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That this House has considered the 10th anniversary of the investigation into the Winterbourne View Hospital and the Transforming Care Programme.
It is a pleasure to speak in this debate with you in the Chair, Ms McVey. I thank the Backbench Business Committee for allocating time for this important debate.
The debate is being held to mark the 10th anniversary of the BBC “Panorama” programme that revealed the scandalous treatment of autistic people and people with learning disabilities in Winterbourne View Hospital. One of the experts on the programme said that Winterbourne View was
“run by a group of bullies for their own entertainment.”
It should shame everyone involved in the healthcare system that it took a team of journalists to uncover those abuses, when complaints from whistleblower Terry Bryan were ignored by the management of Castlebeck, which ran the hospital, and by the regulator, the Care Quality Commission.
I recently re-watched the programme—a decade on, the abuse shown is still shocking.At the time, it was rightly described as “torture”.One resident was showered while fully clothed, and had mouthwash poured in her eyes. On the same day, she had jugs of cold water poured over her head and was kept outside in March until she was shivering. Another resident was asked by a member of staff whether they wanted the staff member to
“get a cheese grater and grate their face off”’.
Residents were slapped and held down under chairs. They had their hair pulled and were pinned down while medication was forced into their mouths. One resident was so distressed by that treatment that she tried to throw herself out of a second-floor window and was then mocked by staff.
I remind Members that we will be going to the Front Benchers no later than 4.25 pm, and we would also like to hear Barbara Keeley wind up within that time limit.
Thank you, Ms McVey. First, let me put on the record a declaration of interest: I chair the all-party parliamentary group on learning disability, so that is the context in which I am speaking. Mencap, which provides the secretariat for the APPG, has provided a very helpful briefing for the debate, which it has made available to all Members.
It is a great pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I do not propose to repeat everything she said, although I agree with the large bulk of it and the thrust of her remarks. I want to focus on the specific commitments that the Government have made. I am afraid—I say this with no great pleasure as a Government Back Bencher—that the Government have missed commitments on a number of occasions. I want to put on the record some very specific questions for the Minister about what the Government are doing to ensure they hit the revised targets that they have set out. I also want to remind people listening that the Government have now made a clear commitment to introduce proposals to reform social care this year. I know the Minister is well aware, as is the shadow Minister and everyone present, that social care does not just include care for older people; it includes care for people with disabilities.
I say that is because, when the public conversation happens, after about five seconds it immediately turns into a discussion only about older people—usually older people in a residential setting. We tend not to talk about older people who receive domiciliary care that enables them to stay in their homes, and the media do not focus on the fact that, actually—I think it is still the case—the majority of public spending on social care in England is not on older people; it is on people of working age. If we are to introduce social care reforms, they will not be worth having unless they properly encompass people of working age, including people with learning disabilities or autism. They will need to be very different reforms from those that deal with older people, because although many older people, though not all, have assets that enable them to make a contribution—obviously we will have a debate about the appropriate level of contribution—people of working age do not have such assets, particularly if they have been disabled from birth. If we were to have a means test of any description, we would simply build in a new barrier to people of working age with learning disabilities or autism getting into the workplace and working, which is what most of them want to do. Most of them are able to do so if we provide the tools.
It is a pleasure to see you in the Chair today, Ms McVey. I am grateful to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for having secured today’s debate, and for the depth of her commitment to the rights of disabled and autistic people over many years.
The 10th anniversary of the screening of the “Panorama” documentary that showed the horrific abuse of vulnerable residents at Winterbourne View near Bristol is a time for sober reflection. We remember the victims and their families, and the horrific trauma they suffered. What happened at Winterbourne View was sickening, and it was chilling that despite safeguarding concerns having been raised several times previously, it took an undercover documentary to prompt urgent action. The Winterbourne View scandal should have led to a genuine transformation of care and support for people with learning disabilities and autistic people. The scandal revealed a system that was not fit for purpose; a level of institutionalisation that resulted in a dehumanising culture; and huge problems with transparency and accountability. The Government acknowledged that hospitals were not the right place for people with learning disabilities and autistic people to be living, and promised to end that practice.
However, in a terrible failure, not only are around 2,000 autistic people and people with learning disabilities still trapped in inappropriate hospitals, but there have been further appalling scandals. At Mendip House, eight years after Winterbourne View, we saw the taunting, bulling and abuse of autistic people. At Whorlton Hall, nine years after Winterbourne View, we saw a disturbingly similar revelation of horrific abuse in a private hospital behind closed doors. There have been many, many individual stories of families whose loved ones end up in assessment and treatment units under the Mental Health Act 1983, who battle—sometimes for years—to get them out, and live in fear for their health and safety every single day as they do so.
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Jack Lopresti (Filton and Bradley Stoke) (Con) [V]
It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on securing this important debate.
Winterbourne View Hospital was in my constituency. The horrifying evidence of the systematic abuse of some of the most vulnerable people in my society, which happened in a place where they were meant to be safe and looked after, came to light just a year after I was first elected to serve as the Member of Parliament for Filton and Bradley Stoke. Immediately after the “Panorama” documentary was broadcast, I summoned to Westminster the chief executive of Castlebeck, which ran the hospital, and told him that the hospital had to close and that patients must be properly looked after in a sympathetic and caring manner.
Nobody who watched the documentary could be anything other than horrified by what they saw: a total and complete failure of humanity, a lack of any sort of care on the part of the staff responsible for those vulnerable adults, and the catastrophic failure of agencies and organisations to act sooner, which could have stopped the abuse before so many people fell victim to it.
In 2010, Terry Bryan, a former senior nurse at the hospital, brought forward concerns to the review. As the council states in its report on the hospital, his concerns
“made no difference in an unnoticing environment.”
The Care Quality Commission also acknowledged that it did not respond to Mr Bryan’s concerns. According to the report, it did not follow up because it thought Castlebeck and the council were doing so.
As I said in the House in September 2012, 40 safe- guarding alerts were sent to the council but not acted upon, because the council assumed that the hospital was being honest. Many of those terrible incidents could have been avoided had those alerts been dealt with. Twenty-nine contacts between the hospital and Avon and Somerset police were reported between January 2008 and May 2011. The police acknowledge that for staff-on-patients incidents, they relied far too heavily on the hospital’s information instead of listening to what patients were telling them or properly investigating concerns. Only one member of staff was ever prosecuted before the documentary was aired. Winterbourne View was a catastrophic failure of corporate responsibility and care for the most vulnerable.
In October 2012, I asked at Prime Minister’s questions whether care providers should be prosecuted for wilful corporate negligence if patients in their care had been abused. In 2013, I co-sponsored a private Member’s Bill to hold corporations criminally accountable for abuse and neglect in care settings. I am glad that since that dreadful incident, the Government have put in place some measures to improve the care of residents, and I welcome the steps that the Government have taken through national agencies such as the NHS, and local authorities, to ensure that care providers and givers are adequately resourced, and that patients are adequately protected and that their families can have confidence in the care system.
It is a pleasure to serve under your chairmanship, Ms McVey. I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing this debate. I am pleased to be here to speak on such a crucial topic. First, I want to reflect on the past 10 years since the Winterbourne View scandal, and secondly, look forward and ensure that such horrific events cannot happen again.
What the BBC “Panorama” programme exposed was absolutely shocking, disgusting and heartbreaking. It revealed patients with a learning disability and/or autism being repeatedly pinned down, slapped and taunted by staff. That community was let down. Following that, the Government promised to transform care for people with a learning disability and/or autism by 2014 by supporting those in assessment and treatment units to move out of those settings and get the right support in the community. The Government still have a long way to go before they achieve what was promised. It is vital that we continue to learn from Winterbourne View. The Government have shown that they are willing to make the necessary changes, by publishing the White Paper on reforming the Mental Health Act. I commend the reforms that it has set out.
I want to send my personal thanks to the Department of Health and Social Care as well as the Lord Chancellor for driving forward reform of the Mental Health Act. The Act has long been outdated, and I hope that implementing many of the recommended changes will fire the starting gun on changing the way our country views and treats mental health conditions.
There is a clear desire, set out in the White Paper, to change the culture surrounding mental health by enacting a person-centred approach to care. That is a new approach to the way in which our mental health service is run, and will begin to achieve the desired goal of bringing the Mental Health Act in line with 21st-century principles in medical care.
It is a pleasure to serve under your chairmanship, Ms McVey. I am incredibly grateful to speak in this debate on such an important topic, which many of my constituents have written to me about. I am very grateful to the hon. Member for Worsley and Eccles South (Barbara Keeley) for bringing this matter to the House.
It was my constituency predecessor, the Care Minister at the time, Sir Norman Lamb, who publish the in-depth review commissioned by Paul Burstow into what happened at Winterbourne View. As we know, the abuse and neglect inflicted on patients there was utterly horrific. Inspections by the CQC of 150 hospitals and care homes for people with learning disabilities found inadequate practice in in-patient services, including poor person-centred care, limited appropriate activities and a lack of monitoring and learning from incidents of restraint. The inspections were clear: we can and, as it was pledged, must do better.
In my constituency it is a real pleasure to support Frances Dawney and all the staff and residents at Abbottswood Lodge. It is an exemplary care home for residents with complex needs and, sadly, with the pandemic I have been unable to visit as much as I would like to. It is a real model of what care and love with dignity should be for adults with learning disabilities.
Ten years on, we must recognise the NHS long-term plan and the much-needed changes that it will bring to in-patient units for those with disabilities and autism. Crucially, the plan states that by March 2023 or 2024 in-patient levels will have reduced to less than half of those in 2015, and that for every 1 million adults there will be no more than 30 people with a learning disability or autism in an in-patient unit. That is something that we absolutely must achieve, because we probably all recognise that progress has not been fast enough. It is also important to recognise, as I am sure we all do, that hospitals are not where people should live. As such, I absolutely support the long-terms plans and that commitment, as we move people towards community-based support and, ultimately, closer to home.
It is a pleasure to serve under your chairmanship, Ms McVey. I direct Members to my entry in the Register of Members’ Financial Interests. I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on securing this important debate.
The circumstances of the Winterbourne View scandal have already been described, so I do not want to repeat that history, but I share others’ shock and outrage at the way in which some of the most vulnerable patients in our healthcare system have been treated in assessment and treatment units. Those attitudes and that kind of abuse should be historical; the shameful thing is that they are still with us a decade later. Ten years after the NHS should have changed for good, new scandals keep emerging.
Across the system, the levels of physical and chemical restraint remain disturbingly high. The CQC report is the latest to recommend change, and the Government’s response is needed urgently. Although there has been a welcome emphasis on moving patients into other settings, we know that there are more than 2,000 people with a learning disability or autism in assessment and treatment units right now, and about 200 of them are children.
Progress has been slow. Admissions are not falling, and those patients are still staying in ATUs for an average of five and a half years. We have yet to build enough support in the community. The building the right support programme is a catalogue of missed targets, and I hope the Minister can tell us why. We should have done more, and we should have more confidence in the targets set by NHS England’s long-term plan.
The record to date is not encouraging. Until the cross-governmental action plan is published, as promised, scepticism will prevail. We have heard why families are worried. There are two aspects of current care that particularly trouble me. The first is the widespread use of anti-psychotic medication. Drugged-up patients are no doubt easier to manage, but it can take years to wean them off those drugs, and even then the consequences continue.
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That behaviour was the end result of a system that did not see residents as people. Rather than the person-centred support that we would rightly expect in any hospital, a closed culture developed where abuse became normalised. Such abuse should not have been left to be uncovered by a journalist and secret filming. A whistleblower, Terry Bryan, had taken his concerns to the management of Castlebeck, then to the local safeguarding board, then to the Royal College of Nursing and then to the Care Quality Commission on three separate occasions. It was only when all that led to no action that he approached the BBC.
Ultimately, 11 members of staff at Winterbourne View pleaded guilty to neglect or abuse, and six of them ended up spending time in jail. However, Winterbourne View was not just a failure of one hospital or a few staff—although it certainly was that.The people in that hospital were let down by the entire system: from a provider that did not pay enough to attract or retain dedicated or qualified staff and did not supervise or manage them, to a regulator that failed to listen to the concerns of a whistleblower and to commissioners who were happy to put people in that hospital and then fail to monitor the placement or follow up with discharge plans.
Since 2011, residents in other in-patient units have been subject to similar abuse. As recently as 2019, another BBC “Panorama” programme uncovered similar treatment at Whorlton Hall in County Durham. Staff there were filmed verbally and physically abusing residents.
If the residents of Winterbourne View were let down by a system that simply did not place enough value on them to intervene, everyone who has faced abuse in those units since 2011 has been let down by a string of Governments, who have failed to take the action necessary to stop the abuse happening.
The only way we can ensure that there is no abusive treatment in those units is to move autistic people and people with learning disabilities into the community, where they can be given appropriate support to live independently. In 2011, following those shocking revelations, the Government seemed to recognise that, and David Cameron pledged to close all inappropriate in-patient units by 2014—but that was only the first in a long line of broken promises. By 2014, there were still thousands of people detained in those inappropriate institutions.
In 2015, NHS England pledged to reduce the number of people in assessment and treatment units by between 35% and 50% by 2019, but that target was missed, with the number falling only 5%. NHS England then pushed the target back a year, but that was also missed. By April 2020, the number of people in in-patient units had fallen only 15% in five years.
The NHS long-term plan then committed to reducing the number in units by 50% of the 2015 level by 2024, but on the current trajectory that will be yet another target the Government do not get close to meeting. A decade after the abuse at Winterbourne View was uncovered, more than 2,000 people are still detained in inappropriate institutions. As today’s learning disability mortality review shows, people with learning disabilities who end up in mental health units are nearly five times more likely to die young than their peers. The mistreatment people experience in those units stays with them for life, even after they are discharged. On average, people in such units have been detained in some form of hospital placement for more than five years.
What progress we have seen has been painfully slow. We still see hundreds of people admitted to in-patient units every year, and the number of children detained has risen by a third since 2015. We normally talk of admission to hospital being for care or for treatment, but neither of those words is appropriate here, and far too many people admitted to such a unit will have stories of poor treatment and abuse by staff.
Dan was left scarred by poor treatment in in-patient units, which led to him trying to overdose on pills when he was discharged, and then being detained in hospital for another 18 months. Kayleigh was moved from Winterbourne View to another hospital. Within weeks, she had been pushed and hit, and had made more serious accusations against the staff. Ryan was first detained when he was 17. Over the years, he has been isolated and held in long-term segregation. He has been heavily medicated with drugs so powerful that their side effects meant he had to have 18 teeth removed.
Hospital reports show that Ryan has experienced broken bones, and other injuries that sometimes were treated only after a week had passed. Ryan was supposed to be discharged three years ago. He has had an independent case review, which flagged urgent issues with his care. Over the past year, his family have seen their visits restricted and there have been covid-19 outbreaks on his ward. Despite media attention and legal support, Ryan’s discharge plan stalled repeatedly. While things are now looking up for him, hundreds of other people have not been so lucky, and it should not need TV crews and lawyers to get people basic dignity and proper care and support.
People end up in these totally inappropriate units because the funding is not available to support them in the community. One Winterbourne View resident, Dan, had previously been supported at home by a small specialist provider. When it asked for funding for two more hours a day of support so it could manage the triggers that set off Dan’s challenging behaviour, it was turned down. Dan’s family were then told they had no choice but to allow him to be moved to an assessment and treatment unit. That removed him from his home and from his support network. In the unit, Dan was forcibly restrained and ultimately ended up in Winterbourne View. That abusive care cost the Government £3,500 a week—far more than the extra couple of support hours he needed to remain at home.
Clearly, that was not inevitable. After the BBC’s “Panorama” programme, Dan’s family were supported to move him back home. A suitable property was found in his home village and the care staff who had worked with him before he was admitted to Winterbourne View were rehired. Nearly a decade later, he is still living independently in his own home. Unfortunately, such success stories are far too rare.
A similar story is that of a young autistic woman, Bethany, which I have raised many times in the House. She ended up in in-patient units because her local authority said it needed
“a break from paying for her support”.
By sending her to an assessment and treatment unit, it could shift the burden of funding to the NHS. That is the root cause of the Government’s failure to address this scandal over the last decade. If people are moved out of an in-patient unit, they need to be moved somewhere they will be supported. Under our current system, that kind of community support is funded by local authorities, which have had £9 billion taken out of their social care budgets over the past 10 years. Supporting a person with learning disabilities who might have complex needs is not cheap when compared with many other social care packages, so it is not surprising that cash-strapped local authorities have tried to pass the buck on funding to the NHS.
In the 1980s and 1990s, when the long-term psychiatric hospitals were closed, there was a system of dowries whereby the funding moved with the person as they were discharged to a local authority. That discouraged the kind of siloed thinking that sees a person’s human rights denied because a local authority cannot afford to fund the care they need. The Government could have reinstated those dowries. They could have given local authorities far more funding to ensure that they can support autistic people and people with learning disabilities properly in the community. They could have matched the ambition of their rhetoric with the resources that are needed.
Instead, we currently have a £62 million funding pot spread over three years to support people to be discharged. High-quality community support for people moved out of those units can cost as much as £100,000 a year, but even that is much less expensive than placements in private hospitals, which can cost six times as much. That means that the Government’s funding settlement is probably only enough to discharge 200 of the 2,000 people currently trapped in in-patient units. Because the funding only runs for three years, there is a real risk that when the funding runs out, those people will be readmitted to an in-patient unit.
We are not talking about huge sums of money when compared with the expenditure the Government have taken on over the last year. In 2019, the Labour party proposed spending £355 million a year on dedicated and targeted support, which would have been sufficient to move everyone currently in an in-patient unit into their community.
At the same time as discharging the 2,000 people currently detained, we also need to ensure that nobody else is admitted to those units, and we may need legislative measures to ensure that that happens. Underpinning any changes must be the reform of our adult social care system. We are still awaiting the details of that long-promised reform, but perhaps the Minister can tell us more today. Perhaps she can tell us whether the Government’s reform will increase funding so that local authorities can afford to support everyone who needs help to live independently in their community, including autistic people and people with learning disabilities. If it will not, one of the largest issues in our social care system will be left unaddressed.
It is a decade since BBC “Panorama” revealed the appalling treatment of the residents of Winterbourne View. As a society, we could and should have taken that as a cue to say, “Never again,” and to ensure that all autistic people and people with learning disabilities were given the support they needed to live independently in their own communities. Instead, we have had a decade of broken promises and broken targets. Rather than putting in place an ambitious programme of change, the Government have repeatedly promised reform while simultaneously cutting the funding for the very local services that would deliver that reform.
Autistic people and people with learning disabilities trapped in those inappropriate institutions cannot afford to wait any longer. Rather than more empty promises, they need legal changes to end the use of detention. Alongside that, we must see a radical programme of investment in community social care services to support them to live independently in bespoke accommodation, with care packages designed around their needs. We need a new commissioner, independent of Government, to oversee the process of moving people out of those institutions and hold the Government to account if they fail to make the progress that is needed.
After a decade of failure, I hope today the Minister can give autistic people and people with learning disabilities and their families the reassurance that they need and deserve, because it is long past time that we fixed this problem. However slow the progress, there is no excuse for not making sure all the people detained in institutions are safe. That needs to happen now—today. The two most important changes are the proper oversight of community provision, which is centred round choice and personalisation. We need bespoke packages of accommodation and care, not institutions. People can live happily and independently with an environment and support made for them.
I want to focus specifically on some questions for the Minister. I am mindful about what you said about ensuring we can get everyone in, Ms McVey, so I will try not to make my remarks too lengthy. The hon. Member for Worsley and Eccles South set out the various targets that have been missed. As I said, I take no great pleasure in that as a Government Back Bencher, so I will not repeat all the misses. I want to focus on the latest target in NHS England’s long-term plan, which is to deliver a 50% reduction in in-patient beds by March 2024.
First, I want to ask the Minister whether the Government have done any thinking about whether the 50% reduction is ambitious enough. It would be ideal if we did not have anybody in such settings and we were able to support almost everybody in the community. Perhaps the Minister could comment on whether the target remains ambitious enough. Given that the original target was to deliver a 35% to 50% reduction by March 2019, and that another five years has been added on and we are only in 2021, is March 2024 an ambitious enough target to hit the 50% reduction? Given that the previous targets have been missed, I accept that it might seem ridiculously ambitious to talk about introducing the latest target. However, given that we have let it slip by another five years, I want to test whether it is actually the right target.
The second thing is to focus on how we will reach the target. The hon. Member for Worsley and Eccles South rightly said that the only way we can really stop people being in those institutions is to provide proper support in the community. The Government have set out how they will do that with their transforming care plan and objectives about building the right support. I understand that the intention is that a cross-Government action plan will be produced, so it will be helpful if the Minister will tell us how that is going and when it will be published. To what extent will the proposals to reform social care that are being worked on improve or transform care in the community for people with learning disabilities and autism? Will the decisions to be taken this year—alongside the comprehensive spending review, I presume—provide an opportunity for a step change in getting this ambitious target delivered on time?
The Minister will be familiar with the fact that the cross-party Joint Committee on Human Rights said in its report that it had no confidence that the Government would hit the target in the NHS long-term plan. It proposed a No. 10 unit with Cabinet-level leadership to ensure reform. I listened carefully to what the hon. Member for Worsley and Eccles South said about a commissioner, but I am slightly traditional and old-fashioned, and I think that accountability in Government is held by Ministers. They are elected and accountable to both Houses of Parliament, and political responsibility for delivering on the proposals sits with the Secretary of State and the Minister. I am not keen on having a commissioner as another person who feels that it is their job to chivvy Ministers along, because that is our job, collectively, in Parliament.
I do want to know, however, what mechanisms are in place whereby the Secretary of State for Health and the Minister for Care can monitor what NHS England is doing. At present—this will not be the case under the proposed legislation—NHS England is an arm’s length body with a chief executive, so what are the Secretary of State and the Minister doing, on a regular basis, to hold NHS England to account to ensure that it delivers on this ambitious timetable, and perhaps achieves a more ambitious one?
My experience in Government is that if something challenging has not happened in the past, there is only one way to get it done: Ministers making it clear, and saying, that they care about it; and, most importantly, showing that they care about it by focusing on it regularly, asking for information about delivery across the country—Mencap’s report shows that delivery is inconsistent throughout the country—and getting regular updates on progress, putting a bit of stick about when things are not on track. To do that, they need a plan with regular milestones so that progress towards a target can be measured. It would be helpful—there is no reason why it could not be done—if progress towards such milestones were not just shared with the House, but published, so that the families of people who have been badly treated, including those at Winterbourne View, can see that we are making progress.
Before I conclude, I wish to focus on the use of restraint, seclusion and segregation. I understand that a trigger for the Joint Committee on Human Rights inquiry and a CQC investigation was a BBC Radio 4 “File on 4” programme revealing the shocking use of restrictive practices in in-patient units. The CQC report, which was ordered by the Secretary of State, revealed widespread and frequent use of restrictive practices, including physical and chemical restraint, long-term seclusion and segregation. I understand that we are still waiting for the Government’s response to the report, so it would be helpful if the Minister would set out when it will be published so that we can find out what the Government will do as a result.
I hope that the Minister will set out a plan to make sure that we deliver against the new target so that we will not sit here in a few years saying, “The target that was set has been missed and rolled forward again,” with the families who have been subjected to unacceptable care feeling that no one is listening to them, and we are back on the hamster wheel with nothing having been done. If the Minister can focus on that, we will have taken a big step forward.
The failures are all the more distressing because we know what good care and support in the community looks like, from examples such as Alderwood LLA in Northamptonshire. It runs small homes for autistic people, and all of its services are rated by the Care Quality Commission as good or outstanding. I have spoken many times in this place about my constituent Matthew Garnett, who as a 15-year-old was sectioned and taken to an ATU. I supported Matthew’s parents as they battled for months to get him out of hospitals. With his parents, I visited him in hospital—at St Andrew’s in Northampton—where I was shocked both by how ill Matthew had become, particularly how much weight he had lost, and by the attitude of some of the staff who were responsible for his care. St Andrew’s has been found by the CQC to have multiple failings in several different inspections. Later, I visited Matthew in his new home, provided by Alderwood, where he was almost unrecognisable—a healthy, happy young man, enjoying football and trips to the seaside, volunteering in his local community, requiring a tiny fraction of the medication he had been prescribed in hospital, and living life to the full.
One of the keys to Alderwood’s success was undoubtedly the training and skill of their staff, who are highly specialised in communicating with, and supporting, autistic people. They were able to see such huge improvements in Matthew’s health in part because they were able to communicate with him in ways that reduced, rather than exacerbated, his anxiety. I pay tribute to the campaigning work of Matthew’s mother, Isabelle Garnett, who in recent years has used her family’s terrible experience to campaign under the banner of Homes Not Hospitals. Matthew should never have been in St Andrew’s, yet the Government continue to funnel millions of pounds into inappropriate hospital-based accommodation —places where health and wellbeing deteriorates, where people are physically and chemically restrained or put into seclusion, where contact with friends and family is limited, and where patient advocacy is in short supply.
The Government’s failure to deliver transforming care has been due to a lack of political will. It is not enough to just close hospital beds if the funding is not available to deliver homes in communities. It is not enough to expect that people will not be admitted to hospital if there is such limited support available for people with learning disabilities and autistic people in communities that many families find that they are unable to cope, and face crises of mental health or increasingly challenging behaviour.
The failure to deliver transforming care is also fundamentally linked to the failure to deliver social care reform more widely, and to the paucity of the Government’s vision. We need a sustainably funded social care system that enables everyone with support needs—whether they are working-age adults or older people—to live as independently as possible with dignity and love, but the Government have dragged their feet, ignoring social care for more than a decade.
We have heard far too many statements of outrage and warm words from the Government; we need action. I call on the Minister to put in place the funding needed to deliver homes not hospitals for people with learning disabilities and autistic people, and to stop funnelling NHS money into inappropriate private hospital placements, which so often do more harm than good.
In December 2012, the Government published the “Transforming Care” report. It was of course vital to look at what lessons had to be learned and at what actions the Government must take to stop that abuse ever happening again. Some changes were made. The Government introduced a more rigorous registration, assessment and inspection process for learning disability services, and the Care Act 2014 set out a new basis for adult social care, which included the concept of wellbeing for individuals, including people being in control of their day-to-day lives, and residents having suitable accommodation and being able to contribute to society. The Act also reiterates the importance of good-quality, independent advocacy, and supports people, their families and carers, to help them raise concerns. It also requires local authorities to consider people’s views, wishes and beliefs, and focus on the end results that the people themselves want to achieve.
In January this year, the Government closed the consultation on reforming the Mental Health Act 1983. The changes that the Government are proposing are based on four patient-centred principles. Those principles are choice, autonomy—using the Act’s powers in the least restrictive way—ensuring that patients are supported to get better and, crucially, ensuring that patients are viewed and treated as individuals. The changes will allow people to make choices about their own care when they are well, and choose who might represent them should they become unwell. The Government have focused, as has been said earlier, on reducing levels of in-patient care for people with a learning disability and/or autism. Hospitals are not where people should live, and the Government have committed to move more people into community-based support. However, as we all know, that ambition has been postponed. The most recent target, as set out in the NHS long-term plan, is for a reduction in in-patient provision of 50%, compared with 2015 levels, by 2023-24.
As the commission recommended, the priority for the Government now must be to improve access to community-based mental health support, including crisis care, to prevent avoidable detentions under the Mental Health Act. I am pleased that this is already under way, backed by a ring-fenced fund of £2.3 billion a year as part of the NHS long-term plan.
We must continue to learn the lessons from the terrible events at Winterbourne View. Those who are entrusted to the care system, and their families, must be confident that their wellbeing is the highest priority for those responsible for their care, and of course we must all continue to ensure that such horrific abuse can never be repeated. It cannot be in any way justifiable that alerts are ignored by local authorities and the police, as they were with those terrible incidents, which could have been prevented and should never have happened.
Having spoken to stakeholders, including Mind, the National Autistic Society, Rethink Mental Illness and the Mental Health Foundation, I want to share the conclusions that I have drawn and the lessons that must be learnt following the atrocities of Winterbourne View. Broadly speaking, they are, first, ensuring that the shift from in-patient care to care in the community is backed by a Government commitment to provide community support services. Secondly, all in-patient facilities must take into consideration the requirements of all their residents, and ensure that when individuals are ready to be released, the right care in the community is in place for them. Thirdly, to prevent situations from reaching a stage where individuals have to be placed in an in-patient facility, we must emphasise early intervention.
I applaud the long overdue decision in the White Paper to remove autism and learning disabilities from the definition of mental disorder in the Mental Health Act. For too long, autism and learning disabilities have been grounds for detention under the Act. I also welcome the commitment to build new mental health hospitals, with two schemes already approved and more to come. And we will tackle the maintenance work needed in the mental health facilities where patients are treated.
Before new projects commence, however, it is essential that we ensure that all new facilities that are built take into account the needs of those with autism and learning difficulties. Removing autism and learning disabilities from the terminology of the Mental Health Act will not mean that individuals with autism and learning disorders will not suffer from poor mental health, so they will require access to those facilities in time. Therefore, we cannot continue establishing new mental health facilities that are not constructed with all those who will access them in mind. The needs of those with autism and learning difficulties may be different from those of others who access in-patient services, and those needs must be catered for. I would welcome a new approach to the creation of in-patient facilities that means that the needs of those with autism and learning disabilities are given greater consideration.
The White Paper states that care and treatment reviews will have statutory force to help to address inappropriately long stays in in-patient units. This is a welcome development that will ensure that people with autism and learning disabilities do not become trapped in in-patient care. In total, 2,040 people who have a learning disability and autism remain detained in in-patient settings and 59% of those people who have been detained in hospital have had a length of stay of over two years. That is simply not good enough. However, there are other barriers in place, ensuring that individuals are not being released from in-patient care at the appropriate time. There is a lack of programmes and facilities for people to be released into.
Without the appropriate resources in place, individuals are becoming trapped in facilities that may no longer have the correct environment. I spoke about this today with one of my constituents in Broxtowe, Justin Donne, who is chairman of the board of trustees at Autistic Nottingham. He had this to share:
“What has become clear in our communities is that the suffering of autistic people being locked up is needless, as our advocacy, social and personal assistance services have successfully kept most of our service users out of that condition. Moreover, we get occasional requests from outside our geographical remit”—
that is Nottinghamshire—
“regretting that they do not have the appropriate facilities in their location. This proves that we obviously need to significantly invest more funding in organisations such as ours”—
that is Autistic Nottingham—
“who provide real, tangible help that benefits both the individual and the community, and saves money and hospital resources by investing in essential preventative services.”
The National Autistic Society’s vital community work is a testament to just how successful community support can be in helping individuals outside an in-patient facility. More must be done to address these issues and I look forward to hearing the Government’s comments on this area in particular. I would welcome a commitment to evaluate and improve the services that are currently in place across the UK to support individuals with autism and learning disabilities when leaving in-patient facilities.
The Government have committed £31 million of mental health recovery funding for a range of projects, including admission avoidance and quality of in-patient care. I would welcome a breakdown from the Minister of what specific projects will be funded.
The focus of the White Paper is on a new person-centred approach to care. Putting the individual at the centre of their own treatment enables them to make their own decisions surrounding care and results in a more tailored approach. To those with autism or learning disabilities, it is even more vital that the care is centred on their specific needs. The introduction of a statutory advanced choice document will go a long way to ensuring that that is acted upon and to enable people to express their view on the care and treatment that works best for them as in-patients, and that is before the need arises for them to go to hospital. As the White Paper states, putting these plans on a statutory footing for the first time will require them to be developed in good time in partnership with patients.
My concern about shifting the emphasis of care away from in-patient facilities to community support relates to whether properly established and funded support is in place in the community. The NHS long-term plan established a commitment for increased community support for early mental health intervention, which is echoed in the White Paper. I would welcome a detailed outline of what this expansion of community support will look like at all levels, how and when it can be expected and how it will be implemented across the UK to ensure that all areas of the UK have the same levels of support. As I have stated, we need to focus on prevention. If that is not possible due to the complex needs of the individual, how can we ensure that individuals with learning disabilities and autism in hospitals are safe and respected, that their dignity is maintained and that their human rights are not violated?
I spoke recently with another constituent of mine, Ashley Swinscoe, who does vital work supporting those with autism and/or learning disabilities within our local community. He discussed early intervention and proposed that schools needed to offer support to individuals until they were 21 years old. He said that, through this stage, consistent support should be offered from childhood to adulthood. This consistency would help the individuals manage the stress caused by the changes in life. That would also reduce the risk of behavioural and mental health declines.
If individuals are not ready for supported living and require residential care, providers must also offer supported living in the future. Residential care is not long term, and providers should promise to progress individuals to become more independent, with fewer restrictions, and to move to supported living. That is a suggestion from Ashley Swinscoe from my constituency.
Drawing on the new care models in mental health services, local providers will be able to take control of budgets to reduce avoidable admissions, enable shorter lengths of stay and end out-of-area placements. Where possible, more people with a learning disability, autism or both will be able to have a personal health budget, which will give them a real opportunity to live in their own homes or with their families, rather than in an institution. In North Norfolk, I have worked tirelessly on mental health—my predecessor was such a champion of it. It is so important across the country that we get mental health hubs implemented in areas, and see mental health practitioners in primary care GP networks. That is something that is beginning to be rolled out in my constituency.
Since 2015, the number of people in in-patient care has decreased by almost a fifth, and about 635 people who have been in hospital for more than five years have been supported to move back into the community. Although that is encouraging, it is also a sign of how much we still need to do to ensure that every single person with a learning disability can lead a fulfilled life with the dignity and respect that they deserve.
Social care reform cannot come soon enough. It is rather nice that I have the Minister sitting so close to me. I regularly talk about this matter, and I want to go back to what was said earlier: older people dominate this agenda, but about 50% of all people requiring social care are adults with disabilities, and we must not forget them. The golden question for the Minister to answer is: will we see the social care reforms later this year? We must address social care reforms, not just for older people but for people with disabilities, right the way through to young carers. That is an apt point, as this week is Carers Week.
The second aspect, which can be read about in The Daily Telegraph today, is “do not resuscitate” notices. I put that matter to the Secretary of State for Health and Social Care at the Select Committee meeting today. What we are really talking about here is a culture—a culture in which the needs of those with learning difficulties or autistic people are sometimes treated as not important. As many hon. Members have said, these people are able to live fulfilled lives. They are human beings, with plenty to live for. It is hard to accept the idea that a “do not resuscitate” notice could be placed on the record of Sonia Deleon, who very sadly died. When they looked at why she would not be resuscitated, it simply said the words “learning disabilities”. That is unacceptable.
Our pride in the NHS should not blind us to its failings. It has systematically failed people with learning difficulties and autistic people. Their trauma is real. The damage is lasting. I have confidence that we now have a Government who are going to take their commitments on social care seriously and, as many Members have said, that includes those in the working-age population and not just those who are old. This action must finally happen.