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People with Learning Disabilities (Abuse)

Volume 549: debated on Monday 3 September 2012

Motion made, and Question proposed, That this House do now adjourn.—(James Duddridge.)

Thank you, Mr Speaker, for facilitating what I believe is a very important debate. We recently welcomed and entertained the entire world to the Olympic and Paralympic games. By every measureable standard, both events have been hugely successful for Great Britain, so I have asked myself incessantly, how can a nation reach such towering heights of achievement but retain the capacity to engage in crass behaviour that should make us all feel ashamed? The standard of care and protection that we provide to people with learning disabilities is a shameful indictment of our society. There is no defence for the way we ill-treat people with learning disabilities.

Mencap felt compelled to produce a report on the subject, “Out of sight”. I recommend that everyone with an interest in disability or human rights takes the time to read that report, which was co-authored by the Challenging Behaviour Foundation. It calls for an end to the neglect and abuse of people with a learning disability. The opening remarks are defiant: “Enough is enough.” I echo that, and would add: “No more and never again.”

It is nothing short of a national scandal that we have allowed people with learning disabilities to be so marginalised and ill-treated. It should not have happened, and it had better not still be happening. What can we do to avoid it happening again? We need to find the necessary legislative measures that will root out the outrageous behaviour that has been brutally meted out to defenceless, vulnerable people. The abuse is not confined to care homes.

In preparation for this debate, I reflected on the fact that before the summer recess Lord Rix and I, as co-chairs of the all-party learning disability group, launched the start of learning disability week by hosting a special event in Parliament. We sought to highlight the appalling spectacle of how people with a disability are subjected to hate crime in today’s Britain. Our aim was to raise awareness of the offence, and demand positive progress from police forces across the UK in tackling such crime. Research has shown that in today’s Britain as many as nine out of 10 people with a learning disability have been victims of hate crime or subject to bullying. People with a learning disability tend to take longer to learn, and may need support to develop new skills, understand complex information and interact with other people.

Even as we campaigned, more evidence emerged. Winterbourne View hospital was a care unit that provided short-term monitoring of adults with learning disabilities. The BBC’s “Panorama” programme exposed a pattern of institutional abuse perpetrated by several nurses against the most vulnerable patients in the unit.

The Winterbourne View serious case review was published. It strongly criticised South Gloucestershire council for failing to prevent the abuse, given that, in the years leading up to the terrible scenes that we witnessed on “Panorama”, 40 alerts were sent to the council but were not acted on. It is a tragedy and a travesty that they were not acted on sooner; if they had been, we may have been able to prevent a great many of the abuses and atrocities that we saw on the programme. Does the right hon. Gentleman agree that it is imperative that local councils act immediately on information and on issues that are flagged up, as they were in the Winterbourne View case, to ensure that we never see such terrible scenes again?

I am pleased that the Member in whose constituency Winterbourne View was—I know he has worked very hard on the issue—has intervened, and I am sure that the House will take careful note of what he has said.

Among the abuses that “Panorama” thought important were the following: patients were forced to have showers while fully clothed; mouthwash was poured into a patient’s eyes; a patient had a bucket of cold water poured over her and was forced to sit outside in the cold; patients were dragged along the floor; a patient was repeatedly punched; and a patient was driven to attempt suicide, and was subsequently mocked. That establishes that vulnerable people were tortured for the amusement of men and women guilty of an inhuman and monstrous series of crimes.

The thing that struck me about the Winterbourne View case was that the individual incidents of torture meted out to the people who were being assessed there—my right hon. Friend is right to describe it as torture—was the same torture as was meted out to residents in a care home on the border of my constituency, which, like Winterbourne View, had many residents whose families were miles and miles away. Is my right hon. Friend, like me, shocked to learn that the Department of Health has no central register of out-of-area placements of people with learning disabilities? Will he, in the course of his remarks, ask the Minister if he will ensure that we have national figures about where people are sent, miles away from their families who want to protect them, into institutions such as Winterbourne View?

I am grateful to my hon. Friend. On these matters she shows a great humanitarian understanding, and the very point that she raises was raised with me today by families who came down to London from all over the UK because of this debate. My hon. Friend should know that she has considerable support.

The harrowing examples that are given, and there are many more, of depraved activity that some will inflict on the most vulnerable among us are almost impossible to comprehend. My hon. Friend outlines some of the reasons for that. The courts will deal with those responsible, and that is how it should be. Families of the victims may find solace when the guilty are sentenced, but what of those who seek no vengeance? What of those who take the view that such abuse should never have happened and want to know why it did happen? It is fair to say that we all want to know who was responsible for presiding over this human crisis. How far and how wide does culpability spread?

We cannot erase the evidence of abuse, where and when it happened. We cannot undo the pain, the suffering and humiliating experience endured by people with learning disabilities, and we most certainly cannot leave it to the monolithic bureaucratic machine to ensure that such abuses never occur again. We have completely and unmistakably failed to protect adults in many aspects of their character where we see that their mental capacity is that of a child.

Winterbourne View was operated by a company called Castlebeck Care Ltd, which charged the public purse an average of £3,500 per patient per week for the services that it provided. For that amount of money, a person could stay in the Ritz hotel. For that amount of money, Castlebeck Care Ltd saw a turnover of £3.7 million per year from Winterbourne View. We should know what that money was spent on. We do not know, but the Department of Health should be able to solicit this information and put it into the public domain—again, a point that the parents whom I met today made loudly and clearly. It is only then that a proper, informed judgment can be made of whether the reason for being of those who are providing such services is the pursuit of profit or patient care.

As I said, I met today families who related their own experience. What they told me is that questions and challenges must be addressed to local councils and local health authorities, which have a crucial role. The Improving Health and Lives organisation published a report written by Professor Emerson of Lancaster university, which analysed the Care Quality Commission’s investigations into 150 care providers. Professor Emerson established that only one in seven patients were being supported in an environment that was fully compliant with statutory regulations. He also established that units operated directly by the NHS were more likely to be compliant than those that were out to make a profit. Half the units investigated did not meet those important statutory levels of care.

The Care Quality Commission knew exactly what was going on. Reading through the material, it is impossible not to conclude that its inaction was simply shocking. It presided over the shambolic and chaotic delivery of vital care services. It was appalling when not even lip service was paid to the adherence to statutory regulations or the basic minimum levels of care. Prior to the abuses at Winterbourne View, there were months and months when the commission carried out no inspections at all. Its self-described “light-touch regulation” is part of the reason these abuses occurred. Winterbourne View was inspected only once every two years in the absence of any complaints. Clearly, that is profoundly unacceptable. The commission was also affected by the coalition Government’s civil service recruitment freeze, which resulted in it having fewer inspectors than it clearly required.

Inspectors must increase the pressure in care units that are underperforming. Inspections must occur more regularly and without warning. There must be stiffer penalties for care providers for non-compliance with their statutory obligations. The commission must be relentless when it comes to investigating care providers that cause concern. Of course, as we all know, Winterbourne View was closed down, but how many people know that Castlebeck Care Ltd had two other units closed down as a result of serious concerns about the level of care? The “Panorama” documentary not only exposed Winterbourne View; it laid bare the unbelievable ineptitude of the commission, which was utterly incapable of taking action in all three units before the scandal was exposed. In my view, the new mantra should be, “Inspections will occur anywhere at any time and without prior notice.”

My right hon. Friend talked about meeting the parents of the patients in the care homes. One of the concerns that have been raised with me is that of elderly parents who care for children with learning disabilities. In particular, my constituent Ivor Needs has a son who is vaccine damaged. Because Winterbourne View is in the vicinity of my constituency, they are really concerned because they have no confidence that the system will be able to look after their child when they are no longer around to do so. Does my right hon. Friend agree that we need some system in place to ensure that people such as Ivor’s son, Matthew, are looked after when their parents are no longer around to do so?

My hon. Friend makes an excellent point and, yes, she is correct. That point was raised with me today several times. Over the years I have certainly had many letters from parents who simply ask, “What will happen to our children when we are no longer here?” I am sorry to say that, on this evidence, I worry very much indeed.

There must also be a review to ensure that the current funding system does not incentivise the keeping of patients for long periods at assessment centres. If adults with learning disabilities are better treated and cared for in their own communities, there has to be a support network. Having local care units that are integrated into local treatment centres is a better model than dispatching patients for assessment hundreds of miles away from their friends, families and communities.

We cannot ignore the voices of the 86 leading figures and charities in the care sector who have stated that the current model poses a real risk that similar abuses will occur in future. Enhanced sentences rightly already exist for those found guilty of racism and homophobia. To begin the process of moving to local integrated units, the Government should begin closing large assessment centres and set a time scale. Local commissioners should develop local services that meet the care requirements of those with learning disabilities.

Sadly, those issues were identified long before the scandal emerged. The late Professor Mansell’s report “Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs” was clear in its analysis and prescribed remedy.

The current care model, and the regulation of it, led to these abuses. It is the system that we are challenging. Simon spent 15 months at Winterbourne View and was hit, pushed, abused and tormented. When he cried for help, we collectively let him down. Then there is the experience of James, a child with a learning disability and autism who suffered abuse and neglect. When James needed help, we collectively let him down. Chrissy suffers from various conditions such as autism and epilepsy as well as from challenging behaviour. When Chrissy needed help, we collectively let her down. There is also Victoria, whose father died before she was nine years old. She suffered a lot of family stress. When Victoria needed care, we collectively let her down. Emmanuel, only six months out of school, was sent away to a unit far away from his family, where he remained for 18 months. All those people, and many more, have been collectively let down.

The scandal, highlighted so bravely by Terry Bryan, is predicated on the notion that if people want to abuse someone, they will, under the present system. The status quo is no longer a tenable option. I trust that the Minister will recognise that we need Government intervention to tackle and cure the cause of abuse. We never want a repeat of Winterbourne View or any similar home in today’s or tomorrow’s Britain. We want public support for our efforts in caring for and protecting people with learning disabilities. We must never collectively let them down again.

I congratulate the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) on securing this important debate and thank him for setting out so powerfully the case for action, not just by the Government but by all those in the system. He acknowledged that the responsibility for safeguarding the vulnerable in our society sits with us all. We should all be vigilant and we must be willing to blow the whistle and to stand up and be counted.

The Government agree with the right hon. Gentleman that, like anyone else, people with learning disabilities have the right to lead their lives free from fear, harassment, harm and abuse. People with learning disabilities should be treated with dignity and respect.

This is the first parliamentary opportunity to refer to a sentiment shared across the House tonight. I should like to pay brief tribute to the work of Lord Morris of Manchester, Alf Morris. Opposition Members will know him from his service as a member of the Labour parliamentary party for many years. He was an undoubted, doughty challenger and campaigner for the rights of disabled people, regardless of their disability. He will be missed, having departed this world during the recess. He was the first Minister with responsibility for disabled people and the pioneer of disability legislation in this country, along with Lord Jack Ashley, who is also sadly missed. I suspect that they are both looking down on this debate and regretting the fact that we are still debating abuse of this sort. I want to put on record my tribute to both of them.

I am very respectful of what the Minister has said about two great men, Lord Ashley and Alf Morris. The last discussion I had with Alf Morris was about this very issue.

Motion lapsed (Standing Order No. 9(3)).

Motion made, and Question proposed, That this House do now adjourn.—(Mr Dunne.)

The House and the Minister will not be surprised to hear that Lord Morris’s final words to me were about the battle of haemophilia and making sure that those who were treated with inappropriate blood should have their rights met. I thank the Minister for his comments.

I am sure that Lord Morris would have been following these matters very closely and with great interest, and I am grateful to the right hon. Gentleman for raising them.

The events at Winterbourne View that the right hon. Gentleman so clearly described were horrifying and depressing. They were horrifying because they so sharply defined everything that is rotten and can go wrong in closed institutions where people are out of sight. What took place at Winterbourne View was criminal. A culture of abuse was allowed to fester and grow undetected and unchecked. The serious case review by Margaret Flynn sets out in great detail the failings of Castlebeck Care Ltd, and it makes grim reading. The right hon. Gentleman reported many of its findings to the House. The events at Winterbourne View were depressing because, as the report by Mencap and the Challenging Behaviour Foundation, “Out of Sight”, reminds us, it is not the first time that closed institutions have let down people with learning disabilities. The right hon. Gentleman highlighted the personal stories that are contained in that important report, and those stories are very telling, with families feeling let down by the system and the sense that the best interests of the individual are not being served and that their views, wishes and feelings were not sought, and if they were sought were not understood.

In October this year, the court will hand down sentences to the 11 members of staff who have pleaded guilty to maltreatment of patients at Winterbourne View hospital. There are no excuses and no mitigating circumstances. What happened was degrading, dehumanising and despicable. I understand that the Crown Prosecution Service will ask the judge to take into account the fact that these are disability hate crimes when determining the sentence of the defendants.

Can the Minister inform the House whether the people who behaved in such a sadistic way had, prior to recruitment, shown any evidence of tendencies of this sort? We would usually expect people who go into the caring professions to be empathetic, sympathetic and caring. How come people who gloried in sadism found themselves in such positions?

That goes to the heart of a number of the points made in the serious case review about the nature of the recruitment processes that were used by Castlebeck and the way in which it then carried on inadequately to train, supervise and monitor the conduct of those staff. I will come back to some of the actions that the Government are taking in that regard to make it much more difficult for that to occur again in future.

Of course, what happened at Winterbourne View came to light only as the result of the actions of the whistleblower, Terry Bryan, and the Panorama programme broadcast by the BBC. I personally thanked Terry for his actions when I spoke to him some months ago about the interim report that we published in June, and I do so again tonight. Thanks to Terry, the Care Quality Commission has changed its systems and set up a dedicated whistleblowing team. An even greater emphasis is being placed on the importance attached to the role of whistleblowers. That is why the Government have introduced a free whistleblowing helpline, not only for NHS staff but, for the first time, for social care staff, so that they can get advice on how to report concerns that they have. There has also been a strengthening of the NHS constitution to make these matters clear to their employers as well.

Terry Bryan blew the whistle on the worst excesses of a wider systemic failure. As I acknowledged in the Department of Health’s interim report in June, the problems revealed at Winterbourne View are more systemic. There has been a tendency when reporting on Winterbourne View to heap much, if not all, of the blame on the CQC. Indeed, the CQC seems to stand as the barrier to everyone else who should be in the dock being criticised, scrutinised and challenged for what went wrong. Although the CQC, rightly and properly, acknowledged its failings and apologised at the time, the issue of staffing and the freeze that this Government introduced on coming into office in May 2010 was specifically lifted for the CQC in October 2010, and there were no restrictions on staff recruitment. If there were failings of recruitment, the CQC would need to answer for them—indeed, it has—before the Health Committee.

Every part of the system—NHS and social care commissioners, providers, regulators and health and care professionals—has a part to play and, indeed, has questions to ask itself about what has passed.

The Minister rightly pays tribute to the whistleblower, but does he agree that when vulnerable people are moved away from their communities and, indeed, their families to care homes that may be many miles away, complaints are less likely to be made and, therefore, inspections less likely to be triggered?

My hon. Friend makes an important point and anticipates what I am about to say. The Department’s guidance is clear. People should be supported to live in the community, wherever possible, and only in strictly limited cases should assessment and treatment centres be used. Nowhere in policy or guidance is there justification for long-stay assessment and treatment hospitals. Indeed, the CQC found length of stay ranging from anything between six weeks and 17 years, with five to seven years not uncommon.

The hon. Member for Slough (Fiona Mactaggart) raised the issue of data during her intervention on the right hon. Member for Coatbridge, Chryston and Bellshill. I agree that we need to improve data collection so that we have a clearer picture of what is going on. The painstaking work of the serious case review, Department of Health officials and others to create a clear picture of the system begs questions about the adequacy of data collection for many years.

I wrote to the hon. Gentleman last week—although, having been a Minister, I suspect that he has not seen my letter—asking him to conduct an audit of out-of-area placements of vulnerable people and to publish the figures on people who are placed a long way away from home. Will he commit tonight to do that?

What I will rightly do—having been a Minister, the hon. Lady will understand this—is give her the justice of reading her letter and considering properly what she has asked. There is merit in what she has said. There is certainly merit in ensuring that those who commission such services are collecting that information so that they have a clear picture of those who are being placed out of area.

I am more interested in the more fundamental question of the appropriateness of something that is outside of policy becoming a practice and being established as an ongoing practice. My point is that we need to look critically at the system that has allowed out-of-area placement to grow to the extent that it has, which has allowed such abuse to go unnoticed in some places for too long. There is no place for such long-stay institutions detaining vulnerable people far away from home.

Providers, commissioners, regulators and individual professionals all have a responsibility—a duty of care to those on whose behalf they commission services. Last year, in the wake of Winterbourne View, the CQC conducted 150 inspections of other services for people with learning disabilities. It adopted new ways of working involving experts both by profession and experience. Although the CQC found no other cases of abuse like those exposed at Winterbourne View, it is disturbing that half of the services that the CQC inspected revealed evidence of poor quality care that was failing to meet essential care and safeguarding standards. Everyone who is involved across the NHS and social care has a vital part to play in driving up standards.

As I have said, the Department’s guidance has been and remains clear. The interim report sets out clearly the elements of the model of care that we expect to see commissioned. However, that is not always happening on the ground. Those commissioning, or in too many cases, spot purchasing, long-stay assessment and treatment services need to look carefully at what they are doing. Indeed, I can tell the right hon. Member for Coatbridge, Chryston and Bellshill that the chief executive of the NHS Commissioning Board and the Department’s director-general of social care wrote to chief executives and chairs of all NHS bodies and local authorities to highlight the interim report and reinforce their responsibility to improve commissioning.

When I published the interim report in June, I set out five objectives for improving services for people with learning disabilities and behaviour that challenges. Those objectives underpin the 14 national actions set out in the report to improve care and support for people with learning disabilities or autism and behaviours that challenge. Those actions include promoting open access for families and visitors and ensuring that people are involved in reviewing the care that they receive; encouraging the CQC to carry out unannounced inspections at any time of the day and week; working with the CQC and the Department for Education to promote best practice and positive behavioural support and ensure that physical restraint is only ever a last resort, and certainly not a tool of choice as it clearly was at Winterbourne View; improving integration between the NHS and social care by setting up health and wellbeing boards to agree joined-up ways of improving services; and getting a range of national organisations, including the Association of Directors of Adult Social Services, the Royal College of General Practitioners and other royal colleges, the NHS Confederation and the NHS Commissioning Board, to sign up to a concordant setting out the actions that each will be committed to taking forward to deliver the right care for people with learning disabilities and challenging behaviour.

One final action that I commend to the House is our work with the NHS Commissioning Board to improve the use of NHS contracts. When we read the serious case review, it is shocking to see how few NHS organisations used NHS contracts to contract their services. They used Castlebeck’s own contract, which was a poor document. The serious case review is just part of what we need to examine. There is also the NHS review of commissioning that was conducted by the South West strategic health authority, which sets out a number of other actions that are being taken to address failings.

I made it clear when we published the interim report that I would very much welcome feedback on it to ensure that the final report, and the action plan that we will publish alongside it, would be as robust as possible and deliver what Members of all parties wanted. I therefore welcome the report by Mencap and the Challenging Behaviour Foundation. As part of our response, we will consider the role of commissioners and how we can support them in the new health and care system.

In addition to the work that my Department is doing directly in response to Winterbourne View, we are taking a number of other steps to improve the care and support system. For example, we are introducing the first ever code of conduct and national minimum training standards for health care and adult social care support workers. That goes to a point that was made in interventions. That work is being taken forward by Skills for Care and Skills for Health and will ensure, for the first time, that employers and people who provide care understand their responsibilities and roles in delivering high-quality and acceptable care to people who need it.

In July, when we published the White Paper on care and support, we set out plans for measures to increase the availability of appropriately skilled care workers, including by expanding the number of care apprenticeships. The White Paper also made the case for strengthening safeguarding, which is what this debate is fundamentally all about. That is a key priority for the Government.

We are committed to preventing, and reducing the risk of, significant harm to adults in vulnerable situations, while supporting individuals to maintain control over their own lives and to make informed choices without coercion. That is why the draft Care and Support Bill sets out a new statutory framework for adult safeguarding to address some of the defects that have been identified, and key responsibilities for local authorities and their partners in the NHS and the police. It will ensure that safeguarding adults boards exist everywhere in England. The Bill will place all that on a statutory footing for the first time.

I am grateful to the right hon. Member for Coatbridge, Chryston and Bellshill for securing the debate. In learning the lessons from Winterbourne View, I am determined to ensure that the voices of people with learning disabilities and of families are right at the heart of what we do.

The National Forum of People with Learning Disabilities and the National Valuing Families Forum sit on the programme board that I chair, which will oversee progress on the action plan. Both have key roles to play locally and nationally in driving change.

Let me end by making it clear that the Government’s approach to people with learning disabilities is grounded in fundamental principles of human rights, independence, inclusion and choice. There can be no excuses. There is no tolerance of those who abuse disabled people.

The right hon. Gentleman has done the House a service by bringing these matters to it tonight. I look forward to coming back to the House later this year with the final report setting out the actions that the Government will take to stamp out abuse.

Question put and agreed to.

House adjourned.