test of a civilised society is how we care for the most vulnerable—sadly, it is likely that Winterbourne is not an isolated example, and that even today many frail elderly people, often with dementia, and people with mental illnesses or learning difficulties are being abused and neglected—we must all think hard about how to move forward. Strong and unannounced inspections are clearly a significant part of the answer, but are there ways in which we can involve local communities and concerned citizens in safeguarding the well-being of people in homes—often private homes? If around every home there were two or three citizens who had rights to enter and could befriend some of the people there, that might be another way in which the community could add to the statutory services to try to prevent occurrences in future.

I am grateful to the right hon. Gentleman for his question. We must acknowledge that there will never be a time when there is an inspector in every room of every care home for every minute of every day. We must therefore make sure that the systems in place are robust, and that organisations are recruiting the right people and delivering the right training and supervision. However, the right hon. Gentleman’s point about the involvement of the community is spot-on. That is why we are proposing the establishment of HealthWatch and why we see that as an opportunity for citizens to become involved in the provision and scrutiny of health and social care in their communities.

Very often a whistleblower is the vital link that people in such vulnerable circumstances have with the outside world, so I am pleased to hear that that will be a big part of the review. I have written to the chairman of the CQC to ask how many such whistleblower complaints were made in the past 12 months but not been followed up. The data are essential. May I have the Minister’s assurance that the review will find out that information?

My hon. Friend draws attention to an area that we need to look at as part of the various aspects of the work that I described to the House today. Although I do not know the basis on which such data are collected by the CQC, I undertake to look at what data are available.

I accept the Minister’s logic in not asking for heads to roll ahead of the report of the independent inquiry, but will he give the House an undertaking that once he has asked the questions and received the answers, he will not shy away from allocating responsibility and will do what the NHS is usually very bad at—allocating responsibility at some stage and asking people to resign?

I think I will say yes to that, but I want to make it clear that I am not answering in the context of hypotheticals. I do not know the conclusions of the exercise, and Ministers who come to the Dispatch Box and promise that things will never happen again are all too often and too soon proven wrong. We must make sure that we do everything we can to learn lessons from this to minimise the risks in the future, and we need to make sure that responsibility and accountability are at the heart of the reforms that the Government are making to health and social care.

The Minister is right to say that we need to learn lessons from this, but how long will it take us? The CQC has admitted inspecting Winterbourne View three times in the past two years. The South Gloucestershire safeguarding board was informed in October, but apparently took no action before the programme was aired on television. This is not the first such scandal. When I was first elected, one of the first things I did was to persuade the Department of Health to commission the Bergner report into the Longcare home scandal on the borders of my constituency —a similar huge institution in which residents were raped, abused and tortured by the people who were given care of them. It seems to me that it is not just the individual institutions but Government who need to learn the lesson. How much money is the Minister putting into advocates and listeners of the volunteer kind mentioned by my right hon. Friend the Member for Croydon North (Malcolm Wicks), or of the professional kind, so that the voices of those who cannot always speak for themselves are heard in the inspection process?

I mentioned in my statement that each of the individuals who have been affected in this terrible way have advocates. The hon. Lady makes an important point about the role that advocacy plays for those who lack capacity or the ability in certain circumstances to advocate on their own behalf. We are looking at that as part of the overall reforms of health and social care, but as for a precise sum of money, I do not have a figure in my head that I can give her now. I will write to her on that point.

My elderly constituent, Mr Ivor Needs, has been looking after his vaccine-damaged son, Matthew, for many, many years. Ever since I became an MP, he has been expressing concern to me about what will eventually happen to Matthew when he is no longer able to look after him. How can we reassure people such as Mr Needs that the Government are pulling out all the stops and doing all they can to ensure that care homes in the Bristol and south Gloucestershire area will be fit for purpose and a fit place for him to entrust the care of his son?

I entirely understand that question. I suspect the hon. Lady speaks for many who saw the programme and therefore fear for their loved ones who may be in other institutions. That is why we have to act in a thorough and thoughtful way, why we have to act quickly, and why the various processes that I described today are the best way to reach conclusions quickly. Because of the separate criminal inquiry, a separate independent inquiry would not be able to start until those judicial processes had been completed. That is why we want the internal processes to go forward. We have provided external scrutiny to make sure that they deliver what we all want—greater assurance that the system will deliver the best quality care for our loved ones.

The Minister has stated that there cannot be an inspector in every bedroom, and that is why he and hon. Members across the House this afternoon have acknowledged the vital role of whistleblowers in protecting vulnerable adults. Will he speak to colleagues in the Department for Business, Innovation and Skills to ensure that any changes to employment law do not make it more difficult for people to blow the whistle, especially new employees who often see a service through fresh eyes and therefore see faults that others have grown used to?

I will certainly have those discussions, and I would add that there is another area that we need to focus on, and that is the training and development of the work force. That is why just two weeks ago I announced not just a work force development strategy, but additional new resources to underpin that strategy for all providers to enable them to ask Skills for Care for the resources to develop their work force.

Will the Minister also look at the vetting and barring scheme in this country, and in particular have regard to the provisions in the Protection of Freedoms Bill, which is going through the House at the moment, that will remove millions of people who work with vulnerable adults from the thorough background checks that the Independent Safeguarding Authority carries out at the moment?

I will take away that point, reflect upon it and write to the hon. Lady rather than give her an off-the-cuff answer of any sort.

Like my right hon. Friend the Member for Croydon North (Malcolm Wicks), I too believe that we are kidding ourselves if we think that this is a one-off and it is not happening day in, day out. There will be vulnerable adults living in their own homes today, behind locked doors, who are in fear of the carers who are paid to look after them. Might not another way of getting an eye into the locked environment be the use of telecare to make sure that someone outside is aware of what is happening in these locked institutions?

I would not want to give the impression that we would see that as a substitute for any of the other points that have been made on this urgent question today, but undoubtedly telecare, telemedicine and assisted technologies have their part to play, both in improving the quality of care and increasing independence for individuals. That is why the Government support that as part of the way in which we see the future for social care unfolding.

A recent Tyne Tees television report uncovered cases of appalling abuse and neglect in the north-east that are now being investigated, and the staff in those cases reported dreadful treatment from their employers, not just losing their jobs but having their professional reputation smeared. Will the Minister please elaborate today as there will be workers who are aware of abuse but are in fear of their jobs, who could report abuse if they had some reassurance today of the changes that the Government are looking to make to protect vulnerable workers?

The first thing I would say is that if anyone sees criminal activity of the sort that took place at Winterbourne View, they should blow the whistle on it. There is no if or but about that. The Government have consulted and we are looking at the responses to the consultation on whistleblowing. I am not in a position to elaborate further, but it is absolutely vital that people feel able and safe enough to come forward if they have concerns about neglect, abuse or poor-quality care.