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People with Learning Disabilities

Volume 798: debated on Thursday 6 June 2019

Question for Short Debate

Asked by

To ask Her Majesty’s Government what action they are taking to address the treatment of people with learning disabilities and complex needs in in-patient units; and what plans they have to provide adequate, alternative community support.

My Lords, the Minister will be aware that this Question was prompted by the BBC “Panorama” programme shown immediately before the Recess and the statement made by the CQC at the same time. I thank the Library, Mencap, YoungMinds, the Royal College of Speech and Language Therapists, and others for their briefings. I also thank the noble Lords taking part in this short debate.

The “Panorama” programme was shocking. You have to wonder what the owners of Whorlton Hall, Cygnet Health Care and the CQC were doing in previous years; they were certainly not looking in the direction of, or carefully enough at, the care of some of the most vulnerable people in our society. The programme revealed conduct and attitudes almost medieval in their cruelty and ignorance. The fact that it took place somewhere that should have been safe and caring is shaming for all of us. The BBC’s undercover filming appeared to show patients with learning disabilities being mocked, intimidated and restrained. We know that 10 workers have since been arrested and that the health watchdog—the CQC—has launched a review, led by David Noble, into how it handled a 2015 report raising concerns about Whorlton Hall hospital. It beggars belief that although the former Care Quality Commission inspector Barry Stanley-Wilkinson flagged up the potential abuse of patients four years earlier in an as yet unpublished report, it took an undercover programme to reveal what was going on in the home. It is even more unbelievable given that the site had at least 100 visits by official agencies in the year before the abuse was discovered.

Of course, this is not for the first time. Since the 2011 Winterbourne View abuse scandal—also revealed by a BBC “Panorama” programme—Ministers have promised repeatedly to move such people out of unsuitable secure units and into community care, yet the number of adults with autism and learning difficulties locked up in ATUs fell only slightly over the past three years, while the number of children in them has more than doubled. Last year, there were 28,880 restraint incidents in England alone.

The Transforming Care programme has taken many forms since 2012: the initial two-year targets were missed and a new lead was appointed but resigned. After two critical National Audit Office reports, two Public Accounts Committee hearings and various other reports, NHS England and partners wrote Building the Right Support. Eventually, a three-year programme for 2016-19 was announced, with three aims: to develop new community support and services; to improve the quality of care in in-patient settings; and to reduce the number of people with learning disabilities and/or autism in in-patient settings by between 35% and 50% by March 2019. The programme failed to deliver these aims. By March, at the end of the programme, bed numbers had decreased by only 19%. What is the Government’s response so far? It is true that NHS England included that target in its long-term plan. However, that has simply moved the delivery date, with NHSE now aiming to meet the target in five years’ time. That is not good enough.

It is also true that, in the meantime, the Secretary of State commissioned a CQC review of seclusion and restrictive practices in response to numerous media exposures of poor practice. The recent interim report reveals the widespread use of restraint and restrictive practices in in-patient units for people with learning disabilities and/or autism. In May 2019, a damning report from the Children’s Commissioner highlighted the shocking treatment of children in these places and the lack of community support leading to their admission. This very sorry tale reveals a lack of leadership, ability or preparedness on the part of the Government to effect real change for this most vulnerable cohort of our fellow citizens.

The truth is that, seven years on from Winterbourne View, the system continues to sanction an outdated and wrong model of care. If people are contained in institutions a long way from home, awful things seem to happen behind closed doors. Can the Minister tell the House whether the Secretary of State now takes personal responsibility for closing down institutions that provide the wrong model of care? Why does the CQC continue to register new institutions that offer inappropriate institutional care? Does the CQC need new powers? What lessons must we learn from the fact that the CQC rated this place “good”? Is this another case of whistleblowers not being listened to? How much was Cygnet Health Care charging the NHS per week for this awful abuse and neglect?

This horror came in the same week as the damning CQC report on segregation, an equally scathing report by the Children’s Commissioner and the LeDeR—the learning disabilities mortality review—report confirming the extent to which people with learning disabilities and autism are fatally failed by our system. Does the Minister accept that we are tolerating widespread human rights abuses? Surely families want not another review but action to protect their loved ones. Many of the people abused at Whorlton Hall were hundreds of miles from their families. Does the Minister recognise, and will she commit to the fact, that cutting people off from their support networks allows such abuse to carry on without anyone noticing?

The Government’s inadequate response to this matter is deeply shocking. There is agreement among experts in this field, including many health and social care professionals, that robust community support and leadership across government is needed to ensure transformation. Most recently, but still six months ago, Sir Simon Wessely’s report— Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion—was published. It included a number of positive proposals meaning that children and young people would be treated in hospital only when absolutely necessary and clarifying their rights to be involved in—and challenge—decisions about their care. I agree with YoungMinds when it says that it is,

“concerned that essential reforms to improve the quality and type of support for young people with complex needs and mental health conditions could be further delayed or put at risk”.

On its behalf and that of thousands of young people and their families, I have some questions for the Minister. When will we see the Government’s response to the Wessely review recommendations? When will we see a new mental health Bill? When will the Secretary of State for Health and Social Care grasp the nettle and drive forward cross-departmental work and joined-up NHS and social care support? Only proactive and strong leadership from the top will unlock the systemic blockages stopping people from moving out of in-patient settings and back into their communities.

Mencap proposes four actions that should inform the Government’s action programme. First, it proposes increasing cross-departmental leadership, accountability and oversight through a commitment from the Secretary of State for Health and Social Care to convene and lead a new, cross-departmental ministerial group with the Minister for Children and Families and the Minister for Housing, Communities and Local Government. It states that referring the Transforming Care programme to the inter-ministerial group on disability, as the Government previously suggested, is wholly inadequate given the attention that the programme requires, so it will not be effective. Secondly, it proposes a commitment from the Secretary of State to ensure that learning takes place from the independent evaluation of the Transforming Care programme, and that this leads to new and credible implementation plans across health, social care, housing and education. Thirdly, it proposes pooled and ring-fenced funding to build high-quality, specialist support in the community. The buck-passing between health, education and social care has to end, with budgets pooled and focused on getting the right outcome for the person by intervening early so that children get the right support and adults have the right adapted housing and specialist staff support they need. Finally, it proposes co-production with families and individuals with lived experience. The regulator, specialist practitioners and commissioners should drive forward workable solutions, but not without the lived experience of children and adults with a learning disability, as well as of their families.

Finally, I have to raise the question of who owns, runs and profits from these homes. Julie Newcombe, a mother who—as she puts it—“rescued” her son and set up Rightful Lives, said:

“There is a huge conflict of interest within the private sector because heads on beds equals money in the bank, which means profit becomes the ultimate barrier to discharge”.

Last November the Mail on Sunday published an article, “Profiteers of Misery”, lifting the lid on the profits made by private companies that run establishments such as Whorlton Hall. We need to discuss and raise the issue of the conflicts of interest—with which, of course, we are very familiar through our recent consideration of the MCA Act.

Universal Health Services—whose former CEO, I think, is Simon Stevens, now the head of NHS England—is a huge US healthcare firm snapping up British psychiatric services. Its British operations are run by Cygnet Health Care, the owners of Whorlton Hall. Cygnet Health Care boasted in recent accounts of earning revenues from 220 NHS purchasing bodies and almost doubling its profits to £40.4 million in the last year. Will the David Noble inquiry look at the issues this raises—underpaid and inexperienced staff—and ascertain what the occupancy rates were and whether patients were being kept longer than was needed, ultimately to boost the profits of Cygnet and its US parent company, Universal Health Services?

My Lords, as I shall refer to some workforce issues, I refer noble Lords to my membership of the General Medical Council. I am grateful to my noble friend for instituting this debate. The questions she has posed are very significant. As she said, the “Panorama” programme depicted shocking events. The depressing thing, of course, is that it follows not only Winterbourne View but a series of reports published in the last few years identifying the scale of the problems. My noble friend went through some of them; I will mention three.

One is the Children’s Commissioner for England report of 2019, published only two weeks ago, which found that there are 250 autistic children or children with a learning disability in mental health hospitals in England, who on average had spent six months there. Many, she said, are far away from their homes, friends and families. One in four had not had their care plan reviewed in the last six months. Despite the fact that restraint and seclusion should be only a last resort, many staff in mental health hospitals spoke as if they were routine matters. Last year the CQC was asked to carry out a review into the use of restraint and seclusion in mental health hospitals. It really was a shocking situation: 31 of the 39 people found in long-term segregation whose cases investigators assessed were on the autism spectrum; some were on wards that did not have the appropriate environment for autistic people; many staff lacked training; in the cases of two-thirds of the people the CQC assessed, staff had stopped trying to reintegrate them into the main ward; and a third of the people it assessed were experiencing a delayed discharge because there was not a plan for appropriate care in the community. The National Autistic Society has laid bare many of the problems that these reports have identified.

There was also the very interesting National Audit Office report in 2017, which raised a number of complex challenges that the various partners involved in supporting people with learning disabilities face in making the system work much more effectively and delivering what my noble friend has asked for: appropriate care in the community. It identified that the flow of patients into mental health hospitals was not working effectively and that, shockingly, in December 2016, 28% of such patients had still never had a care and treatment review. Fundamentally to the financing of this, money was not being released from mental health hospitals quickly enough to help pay for the kind of community support we need to see.

We also know, from a report published two days ago by Health Education England, that the learning disability nursing headcount could hit critical levels in the next five years—some would say it has hit those levels already—with vacancies upwards of 30%. In addition to some of the issues we have in recruiting nurses—including bursaries, et cetera—I believe there is a huge crisis in the learning disability field and, so far, no real, tangible means of trying to deal with it.

I know government Ministers are and have been committed to doing something about it, as my noble friend says. We are not short of reassurances that Ministers have given to this House and the other place, and I do not doubt Ministers’ sincerity. It was only on 21 May that the Secretary of State announced a number of initiatives on,

“the model of care for autistic people and people with learning disabilities”,

and the appointment of,

“specialist, independent advocates who will … work with families … join up services … work to move people to the least restrictive care and then out into the community … a new working group for learning disabilities and autism, bringing together experts, clinicians, parents and carers to develop a new model of care … a new awareness campaign, to encourage staff, families and friends to come forward if they have concerns about care”.

I could not disagree with any of that; I am sure it is welcome. The question is: where is the beef? What is going to make this really happen? Is this just a continuation of, frankly, a system of scandals that have been with us for decades?

I could not help going back just over 50 years to Geoffrey Howe’s report into Ely Hospital in Wales, which was the start of a series of inquiries into hospital care for people with learning and mental health disabilities. It led the movement towards more community care. At the time, it caused great shock that our fellow country men and women could be treated so badly in institutions ostensibly established to care for and support them. I make the connection between what was exposed so recently by “Panorama” and what was found by Geoffrey Howe just over 50 years ago in Ely Hospital. I do not think that we, collectively, can be proud of what has happened. Of course improvements have been made, but an awful lot more needs to be done. Ministers often make the glib statement, “We want to make sure this can never happen again”. The Government have been wise not to make that statement in relation to people with learning disabilities. At the moment, I do not believe there is anything to guarantee that it will not happen again.

It is clear, for a start, that there does not seem to be any national leadership. In the end, who is in charge of making a new service work effectively? I cannot see anybody one can identify as being in charge unless it is Ministers, but Ministers do not—or say they do not—have the levers to make the system work effectively. It is clear that commissioners are not up to the task. The lack of interest that many commissioners take in those people, once they have been allocated to these places, is so striking. Given that many of the people in those places come from long distances away, it is almost impossible for their home commissioners to monitor what is going on.

The current system is simply not capable of stopping this. Ministers must appoint someone centrally with the powers to dictate what will happen. Unless we do that we will simply come back here year after year with yet another scandal. The measures taken so far are sensible, but will not cut the cake.

My Lords, I thank the noble Baroness, Lady Thornton, and I am delighted to follow the noble Lord, Lord Hunt. I pick up two words that both of them used in their remarks. The noble Baroness talked about the “outdated” system and the noble Lord about the need for a completely “new” service. As someone who comes from the world of innovation and new service design, I would like to talk about how very deeply I believe that better use of technology can help both people in communities and those who need to be in a hospital environment.

The potential for technology in this arena is breath-taking. I have seen examples of people with severe mental health challenges using virtual reality technologies to conquer profound issues of schizophrenia and learn how to interact with people who they were unable to share a room with before. Mencap did a fantastic study with people who had extreme mental health challenges, helping them to see what it was like to walk down the street. One incarnation of that was to go into a voting booth, so that they did not feel overwhelmed by that environment. These are not complicated technologies and they are available now. They can help people to live lives that all of us take for granted, if we are not faced with such challenges.

I argue that there is a lack of leadership, but also that we should not just use technology for technology’s sake. We need to use technology hand-in-hand with human solutions, led by the users of these services. I am a proud patron of AbilityNet, which provides assisted technology to people with both physical and mental challenges. One thing it does is provide volunteers to help people with the technology that is already available to them in their homes. The examples of people’s lives being made considerably better with a relatively small amount of free help are quite remarkable. We should bear in mind that this is a very small charity with a small network of volunteers, yet it has a huge impact on the constituents it serves.

I met a woman who had pretty much no contact with any of her family around the world. She was extremely isolated. She had been given, as often happens, a bunch of expensive kit by somebody, but it sat in the corner and she was actively frightened of using it. An AbilityNet volunteer came to show her how to turn on the computer, how not to be frightened of it, how to make sure that she was in charge of it and not the other way round, and to assure her that it would not listen to everything that she said—I hope that that was true. She could then connect to the worlds that she wanted to be connected to. She had family in Canada, and the technology prevented her needing extra support in the week because she was able to do a little more for herself. Everyone was a winner. Local services had less hassle to get to her every day because she was able to have that point of connection with someone from her family in another country.

I also met a wonderful man who was completely blind and who had been given a piece of assisted technology that he was frightened of. Again, with a relatively small amount of volunteering help, he was able to run his business using that technology.

I am not a complete Utopian: technology will not solve the profoundly disturbing cases that the noble Baroness, Lady Thornton, so articulately described. But if we are to reimagine a service fit for purpose in 2019—not 1819, as some of these horror stories suggest—we have to think about technology at the heart of how we design solutions. We should not make them only digital, but they must be able to help people run their lives by making use of the amazing ability that we now have in 2019.

I am also chancellor of the Open University. As many noble Lords will know, we have one of the largest constituent groups of disabled learners in the country. That is partly because of the OU’s long history of adaptive technologies and assisted technologies, and the extremely competent team of people who build brilliant learning technologies for people with complex needs. I am often in tears as I stand on the stage during degree ceremonies, when I meet people who put us all to shame. They have not only faced massive learning difficulties, both mental and physical, but may have suffered a bereavement, may not have a carer or may have been working a job at the same time—hard to believe, but true—and have completed a degree. I give thanks for the Open University and its incredibly robust network and systems that provide an outlet for people who want to continue with their education, at whatever stage of their lives. I urge the Government to think about how to reinforce those institutions—the big ones such as the Open University and the small ones such as AbilityNet—that do a very valuable job in communities. They must be a core part of how we reimagine services in the future.

We should not, however, overcomplicate some of the needs if we are designing a service from scratch. In my mind, it comes down to three important things: good infrastructure, good skills and investment. Good infrastructure is often overlooked. I did some work for Jeremy Hunt when he was Secretary of State for Health, looking at innovation in the NHS. I do not think that he was very pleased with me when I suggested that the biggest innovation would be to provide high-quality wi-fi across all of the estate. Thankfully, that is happening, but not quickly enough. Good quality wi-fi really does transform patients’, carers’ and staff’s experience of technology in hospitals—think how our own lives were transformed in this Chamber when it was no longer a patchy reality for us here.

Secondly, many noble Lords will know that I have long worked on the issue of skills, but far too many people are still not given access to training and skills at whatever point in their lives. It is not just the person who suffers but their carers and the people looking after them. When I spent far too long in hospital, many of the nurses and doctors had no idea about technology. They were given no training or education on how to use it. How are we expected to equip ourselves for the modern age if we do not know how to use the stuff that is available to us? Skills are very important piece of the puzzle.

Finally, on investment, I am often ashamed when I look at the venture capital commitments from the sectors that I am lucky enough to work in. Too little money goes to inclusive technologies and creative use of technology for people who are perhaps the hardest to reach in our communities. It is imperative that we demand more of the sector, and that the Government lead and show examples of what is possible. Let us not forget that the touch screen was only invented for people who had difficulty moving their hands, and many other amazing inventions came about because of the needs of some of the furthest to reach in society. I believe very deeply that if you build for the furthest, you actually do a great service for the vast majority of people. These are not people on the outlying extremes of our society; they can help us learn more about ourselves as well. It is fundamental to inclusive design, and we need more investment from the sector. There are good examples in London of people who are trying to put investment in. Atomico Angels is a small fund that has been set up, and some great stuff is happening with LocalGlobe, Zinc and others, but it is not enough. The scale is dwarfed compared with what is going into other parts of the technology sector and compared with where it should be.

I end by painting a picture of a happy place. We started with the noble Baroness, Lady Thornton, describing some very broken places, but I am lucky enough to know Dame Stephanie Shirley, an amazing technology entrepreneur from the late 1960s and 1970s, who has spent the later part of her career as an extraordinary philanthropist. She had a child who died of an extremely serious form of autism, and she has built a school, Prior’s Court, for children who suffer from this very severe autism, many of whom cannot speak or look after themselves. If anyone needs an example of how we can design for the future, I urge them to visit Prior’s Court. It should be upheld by the Government as an example of what is possible. She has robots talking to the children, because sometimes it is easier for them to communicate with something that does not have all the complicated cues that we have on our faces, and she has art and screens. It is not a technology-led place: it just embeds the best of technology. I salute Prior’s Court. Let us forget the past of Winterbourne Abbas and use Prior’s Court as an example of the future.

My Lords, I declare my interest as the chair of the board of trustees for Hft, Home Farm Trust, a national charity that supports adults with learning disabilities. We support more than 2,500 adults in community settings across England. I was fascinated to listen to the noble Baroness, Lady Lane-Fox. We actually use modern technology: if one household wants to talk to another, they just touch the television in the corner, it all pops up and they have a chat, which brings them much closer. I would also like to talk to her outside the Chamber about research that might be going on.

My interest in learning disabilities goes back to 1997, when I was a non-exec director on the board of an NHS trust delivering services to adults with a learning disability, as well as other services including community services and mental health services. Non-execs were expected to visit settings where services were delivered, and I sincerely hope that that is the case right across the NHS now. On our way back from a meeting, a non-exec colleague and I decided to visit one of our hospital settings unannounced. What we found was not quality care: no one paid any attention to the environment, patients were strapped in chairs and the place did not feel right. People who go into hospitals will know whether one feels good or does not—it is in your water, if you like. There was a feeling of containment, not of care. We went straight back to the chief executive and played merry hell. That was more than 20 years ago, and things should have moved on.

I thank the noble Baroness, Lady Thornton, for tabling this debate, but we should not be having a debate at all. Budock in 2005, Winterbourne View in 2011, Calderstones in 2016 and now Whorlton Hall in 2019 each showed us scandalous and shameful treatment of adults with a learning disability living in a setting run by, or for, the NHS. Reports were written and inspection and improvement teams sent in, so what can the Minister say to the House by way of reassurance that in three, four or five years we will not see a repetition of these scandals? Can she tell us who has to put their foot down and where to enable the report Building the Right Support, which was written in 2015, to be implemented?

That report is where we can find the national service model. Services in the community have to be set up, and local authorities have to commission services. We have spoken about local authorities and commissioning. Sometimes local authority commissioning is unimaginative; sometimes it is just a case of an uplift, or of saying that it will take five hours a week to care for Mary Lou, John or James, without putting the individual at the centre of the care plan.

The LGA, ADASS and NHS England co-authored Building the Right Support. They said that before the end of 2018,

“we will take stock and look at going further”.

Can the Minister confirm that, six months on from that date, stock has indeed been taken and what “going further” means? Where have alternatives not been found, and by when will this be achieved?

Let us be clear about the scale of the issue. In April 2019, data from NHS Digital showed the continuing human rights scandal facing some of the most vulnerable in our society. At the end of March, there were 2,260 children and adults with a learning disability still being detained in in-patient units. That is 437 more than the minimum target set by the Government in October 2015 to move between 35% and 50% of people with a learning disability and/or autism out of institutions and into community-based support by the end of March 2019. The number of children has more than doubled to 240, and the biggest group of children—61%—is of girls with autism and no learning disability. I remind noble Lords that these children are detained. In one month, there were 2,605 uses of restrictive interventions—physical restraint—875 of which were against children. The average time in in-patient units, away from home, for people with a learning disability and/or autism is more than five years. Finally, 16% of people in an ATU have been there for more than 10 years.

As of a couple of weeks ago, another working group has been set up for learning disabilities and autism to fund specialist advocates to review the care of patients in segregation or long-term seclusion. That is welcome. The Secretary of State has promised to work with families, join up services and work to move people to the community where appropriate. That is welcome. But there are two areas still to be addressed: the first is money and the second is workforce. It costs quite a lot more to care for someone in the community, but that is the price society should pay for ensuring someone lives the most fulfilling life possible, with dignity. This care funding comes from local authorities, which, as I said earlier, are not all the most imaginative commissioners. They should be commissioning a care package according to what is in an individual’s care plan, but not all are. The Chancellor should acknowledge that and ensure that a realistic settlement is given to local authorities.

The failings in all the scandals I outlined earlier were human. Care workers and nurses were either ignoring any training they had received about care and compassion or were poorly trained, and certainly poorly managed and supervised. Supervisors and management either turned a blind eye, or were complicit. However, not all is doom and gloom. There are many outstanding and good learning disability services in communities. It is time we thought of care as a profession, and one that has robust registration, as in Wales, in which carers are valued and paid a reasonable wage, and in which there might even be some sort of professional progression. This will come at a cost. I hardly need to remind the Minister that we still want clarity, despite no Green Paper. Then, and only then, can we start to lay a foundation for quality care for some of the most vulnerable in our society.

My Lords, I thank the noble Baroness, Lady Thornton, for securing this serious and timely debate and I am very grateful to noble Lords for their informed contributions on a very sensitive matter. The care and treatment of people with learning disabilities and autistic people has rightly come under intense public scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society. Today’s debate provides an important opportunity to reflect on this crucial issue.

Nobody who watched the BBC’s “Panorama” programme on Whorlton Hall could have been anything but deeply shocked and disturbed by the abuse it exposed. The actions revealed by the programme, the abuse of vulnerable people in a setting where they should have been safe and well cared for, was truly appalling. We are very clear that people with learning disabilities and autistic people have the right to feel safe in their environment and to be treated with dignity and respect. As the noble Baroness, Lady Thornton, rightly said, Durham Constabulary is investigating and has so far arrested and questioned 10 members of staff about offences relating to abuse and neglect. We cannot comment on matters that might prejudice that process, but 16 members of staff have also been suspended and all patients have now been transferred out of the hospital and it is closed to new admissions. In addition, my right honourable friend the Secretary of State for Health and Social Care has asked the CQC to look in detail at its inspection and regulatory approach to Whorlton Hall to ensure that lessons are learned from what has happened in this case and in other cases that have gone before it. The CQC has commissioned independent reviews. The first is looking into how the organisation dealt with concerns raised by an inspector in a draft report prepared in 2015, as has already been mentioned; the second is a wider review of what could have been done differently or better in its regulation and inspection of Whorlton Hall between 2015 and 2019. The findings and recommendations of both reviews will be published. It is clear that opportunities to intervene were missed, and we must be open and transparent in getting to the bottom of why this happened.

The noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, mentioned the Children’s Commissioner’s report. She has also investigated the treatment of children with learning disabilities or autism in in-patient mental health hospitals. Her recently published report showed how too many children are still being admitted into secure hospitals, often a long way from their home, when they should be in their community, as well as being subject to restraint and seclusion. I will return to that in a moment. She warns that the current system of support is letting down some of the most vulnerable children in the country. We will consider her report extremely carefully.

I want to turn to points made by the noble Baroness, Lady Thornton, regarding private providers. Around half of the provision of specialist in-patient care is in the independent sector. This is carefully looked at by regulators and by the Government. At the moment, there is no evidence of a systemic difference between the quality of care and that of the NHS or voluntary providers. The care is NHS-commissioned and is subject to the same commissioner oversight, contractual provisions and regulation by the CQC. The same safeguards under the Mental Health Act also apply to protect the rights of patients. However, we keep this matter under careful review and will continue to do so.

I now turn to the important question that was raised about restrictive interventions, given the prominence they have been given in recent reports. It is important that we see a decrease in the use of such interventions. Data collection is not robust enough for us to make comparisons between years to see whether the use of restraint is rising, but it provides enough certainty for us to know that it is still used too much. We must minimise it and, where it is used, ensure that it is done safely and effectively, in line with the Positive and Proactive Care guidelines. Understandably, there is public concern about the use of restraint, prolonged seclusion and the segregation of people with mental health problems, a learning disability or autism.

In response to the case of Bethany, a young autistic woman who was held in seclusion at a hospital for far too long, my right honourable friend the Secretary of State for Health and Social Care has commissioned the CQC to undertake an in-depth thematic review of restrictive practices in health and care settings. The CQC published its interim findings and recommendations on 21 May and the Government have accepted them in full. The care of every hospital patient in long-term seclusion or segregation will be reviewed, and patients will have access to specialist independent advocates to support them and their families, as has been mentioned.

The model of care for autistic people and those with learning disabilities must be fit for purpose. We will convene an expert group to develop a new care model, taking the very best practice as the foundation. We will also strengthen the safeguards, working with the CQC to develop new regulatory arrangements for hospitals that use segregation. In addition, we will develop a new awareness-raising campaign, as has already been mentioned, so that no one will be “out of sight, out of mind”, as has too often been the case. We want to end inappropriate out-of-area placements and ensure that people are cared for as close to home as possible. Where out-of-area placements are essential, as they sometimes are for very specialist care, commissioners will need to visit children every six weeks and adults every eight weeks on site. I hope that that will improve the situation and reassure the House.

The noble Baroness, Lady Thornton, asked why the CQC registered new facilities that do not offer an appropriate model of care. The CQC has a set of stringent rules for registering the right support. It only registers a new learning disability service that meets the service model for building the right support. However, I am sure that, given the circumstances that have arisen, this will be looked at very carefully. The noble Lord, Lord Hunt, was right: given the situations that have arisen, there needs to be a holistic and systemic response.

Many of the actions that have been taken and which we have been debating began in 2014-15, and it is important that we see the progress that has been made since then. The Learning Disabilities Mortality Review Programme—the world’s only national programme looking into why people with learning disabilities die—was set up relatively recently. It has made some progress and has recommended specific steps to improve our response to those with learning disabilities in the community to ensure that they have a better quality of life. The noble Baroness, Lady Thornton, made that exact point when she talked about improved community support. That is why annual GP health checks for people with learning disabilities to help reduce recognised health inequalities is a commitment in the long-term plan, and it is why, over the next five years, national learning disability improvement standards will be implemented and will apply to all services funded by the NHS. That is one of the systemic requirements that will help to drive improvements through the system—something that I think has been missing from the response until now.

Furthermore, NHS England and NHS Digital are working to include a digital flag in the records of people with a learning disability or autism so that information can be shared across health and care records and organisations. In the NHS Long Term Plan we have committed to implement this by 2023-24. It is another systemic response that should create a significant improvement. In addition, people with a learning disability or autism, or those with the most complex needs, will have a designated keyworker. These will initially be provided to children and young people who are in-patients or at risk of being admitted to hospital. All these improvements should make a significant difference, as will the review of the autism strategy, which is well overdue.

The noble Baroness, Lady Lane-Fox, is absolutely right that augmented rather than artificial intelligence—people plus tech—has the potential to completely transform the health of this nation. I thank her for an inspirational contribution. She will be pleased to hear that we have now completed rolling out wi-fi across the GP network and that we are well on the way with the secondary care system. She is right about skills being essential to driving digital transformation across the system, and that is why we set up the NHS Digital Academy. However, we recognise that more needs to be done. Investment was one of the core elements of the Patient Capital Review. We want to drive that forward and I would very much like to hear the noble Baroness’s proposals for it.

On the Transforming Care programme, although hospital might be the right environment for a small number of people with learning disabilities or autistic people at a given point in time, everyone should have the opportunity to live in the community. When people need in-patient support, it should be for the shortest time possible, of the highest quality and delivered in the safest settings where people are free from harm and abuse. The goal of the Transforming Care programme is to reduce the number of in-patients. We have reduced the number by 22%, and we are still fully committed to reducing it by at least 35% as soon as possible during 2019-20, as set out in the NHS Long Term Plan. That remains a commitment. Local areas will be expected to use some of the growing investment in primary care and community care services to meet that commitment.

I would like to respond to the point that was made about the number of child in-patients having doubled. In part this was because, we believe, commissioners did not correctly record children in the NHS Digital figures before 2015. We are checking the data and will respond later.

The noble Lord, Lord Hunt, was absolutely right about self-training, and that is why we have consulted on proposals to introduce mandatory training. Our plans to introduce mandatory training for all relevant health and care staff will go a long way to ensuring that more people receive the safe, compassionate and informed care that they are entitled to.

We will of course continue to work with all partners across government and across the health and social care system to consider any recommendations that can improve care for people with learning disabilities and to address the shameful inequalities that they experience. Every person has a right to effective, compassionate and dignified care. If you have a learning disability, these expectations should be no different.