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Care Quality Commission Report

Volume 808: debated on Tuesday 15 December 2020


Asked by

To ask Her Majesty’s Government what steps they are taking in response to the report by the Care Quality Commission Out of SightWho Cares?, published on 22 October.

My Lords, the Government are clear that in-patient care should be high quality, therapeutic and for the shortest time possible, and that any kind of restraint should be used only as a last resort and in line with strict protocols. That is why the evidence in the CQC report of poor care and excessive use of restrictive practices is so unacceptable. Our response to the report from the Joint Committee on Human Rights in October outlines many of the measures that we are already taking. We will respond formally to the specific recommendations in the CQC’s report at the earliest opportunity.

My Lords, this report details an horrific culture of restraint, seclusion and segregation in the care of people with learning disabilities and autism. NHS data seems to show around 3,400 in in-patient care, some in isolation for 13 years, with no meaningful activity, outdoor space, natural light, furniture or belongings—their food served through hatches and their only human contact via intercoms and screens. Does the Minister agree that, while that number is unacceptably high, it is low enough that the development of pathways individualised to support community living should be possible? The costs might be high, but the cost of hospitalisation is higher. When will government deliver those long-promised solutions and end these abuses of human rights and human dignity?

I am not sure that I completely recognise the numbers given by the noble Baroness. In August, there were 365 instances of seclusion and 10 instances of segregation of those with autism and learning difficulties, but I would be glad to correspond with the noble Baroness to clarify those things.

I reassure the noble Baroness that the progress that we are making to create the pathways to which she rightly alludes is very much the focus of the department. Earlier this morning, the Minister for Social Care chaired the first Building the Right Support delivery board, in which she brought together representatives of the NHS, LGA, ADS, DfE and MHCLG to make progress on exactly what the noble Baroness is talking about. I reassure her that funds of £74 million have been put in place to help those with autism and learning difficulties who are being discharged into the community.

My Lords, the 66 case studies across hospitals and community settings in this very shocking report were of extremely vulnerable people who have all been badly let down by the health and social care system. Most depressing of all is that the actions promised after Winterbourne View and similar appalling situations in the past, which we hoped would lead to major changes in treatment and understanding in the care and support of autistic people and those with learning difficulties, have just not happened. Once again, there is a litany from the patients themselves, and from their families and carers, saying that, if they had received help and support earlier, or when in crisis, they may not have needed hospital care. What are the Government doing to ensure that the right community support is in place for people with autism or learning difficulties in every local area?

I completely endorse the noble Baroness’s observations. She is entirely right that the 66 case studies in the report make very harrowing reading. That is why the report was commissioned in the first place, as an acknowledgment that the current state of affairs is not acceptable and needs to improve. Overall, £4.5 billion is going to primary care and community health services, and that is additional money to be committed by 2023-24. It is part of the Government’s overall commitment in this area, and we look forward to publishing a White Paper on mental health shortly.

I thank the noble Baroness, Lady Bull, for tabling this Question. The Care Quality Commission report is deeply shocking reading—the utter cruelty of using seclusion and segregation in care settings for people who cannot advocate for themselves. I note that the report recommends that families and advocates are involved in the development of care plans, and I fully agree with that.

Would the Minister comment on the unintentional consequences of Covid regulations in care homes, which means that there has been a huge expansion of the numbers of those who are secluded and segregated who cannot advocate for themselves? For example, there are those with dementia who have been locked away, deprived of contact with their advocates and loved ones and, equally, treated with undignified and inhumane measures. Will he look at the harrowing examples detailed by the Rights for Residents campaign, which will show him that it is not just a small number now but many more, sadly, as an unintentional consequence of government policy?

My Lords, I would be grateful to hear from the Rights for Residents campaign, which sounds like an important and valuable contribution. I reassure the noble Baroness that the numbers of those who have undergone restrictive practices who have autism or learning difficulties do not appear to have risen during the pandemic. That is not to say that the current numbers are acceptable.

My Lords, I refer to my interests in the register. My noble friend has not mentioned—and I would like to remind him of it—that in 2009 Parliament passed the Autism Act. It is the only medically diagnosed condition, apart from mental health, considered important enough to have its own Act of Parliament. Many of the issues raised in the CQC report to do with diagnosis and failure to intervene at an early stage with appropriate and timely interventions are covered in the Autism Act. Will he ask his department to look again at that Act, which is subject to ministerial guidance, and make sure that not only is it implemented but there is sufficient funding for that Act to be put into practice?

I am very grateful for the reminder from the noble Baroness, and I would be glad to take her recommendation back to the department and write to her on whether there are any measures that we need to put in place to ensure that we are fulfilling our commitments under the Autism Act. It was an important Act, and I suspect that we are well within the measures that it has enacted.

My Lords, the noble Baroness, Lady Wheeler, is right to flag that this is not the first time that we have heard this catalogue of appalling treatment. The shame is that in some places local authorities and the NHS use a one-size-fits-all approach to commissioning services. We have to put the individual in care at the centre and treat them and their needs. When did a Minister last issue commissioning guidance to local authorities and the NHS in this matter, as the partners that have to commission the process? What family involvement is recommended in those conversations?

I cannot go into details of commissioning guidance in this short Question, but I reassure the noble Baroness that, when it comes to family involvement, new guidance has been issued in response to the Joint Committee on Human Rights, which puts family involvement in any seclusion or restraint decision. That is an immediate development since the report in October.

My Lords, one thing that comes clearly through the report is the vast amount of different government departments and agencies involved in providing this care. What are the Government doing to ensure that there is proper co-ordination between the various different bodies so that the patient, the person who has to get the care, is assured of getting it —for both them and their families?

My Lords, my noble friend makes an extremely important point. The role of families and communities in the social care provided to those with autism and learning difficulties is extremely important and will be at the centre of every recommendation that we make in response to this report.

I declare my role as chair of the National Mental Capacity Forum. Are the Government considering the separation of learning disabilities from within the Mental Health Act to drive training in early crisis recognition and de-escalation in the community, learn from good practice and pilot alternative ways of providing places of safety in a crisis? The underlying social problems need social care solutions and are not always appropriate for, or amenable to, medical intervention.

The noble Baroness makes her point extremely well. These are exactly the kinds of questions that have been considered by Sir Simon Wessely’s review of the Act. As I said earlier, we are looking forward to publishing a White Paper on the Mental Health Act 1983 shortly, and those are exactly the kinds of issues that it will seek to address.

My Lords, I refer the House to my interests in the register. As vice-chairman of the All-Party Parliamentary Group on Autism, I know all too well the devastating impact this undignified and inhumane so-called care has had on many autistic people. A new autism strategy is crucial, setting out how the Government will ensure that autistic people receive the right support and social services care in the first place, so that they do not end up in these hospitals. Can the Minister assure the House that the autism strategy will address this and the services supporting it receive the funding they need so that autistic people can have the quality of life we all enjoy and take for granted?

I completely acknowledge the noble Lord’s championship in this area. He is right that autism is a distinct condition that should not necessarily be treated in a clinical surrounding, and I pay tribute to those in social care and community care who provide more thoughtful, considerate and sympathetic care environments for those with autism. I share his aspiration that those with autism should be cared for in a productive way that gives them fulfilled lives. He is entirely right that we need to continually refine our strategies to ensure this ambition.