Cawston Park Hospital: Norfolk Safeguarding Adults Board Review

This is not unique. We have heard this before. It sounds familiar, and that is because exactly the same thing happened at Winterbourne View Hospital back in 2012. We have had the report. This was another assessment and treatment unit where people with learning disabilities or autism were abused. The 2012 report criticised the development of assessment and treatment units, saying that they were

“not part of current policy, and certainly not recommended practice…Containment rather than personalised care and support has too easily become the pattern in these institutions.”

Of course lessons were learned. Department of Health reports described the abuse of people at Winterbourne View Hospital as “horrifying”. A Department of Health programme of action was agreed, and I have it with me today. Following the statement:

“We the undersigned commit to a programme for change”,

the very first undertaking is that

“Health and Care Commissioners will review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014.”

That did not happen. Today, in 2021, more than 2,000 patients are still contained in assessment and treatment units. I use the word advisedly: they are “contained”.

This is my second request to the Minister. Will she, on behalf of the Government, recommit this evening to the needed closure of all assessment and treatment units? That is what the coalition Government committed to doing in 2012, but by 2014 it had still not been done. We need to do it now. Why do we need to do it? There is a monumental conflict of interest for these private hospitals. Beyond being merely inhumane, there is a huge commercial incentive to maintain residency, because each of these patients comes with a fat cheque of £26,000 per month.

We can see where the conflict lies and why one family member, when they went to Cawston Park Hospital, was handed a piece of paper on which was written the address of a firm of solicitors. Her statement said:

“Once people are in Cawston Park Hospital you can’t get them out.”

Patients did not leave Cawston Park Hospital, and the problem is structural. If a hospital is paid £26,000 a month to assess and treat a patient, is it surprising that the hospital does not release them?

We have had another review of this latest scandal, and the Norfolk Safeguarding Adults Board’s review of Cawston Park Hospital is excellent. I have read it. It is 105 pages long and there are 13 recommendations. I recommend it wholeheartedly to the Minister, and the Government should apply all the recommendations.

The report has been followed by the usual handwringing responses from the agencies. Action plans have been created and there have been multidisciplinary stakeholder reviews. Profound apologies have been given, and I believe they are profound apologies. Lessons have been learned, but in my submission they have not really been learned, because without a profound culture change in residential care, we will be back here again. We all know it and the public know it.

I recognise and acknowledge the frustration and strength of feeling about the issues raised today. The Department is working with the NHS, local government and the Care Quality Commission to ensure that we identify unacceptable care with urgency and take robust action immediately. I can confirm that Cawston Park closed in May, following action taken by the CQC, and all of the people who were in-patients at Cawston Park have moved either to a supported community setting or to an alternative hospital setting, where immediate discharge was not possible.

I appreciate that everyone listening will want assurance that anyone with a learning disability and any autistic person in one of those hospitals—any one of the 2,000 people he mentioned—is safe. NHS England’s reviews of each individual person’s care arrangements will ensure that there is a clear care plan in place with a clear path to discharge. Such treatment where there were no clear paths to discharge must not happen again.

More broadly, I welcome this opportunity to set out the work that is under way to eliminate poor-quality in-patient settings and properly invest in the community alternatives that people with a learning disability and people with autism deserve.

As the regulator for mental health hospitals, the CQC has a central role in identifying any cases of poor in- patient care and taking immediate action. The Department fully endorses the increased scrutiny by the CQC and its improved inspection approach, which includes spending more time with patients and their families to identify settings that are at risk of developing a closed culture. In particular, the CQC takes more account of what families have to say. The enhanced processes have revealed cases in which quality falls below the standards we expect. Where that is the case, robust regulatory action is being taken. We must not tolerate poor care and treatment, and any provider that cannot meet standards should be tackled immediately, including through closures.

In the report, families describe the excessive use of restraint and seclusion by unqualified staff. Any kind of restrictive practice or restraint should only ever be used as a last resort. The Department is taking action to increase the transparency and reporting of the use of restrictive practices, in response to the recommendations made by the CQC in its review of the use of restraint, seclusion and segregation. Increased transparency is a central aim of the Mental Health Units (Use of Force) Act 2018 statutory guidance, on which we have recently consulted. Work is now under way to commence the Act from November 2021.

As part our longer-term plans to limit the unnecessary detention of people with a learning disability and autistic people, we are seeking to implement once-in-a-generation reforms to the Mental Health Act. Under our proposed reforms, we will limit the scope to detain people with a learning disability or autism for treatment if there is no diagnosed mental health cause for distressed behaviour. To support that, the proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and that every local area understands and monitors the risk of crisis at an individual level. For those who continue to require in-patient care, we are clear that this should be for the shortest time possible, as close to home as possible and the least restrictive possible.

Alongside the longer-term plans to improve in-patient care and support, the situations outlined in the review of Cawston Park highlight the need for urgent action in quicker time. That will require cross-system, cross-Government action in a number of priority areas that have historically presented blockages to progress. The Government are taking action specifically to target such blockages, ranging from identifying best practice models in the community to ensuring that the right workforce with the right training is in place.

In closing, I thank Members for their contributions on this important topic and their commitment to ensuring that people with a learning disability and autistic people receive the high-quality care and support that they deserve. The CQC’s robust inspections are helping us to identify and prevent cases of unacceptable care, such as that of Cawston Park. It is our priority—and my personal priority—to reduce reliance on in-patient care. I have set out today the range of work that is under way not only to reduce in-patient numbers but to drive real change in the care that is available to people with learning disabilities and autistic people, to enable them to live fulfilling lives in the community, as we all want. All our actions will be shaped by the Norfolk Safeguarding Adults Board review report, to ensure that the experiences of Ben, Jon and Joanna are not repeated.