Ian Paisley (DUP)

I beg to move

That this Assembly expresses concern that more than 100 adults and young people with learning disabilities have been forced to remain in Muckamore Abbey Hospital, Antrim — some for periods extending to several years — because appropriate care within the community is not available; demands a full inquiry into the situation to ensure it cannot occur again; recognises the frequently undervalued contribution of staff, families and carers; and calls upon Government to implement urgently the recommendations of the Equal Lives Learning Disability Report of the Bamford Mental Health Review.

As Members of the DUP, Mrs Robinson MP and I tabled the motion, which should appeal to all in the House.

Many people across the Province were touched to learn of the plight of those with learning disabilities — including children and young people — and who were prevented from leaving hospital on account of insufficient funding for community services. It seems strange that the places in which they were supposed to receive benefits developed into places in which they were imprisoned.

Those people were well enough to go home and should not have been kept in hospital. For too long, the needs of people who have learning disabilities have been ignored and have been left languishing at the bottom of the resources queue. In highlighting their needs, their voices have not been as strong as others.

In order to improve the care of those with learning disabilities it is essential that the Government move quickly to implement the recommendations of the ‘Equal Lives: Review of Policy and Services for People with a Learning Disability in Northern Ireland’ report published by the Bamford Review of Mental Health and Learning Disability (Northern Ireland). A massive amount of time and effort has been invested in producing the report, encompassing views from a comprehensive range of backgrounds, and it cannot be allowed to gather dust. It must be dusted down and its proposals studied and applied.

The report provides a road map for change that includes assisting those with learning disabilities to live in their own homes, feel part of the community and have a greater degree of independence. Those with learning disabilities should have exactly the same opportunities as everyone else. There is an onus on all sectors to achieve that. Carers believe that the ‘Equal Lives’ report is the best piece of work that has been produced in Northern Ireland on this issue, and, if implemented, could have the potential to transform the experience of those with learning disabilities and their families.

The needs of those families and carers must be addressed. More emotional and practical support for families is essential. Many parents are forced to give up employment in order to care for a young person, and that has an obvious impact on the household income. There is a real level of informal care provided across Northern Ireland, and the good nature of parents and families is hugely undervalued at Government level.

Equally worthy of praise is the dedicated work of staff — often in difficult and stressful circumstances — both at Muckamore Abbey Hospital and in the com­munity. Muckamore Abbey has been a hospital for people with learning disabilities since 1960. It is managed by North and West Belfast Health and Social Services Trust and is currently in the middle of a major reform and modernisation programme. Since the mid-1980s, the number of patients in the hospital has reduced from over 800 to 296. That reflects Government policy that people with learning disabilities should not have to live in hospital. In 1995, the Department of Health published a paper entitled ‘The Health of the Nation: A Strategy for People with Learning Disabilities’, which stated:

“Each Board and Trust should develop a comprehensive range of supportive services for people with a learning disability and their carers. The overall objective is that, by 2002, long-term institutional care should no longer be provided in traditional specialist hospital environments.”

Clearly, that target date has not been, and will not be, achieved.

However, a plan to resettle people who did not require hospital care had been agreed and implemented from the late 1990s. The ‘Equal Lives’ report recognises that some people will require a period of assessment and treatment in a hospital, but states:

“Everyone should have a home address to which they will be discharged.”

The report also describes the range of services required to maintain and support those people to live as independently as possible in the community. A review of regional bed numbers undertaken by the Department of Health, Social Services and Public Safety in 2005 defined the future requirement for Muckamore Abbey Hospital as 87 beds.

In 2004-05, however, funding to continue the resettlement programme ceased. At that time, it was also becoming clear that almost half of the people admitted to the hospital had their discharges delayed because funding was not available to develop the appropriate support required in community services.

In 2002, the Department of Health, Social Services and Public Safety approved a business case to provide the capital to build new accommodation at Muckamore Abbey Hospital. A new 35-bed assessment and treatment centre and a 23-bed forensic service were developed. Those buildings provide excellent accommodation and appropriate environments for people with learning disabilities who require a period of admission to hospital.

In order to move patients into those buildings in October 2006, however, the North and West Belfast Health and Social Services Trust had reached an agreement with the Eastern and Northern Health and Social Services Boards that two wards would close. Since fewer people than expected moved to com­munity services due to the ending of resettlement funding, some wards had to be brought together to fulfil that commitment to the boards.

More patients than anticipated, therefore, remain on the wards. It was recognised that some patients would be unhappy about the moves, and that their needs would be reviewed following a three-month settling-in period. That process is now under way. Muckamore Abbey Hospital has to employ several different strategies to manage risks and keep patients and staff safe. That includes the locking of doors in some wards.

Returning to the crux of the problem, huge difficulties remain in discharging patients from the hospital to an appropriate community setting. Many of the patients whose discharge has been delayed are younger people with complex mental-health support needs and challenging behaviours. The provision of appropriate accommodation and support services can cost between £80,000 and £200,000 per person per year. A continuous and recurring funding stream is required from the Government to develop those services and enable people to leave the hospital.

Muckamore Abbey Hospital also operates one 16-bed children’s ward. The North and West Belfast Health and Social Services Trust is currently at the advanced stages of completing a business case to relocate that assessment and treatment service for children to a site in Belfast. The business case identifies a need for eight beds for that service, and also emphasises the importance of making appropriate provision for children with complex and challenging behaviours.

Families have expressed the urgent requirement for respite services and residential accommodation. There is also a need for eight additional places in the com­munity, requiring an additional £8 million. The assessment and treatment centre and the provision of other services to support children and families are in keeping with the priorities outlined in the ‘Equal Lives’ document.

In closing, I appeal for sufficient funding to allow those vulnerable members of Northern Ireland society to leave hospital and lead as normal a life as possible in the area from which they come, close to family and friends. Furthermore, I press the Government not to ignore the ‘Equal Lives’ report and to proceed with the speedy implementation of its recommendations. I am sure that my remarks will have the support of the entire House.

I regret that Dr Farren is not in the Chamber at the moment, but I trust that his colleagues will convey my best wishes to him.

I have never experienced retirement and cannot, therefore, recommend to him what to do with his time. However, perhaps Dr Farren would like to give me some recommendations a year from now.

Billy Bell (UUP)

I add my voice to the concern expressed in the wording of this timely motion. It is important that parties mark the last sitting day of the Assembly by speaking up for some of the most vulnerable and disadvantaged members of our community. I am grateful to Dr Paisley for proposing the motion.

It is right and fitting that Members make clear to the policy-makers in Government that they have scored a massive own goal in the case of Muckamore Abbey Hospital. In many ways, the situation there provides a far more fitting indictment of the failure of direct-rule Ministers than any number of words spoken by their critics in the Chamber or elsewhere.

Future policy-making must be copper-fastened against the kind of institutionalised neglect that Muckamore Abbey represents. Make no mistake, the failure is at the highest level of Government. It is not a failure of the dedicated men and women who work in the Health Service and the caring professions. I have nothing but praise and admiration for all the staff at Muckamore Abbey.

The failure is largely due to the lack of account­ability in the political system. Had local, accountable Ministers been in charge, there is no way that the Muckamore issue would not have been aired in the Assembly before now. It is a failure of the twin evils of cost-cutting and remoteness that have so bedevilled the direct-rule fiasco that we are enduring.

The BBC discovered that the discharge from hospital of well over 100 adults with learning disabilities has been delayed for an average of three and a half years. One man remains in the unit 10 years after his treatment ended. Yet, for over 10 years, there has been a policy that no one should live in hospital long term. How can that have happened? It is a mystery — or is it? Do the Civil Service and the Health Department have no way to test whether they adhere to their own policy guidelines? If not, what was the point of putting those guidelines in place?

I agree with my colleague Dr Coulter’s comments, reported in the local newspaper at the weekend. He said that the entire reform of public administration (RPA) process is deeply flawed in its consideration of health issues. The RPA will perpetuate the under­funding situation in the very areas of the Health Service that helped to precipitate the Muckamore Abbey crisis in the first place.

The failure to differentiate between primary and acute budgets in the RPA proposals means that many current Aunt Sally community-based services will still be hard up. Following the funding-generated Muckamore crisis, there must a new way of looking at public service reform. Thus far, it has been far too bureaucratic and driven by empire-building pen-pushers.

It is time for the Assembly to revisit the RPA process, and that should happen as soon as possible after the election. Democratic accountability and patient care must be at the forefront of the Assembly’s actions.

That should inform what we put in place.

Many feel that it is time that the Health Service had a much lighter administration and that more money was spent on front-line healthcare professionals, including those who work in the community. That is the only way in which to prevent another Muckamore-like fiasco occurring. There is nothing more sterile than seeing an army of pen-pushers, as I call them, chasing targets when patients lie festering and undischarged from hospital because the system could not get its act together to establish a procedure that would allow those people to be released properly.

I take great pleasure in supporting the motion.

(Madam Speaker in the Chair)

Sue Ramsey (Sinn Féin)

I also support the motion. It is important for the Assembly to debate issues that are important not only to MLAs, but to the constituencies that they represent and to the community as a whole. However, I put on record my concern that other parties did not support the Sinn Féin motion on collusion, which is also an important issue.

I also put on record my disgust that in this day and age we allow our most vulnerable people to be treated as though they are second-class citizens. The motion reminds me of the debate that we had several weeks ago on the Bamford Review, when we talked about the conditions in which people are treated. We hoped that once the review had been completed, its recom­mendations would be put in place. Therefore it is sad that we are in the Chamber this afternoon debating a similar issue. However, society will be judged on the fact that it treats its most vulnerable as though they are second-class citizens. I am appalled at that behaviour, as, I am sure, is every other Member.

Politicians do not often commend the media, but the BBC and the investigative report that its journalists carried out into the matter need to be recognised. Journalists do not often carry out investigative reports, but the BBC brought the matter to our attention, and that should be recognised.

We have learned that many young adults are being looked after inappropriately in Muckamore. That is an infringement of their human rights. It is also an indication that the Department of Health, Social Services and Public Safety has failed to provide the kind of support and care that would allow those young adults to live as independent people with lives that are as full as possible. However, we also have a responsibility to ensure that young people, particularly those who have disabilities, can be supported fully and included in society.

It is also important to remind Members that the chief executive of the North and West Belfast Health and Social Services Trust and the permanent secretary of the Department admitted in their interviews that they got it wrong. That is probably the first time that I have heard such an admission, and I was shocked and amazed that they admitted it so soon. However, now that they have admitted that what happened was wrong, they have a duty to tell us how they will right that wrong. Going back as far as July 2000, I am reminded of the ‘Children Matter’ report. That considered a way forward for residential care and highlighted the particular needs of disabled children and young people. It seems that little has happened to improve their position since we debated that report. If something has been done, it has failed those young people.

Sinn Féin does not believe that disabled children and young people should spend their lives being looked after in hospital: they are not appropriate places in which to give long-term care to children who require it. However, we must acknowledge that there will always be children who have challenging and complex needs and behaviour. We need to remind ourselves that it is too much to ask the parents of such children to provide care 24 hours a day, 365 days a year.

Parents often reflect the exhausting and sometimes demoralising experiences of both providing care and accessing services for their children. They describe it as a daily uphill battle to try and secure individual elements of care from different agencies, and a battle on all fronts to get the smallest amount of support. It is important that we recognise the difficulties faced by parents and how they sometimes have to face the difficult choice between an inappropriate service and no service. They may, on occasions, have to balance the needs of different children in the family and sometimes access the only respite care available to ensure that the other children are protected.

We need to acknowledge that alternative provision is certainly insufficient and that the most dangerous step would be to take a knee-jerk reaction that could put children into more inappropriate placements. In the interim, provision at Muckamore Abbey Hospital should be subject to the same standards that are applied in other environments where children are looked after.

Planning for children’s disability services should be resource-led and should be in children’s services rather than being driven from a disability perspective. That would ensure that disabled children do not spend long periods of time in respite care and do not become children in care by default. Many of the children in Muckamore Abbey Hospital have complex needs and, more than any other group of children, they require the co-ordination of services and prioritisation of their needs by a number of professionals. For example, they may require nursing staff, medical staff, social workers, pharmacists or behavioural nurses. No one should underestimate the level of resources or co-ordination required to support a child with challenging needs in an appropriate setting, or the work needed to create such settings where they are not available.

We may be using residential respite inappropriately for children who could be better supported in community placements — and people should take that on board. If that is the case, as recent stories suggest to me, then places are being taken up that could be better targeted at those who need them most.

It is essential that services are reviewed for the children on an individual basis and that a response appropriate to their needs is put in place. For example, where a child has challenging and complex needs there should be a service in place from the child’s birth, and throughout its life, which includes the child and supports the family.

The board and trust have recognised their respons­ibilities in this case. I want a review of the needs of all of the children and families involved and clear service plans to meet the needs and rights of those children and young people. The plans must include their inclusion, as fully as possible, in the community, and as independent a life as possible for them.

To conclude, I support the motion and the call for the urgent implementation of the Bamford Review. It is in order, Madam Speaker, to ask for a report, through your office, from the Department on the current position of the review because the Assembly passed a motion recently on the issue. Go raibh maith agat.

Carmel Hanna (Social Democratic and Labour Party)

I support the motion. People with learning disabilities are likely to need additional support to enjoy as ordinary a life as possible — they must be valued for who they are as human beings and not measured by their disability. They must have the same rights and opportunities as other citizens. Despite consensus between the NHS and the various statutory and voluntary agencies about the need to develop consistent and continuous assessment service, that has not been achieved.

People with learning disabilities continue to be marginalised and excluded from mainstream services. As we have seen through the recent example at Muckamore Abbey Hospital, sometimes people are institutionalised for many years. Some of the patients in Muckamore Abbey hospital would be much better being in a community setting. They have very complex needs and require considerable resources and appropriately trained staff. However, they must be equally valued.

Young people and their families need to be better consulted and informed regarding diagnosis and treatment and their views need to be better taken into account.

We need personalised and comprehensive assessment and treatment plans and a clear and flexible action plan for treatment with ongoing dialogue between patients, family, carers and medical staff on patient progress and potential discharge. The whole process is for many so uncertain that it becomes a most worrying experience. Many young people do not know what will happen to them next, what to expect on admission or when they might be discharged home or elsewhere.

Children and young people with severe disabilities may have specific medical needs in childhood, but the basic care needs of disabled children are really no different from those of other children. They are children first. In this context, it is important to recognise the effects of placing a child in a setting such as Muckamore Abbey rather than in a community setting where they have the support of family. Many young people in distress are being admitted to adult wards for treatment because no community-based care is available. Muckamore may be the right place for assessment, for a longer stay, or give the most appropriate care for some people — but not for the people we are discussing today.

Being in distress is a frightening experience in itself, but to be placed in a hospital for years on end, perhaps as a child next to an adult with severe mental illness, can be devastating. Many young people are admitted for treatment and placed in adult facilities because of the lack of child and adolescent beds and facilities. These young people are experiencing problems such as an acute sense of isolation; difficulties with keeping in touch with friends and family; and a lack of activities and education.

I believe that their treatment falls short of the Children (Northern Ireland) Order 1995, and the United Nations Convention on the Rights of the Child. It is unacceptable, and we must ensure that it does not happen again.

Evidence shows that where appropriate community services are available, fewer people need inpatient care. With rapid-response community-based services, people are able to remain more independent, to stay in their homes where possible, and are better placed to achieve their potential. Community care provides treatment in the least restrictive and stigmatising setting as well as family-orientated care and support, and it is more appropriate to an individual’s age and other specific needs.

Early intervention is important in many aspects of health provision, but it is particularly relevant with mental health and learning disabilities. Early inter­vention aims to reduce the length of time that people remain undiagnosed and untreated. The earlier an inter­vention is made, the greater the chance of recovery in an early phase, and the greater the opportunity to create and promote independence and confidence.

The training and development of the workforce is extremely important; that is well attended to in the Bamford recommendations, which stress elements such as a positive attitude and sensitivity. I agree and empathise with the difficult and sometimes challenging task of caring for patients. It is very important to have good working conditions and appropriate, regularly updated training. I acknowledge that sometimes, this work can be very challenging; but it is very rewarding. My sister worked as a nurse in Muckamore Abbey many years ago. She really appreciated and enjoyed her time there.

Finally, I also call for the full implementation of the recommendations of the Bamford Review and of the ‘Equal Lives’ report on learning disability. As Sue Ramsey has said, we discussed this in an earlier motion, and we really need feedback from the Department on the current situation. We have to ensure that all our children have the opportunity to develop to their full potential, physically, intellectually and emotionally.

David Ford (Alliance)

In supporting the motion, I declare an interest, not only as a member of the constituency that houses Muckamore Abbey Hospital — technically, that may not be an interest — but as a former social worker with the Northern Health and Social Services Board (NHSSB), who, at times, was involved with the rehabilitation of those leaving Muckamore Abbey Hospital to rejoin the community in the NHSSB area.

I well remember an occasion in the late 1980s when a colleague of mine was given a senior social worker post, advancing that rehabilitation process. It is appropriate that each of us taking part in the debate acknowledges the contribution of dedicated staff in meeting the needs of those with learning disabilities. Whether they are the staff who provide nursing and other forms of care in Muckamore Abbey Hospital and the other two hospitals, or whether they assist people’s moves to the community and provide day care or support in the home, they are all vital to ensuring a quality of life for those who need the services of the learning-disability teams.

Some of the problems in Muckamore Abbey Hospital are due to the success of the increased shift to com­munity care. Over the past 20 years, between 500 and 600 people have been moved out of long-term care in learning-disability hospitals and have been given better lives in the community. However, some of them have not always had the good lives in the community that they should have had, because the resources, which were already inadequate, have not been increased. The simple fact is that it costs more to keep people in a quality environment in the community than it does to keep them in large institutions, and, as a society, we have not always accommodated that fact.

We must also pay tribute, not only to the staff from Muckamore Abbey Hospital, but to the individuals — in many cases, family members — and the voluntary organisations that have provided community care, enabled the moves to the community and made matters better for those people who receive that care.

It is, perhaps, an interesting coincidence that there are representatives of the Buddy Bear Trust Con­ductive Education Independent School in the Building today. The trust is particularly concerned about young people with cerebral palsy. It promotes the good work that is being done in the community, but is being hindered by the fact that the work is very expensive and is not properly resourced.

It is no surprise that when Mencap published a report in 2003, it called it ‘Breaking Point — families still need a break’. It seems that much of the pious talk about community care actually results in giving the minimum support possible to families, which does, at times, leave parents at breaking point. For example, on simple issues such as respite care, it is now much harder to get placements, particularly for people in their 20s and 30s, than it was a few years ago when they were children or teenagers. There is a real need to ensure that the services are rebalanced, and that has not been done. It is not just about Muckamore Abbey Hospital and the other two hospitals; it is about the package of services that is provided to those people with learning disabilities.

I remember questioning the Minister of Health, Social Services and Public Safety about that issue in the Chamber. I received acknowledgements from her that, for example, the year-on-year percentage increase in funding across different services was always biased towards acute hospitals and against community care. Provision for people with learning disabilities and mental-health needs consistently came at the bottom of the pile. They really were the Cinderella services. However, if the Northern Ireland Assembly debated acute hospitals, particularly the location of maternity services between two hospitals that are one mile apart in Belfast, Members filled the Chamber, and everybody cared. Contrary to that, we are now facing the position that, because the Assembly did not ask serious questions of the Department and the Minister when it had the power to do so some years ago, Muckamore Abbey Hospital has inadequate resources, and there are people in real need and really suffering.

Therefore, before the Assembly starts to point the finger too much at other people, there are Members in the Chamber who should ask whether, when we had the power, they did all that was necessary. I am not entirely convinced that we did. There was much more that the Assembly could, and should, have done.

There are three sets of actions that need to be taken to address the needs of patients in Muckamore Abbey Hospital. First, there should be a general enquiry as to exactly what is happening. I was pleased to hear the Chief Commissioner of the Northern Ireland Human Rights Commission (NIHRC) intervening when the story broke, and, subsequently, I have had a con­versation with her. I am glad to hear that the commission is doing ongoing work.

I am not sure whether that work will extend to a full-scale inquiry, but such an inquiry must be convened. It should not be simply an internal DHSSPS matter, with civil servants saying how hard everyone has tried, but that the money was not there.

There must be genuine recognition that the human rights of citizens have been interfered with. Even if those citizens do not have voices of their own that can heard in the media, they ought to have the voices of public representatives and of agencies such as the Human Rights Commission to ensure that their rights are looked after.

I welcome the comments of another former Assembly colleague, the Commissioner for Children and Young People, on this matter. However, we should recognise that many of the patients concerned are adults, not children. It is slightly denigrating to the position of such patients to concentrate on them as though they were all children. Clearly, there are children with considerable needs, but there are also adults with such needs. We should not focus only on the children.

The second matter that I wish to address — whatever the current financial restrictions — concerns the actions that the North and West Belfast Health and Social Services Trust should take. The trust has recently acknowledged that it knew that there would be problems with some of the current arrangements, that there would be difficulties with some people settling in, and that a review process would be carried out. That is fine, but I wonder how much of that review would have come to light had BBC journalist Dot Kirby not highlighted it.

Any strategy of locking doors on patients who should be in community care needs a fundamental review. Whatever need there may be, at times, for a small minority of patients to be placed behind locked doors, there is absolutely no way that locked doors should be a substitute for proper nursing care and remedial services, which are, by and large, what those patients require.

The Eastern Health and Social Services Board and the North and West Belfast Health and Social Services Trust must both examine their actions and why they had failed to take action until the media got on their backs. Their staff have done much good work, but there have been failures that have led to the current situation. However dedicated those staff have been in trying to make the best of a bad job, they should not have had to make the best of a bad job.

The third area that I wish to address is the need for a commitment from the DHSSPS to the full imple­mentation of the Bamford Report, as other Members have said. The deafening silence from the Minister and from senior civil servants on the various aspects of the Bamford Report, as they have been published, is quite horrifying.

We in the Chamber have acknowledged what needs to be done. We know how much ought to be done, and we have seen the difficulties of funding in the past. However, we still have a Minister who is not prepared to give the necessary commitments to provide basic services and basic necessary care for some of our most needy citizens.

It is simply unacceptable that bodies such as the Buddy Bear Trust and Mencap should be running services on a shoestring budget and on a charitable basis because they are not being funded properly by the agencies of the state that have relevant responsibility. In that sense, however, Northern Ireland is not unique. Generally, as a society, we have been fairly poor at providing long-term care for those who need it. We have been fairly good at providing intensive nursing and medical services for those who have acute problems, but those with a long-term or lifetime care requirement have, by and large, not been treated well, whether it be in Northern Ireland, the Republic, England, Wales or Scotland.

There have been problems in every region of these islands, but the Bamford Report has highlighted what needs to be done, what could be done, and what must be done as soon as possible in this, the smallest of those regions.

It is very easy for the Assembly to agree a more or less motherhood-and-apple-pie motion. There is nothing wrong with saying that we are in favour of motherhood and apple pie, but the real test will come at some point after 26 March when we will see whether Members who make the right speeches today are prepared to put their votes into ensuring that the necessary resources are supplied to implement the recommendations of the Bamford Report.

Sue Ramsey (Sinn Féin)

The Member quite rightly outlined the work done by the MP for South Antrim in ensuring that, in the words of the chief executive of the North and West Belfast Health and Social Services Trust: “this does not happen again”. Does the Member agree that it would be appropriate for an all-party delegation to visit Muckamore Abbey Hospital? All Members have referred to the Department of Health, Social Services and Public Safety’s failure to implement the Bamford Review. Does the Member also agree that, if we met officials from the Department, we could put pressure on them to implement the Bamford Review?

Robert Coulter (UUP)

I am pleased to fully support the motion in the name of my fellow Member for North Antrim Dr Paisley. The motion is extremely serious, because it concerns some of the most vulnerable and exposed members of our community — people who, most of the time, do not have a voice. Let the Members in this Chamber give those people a voice as we give them our support.

Mr Justice Gillen, one of our most senior judges, has highlighted a shortage of skilled professional practitioners in the caring profession. Some 17 young people have spent an additional six years at Muckamore Abbey Hospital in Antrim, when they could have been released to the care of community-based workers. The learned judge has identified that more money is needed to create an early-warning system to ensure that children with learning disabilities or mental health problems are properly treated in the future.

Indignation is not enough; recriminations are not enough. Practical action is required to address a raft of problems. The problems can be identified as follows: first, the current system is clearly underfunded, with the consequence that there are simply not enough trained and qualified care practitioners in the community; secondly, an early-warning system must be put in place to identify potential problems early so that what can only be termed the massive system failure of Muckamore is not repeated.

Owing to cuts, there is no pool of qualified staff in the community to fill any posts that might be created right away. It will take time — perhaps several years — to put that right. Therefore, although the Government’s promise of an additional £1 million over the next two years to address the problem is welcome, it is not in itself enough. An immediate rescue plan must be put into operation.

I am not impressed by the failure of system in our Health Service generally. It brings to mind the rubric that I have been trying to impress on the official mind for many years now — the patient must come first.

The Health Service is full of excellent staff who have a deep commitment to what they do. They are all excellent people whose hearts are in the job and who display a deep sense of care towards their patients. I could not lavish enough praise on the healthcare practitioners at this level in our Health Service. The problem is higher up.

I am concerned by the thinking at policy level at the top, which drives our trusts’ managements to think about nothing but paper targets and financial savings. That thinking has pervaded the review of public administration (RPA) and has resulted in a proposed new system of health governance that addresses none of the patient-focused problems of, for instance, the elderly.

Failing to separate the primary and acute care budgets will starve primary care of money and deal a serious blow to preventative medicine and care in the community. Mental health and learning disability are always the Cinderella services. Acute hospitals consistently receive higher increases in spending, year on year.

I am concerned by the inability of the direct-rule regime and its apparatus of top-heavy officialdom to address this issue in the review of public administration. The entire RPA process will have to be revisited by the Assembly when it assumes the direction of the Province once again. I wrote as much in the ‘Newsletter’ as recently as last Saturday, as my colleague Billy Bell mentioned.

In Muckamore Abbey Hospital and related cases the BBC found that more than 100 adults with learning disabilities have had their discharge from hospital delayed for an average of three and a half years. One person remains in the unit 10 years after his treatment ended, yet for more than 10 years the policy has been that no one should live long term in a hospital of any kind.

In the bad old days, before we had democratic accountability and due process, prisoners would be placed in a cell, known as an oubliette in French. They would then be forgotten and never heard of again. The Muckamore Abbey Hospital case has echoes of that. The only difference is that the care given by staff in Muckamore Abbey Hospital, often in difficult and fraught circumstances, is exemplary. Anytime I visited the hospital, I have had nothing but the highest praise for the staff, who work in difficult situations.

However, in another sense, those patients who should have been discharged are the forgotten. Their forgotten cell may have been more comfortable than the forgotten cell of the past, but hospital was not the place for them; it is not where they should be.

The lesson in all this is that we must not forget. The Assembly must revisit the issue when it reconvenes after the forthcoming election. After that, it must feature regularly on the agenda of the Assembly’s Health Committee until this issue, and all the other issues highlighted by the Bamford Mental Health Review — which we have already debated — are addressed to the satisfaction of the people’s representatives.

It gives me pleasure to support the motion.

John O'Dowd (Sinn Féin)

Go raibh maith agat, a Cheann Comhairle. Today’s debate has resulted from an intervention on Muckamore Abbey Hospital that Mr Paisley made last Tuesday. Sinn Féin had hoped to debate both Muckamore Abbey Hospital and collusion today, and it is shameful that, because the unionist parties blocked the motion, we are not debating the assassination of a young unionist.

However, Sinn Féin also tabled a motion on Muckamore Abbey Hospital, but withdrew it for one reason only: Dr Paisley raised the issue in the House and asked it to debate it. Sinn Féin Members thought that withdrawing the motion was the proper thing to do because we did not want to play political football with the issue; we wanted to move forward on it with a combined voice. Therefore Sinn Féin will support the DUP motion.

Muckamore Abbey Hospital and similar hospitals were designed in Victorian times to lock people up. However, in this day and age, Muckamore should be used as a centre in which people can be assessed before they are released back into the community. Once they have been released, proper community services will be provided to them so that they can lead as full a life as possible. However, for many reasons, that has not been allowed to happen.

What can we, as Assembly Members, do about that situation? We can debate it — and I have no doubt that the motion will receive unanimous support — but that is all that we will do. David Ford asked whether the Assembly has let down the patients of Muckamore. The answer is yes — we all have. While we have been in this debating shop, young adults and children have been locked up in Muckamore. We should be the people who hold the reigns of power and who have the ability to investigate the matter.

I will use my crystal ball to look into the future to see how different the picture could be. Imagine that Iris Robinson were the health Minister. I have no doubt that she would have the chief executive of the trust in her office, tearing strips off him, wanting to know why the situation had been allowed to happen. Any health Committee would investigate the matter and would demand to know why it happened. The Assembly would demand that the Department of Health take action through our local Minister. Unfortunately, we are not doing those things; therefore, we have to take collective blame for what has happened to the young people of Muckamore.

During the recent Assembly debate on the Bamford Review, I mentioned an establishment that I had visited. I said that it was the most depressing place that I had ever been in. That place was Muckamore Abbey Hospital. Another Sinn Féin member and I visited that facility about 18 months ago. That hospital has excellent facilities. At the time of our visit, it was going through a new-build programme, and we were urged to take a look at it. The people who run Muckamore insisted that we look around the whole facility. We did so, and it was depressing. The guy who was with me was an ex-blanket man who spent five years on the blanket. As we walked through the facility, he said that it reminded him of the H-blocks. Although I forget its correct title now, we went to a room that was used to hold people if they were going through an emotionally disturbed state. He said that that room was worse than the punishment blocks in the H-blocks. However, young people were being kept in those facilities.

Since that visit, we have lobbied the trust and the Health Department to continue refurbishing Muckamore, but, more importantly, to ensure that the community facilities are available to allow young people and adults to live as full a life as possible once they have been released. It is clear, however, that those facilities have not been made available.

During the autumn, I also visited Knockbracken Hospital. It has gone through a massive refurbishment programme, and it now has state-of-the-art facilities for people who have learning disabilities and mental-health issues. It is an example to everyone. However, it also has Victorian facilities, and those need to be replaced.

A massive injection of funding needs to be put into mental-health care and helping those who have learning disabilities. During the debate on the Bamford Review, Sinn Féin tabled an amendment that called for the Programme for Government Committee to ensure, in its deliberations with the Exchequer, that the £300 million that is needed to ensure that Bamford becomes a reality is made available. If Bamford does not become a reality, we will continue to let down the young people of Muckamore Abbey Hospital and those people who still live in the Victorian buildings that are in Knockbracken Hospital.

Bairbre de Brún introduced the 11-part Bamford Review to examine the way forward for mental health in the twenty-first century. It was an excellent review; it has done good work on investigating international best practice. However, be assured that — despite the best intentions of whatever direct-rule Minister is in place — it will not be implemented in full, because it is not a priority. It is not part of the priority planning of the Department of Health. We need to have Iris Robinson, or A N Other, as Minister of Health; we need a Health Committee and an Assembly that will ensure that the human rights abuses that have taken place in Muckamore Abbey Hospital stop immediately.

Like David Ford, I welcome the intervention of the Human Rights Commission on this matter. Those young people’s human rights are being abused — they have been let down by the Assembly and by the Department of Health. We must ensure that we, as politicians, change the conditions in which they live. Of all the debates that we have had in this Transitional Assembly, this one highlights better than any other the need for local politicians to work together.

Dr Paisley said that he had never experienced retirement, and he wished Seán Farren well. I never thought that these words would come out of my mouth, but I hope that Ian Paisley becomes First Minister before he retires, because he and my colleague Martin McGuinness and whoever is sitting around the Executive table will not let down the young people in Muckamore. They will not let down those people in Knockbracken who have not moved into the new state-of-the-art facilities, and they will do a better job than any direct-rule Minister who is sent here.

It took a BBC reporter to expose this scandal; that alone says that we all let those people down. It should have been exposed by our Health Committee, or by a probing question to our local Health Minister. I con­gratulate Dot Kirby on her work; she has shone a spotlight not only on Muckamore, but also on this Chamber.

John Dallat (Social Democratic and Labour Party)

When I first heard of this scandal, my heart sank. I asked myself whether it could be the same Muckamore Abbey Hospital that I knew so well many years ago when my family and I regularly visited my brother, Gerard Majella, who was a patient there for five years. I remember the care and love he received from the dedicated staff, who were committed to helping so many children with special needs, sometimes mental, sometimes mental and physical. He died there on 9 August 1968; every day since then he has been remembered, and so too have the staff of that hospital who gave him so much love and care and attention.

Clearly, Muckamore Abbey Hospital has moved on since those days; it has a different role helping people to re-enter the community, or so I thought until I heard that some people had been there for 10 years longer than they should have been. The question that occupies my mind is how this situation can exist. Is it really about money and lack of resources? I do not think so. I am convinced that it has more to do with a mindset that dictates that, where choices must be made, the weak and vulnerable will be put at the back of the queue, and every time they come to the front of the queue they will be sent back again. Some people might describe it as prejudice. That is the way in which people with mental health problems are treated.

From the day and hour a baby is born with special needs, his or her parents have a struggle to get the child assessed, and their battle is only beginning.

Report after report is compiled from the most extensive consultation, only to be hit on the head when choices about spending are to be made. Perhaps it is unfair, but when this story broke I thought of the Romanian orphans. I asked myself why, in a modern society that talks so much about healthcare, young children spend 10 years or more in an institution when they should have been rehabilitated into the community. The scandal at Muckamore must be sorted out.

Is Muckamore the tip of the iceberg, as has been suggested? How many more people with special needs are neglected or in a queue with no end? How many are waiting for an assessment that never seems to happen? Is the provision for those individuals adequate or are they being neglected in the same way as those in Muckamore Abbey Hospital?

In the previous Assembly, there was a great deal of consultation and loads of reports on health issues, but no substance. In the meantime, money was spent on an Assembly that did not meet. Yet, the people whom we talk about today continued to languish in an institution that was intended only for short stays. What a pity; what a shame.

As Members leave the Chamber, we can give a commitment to end this inequality in society, the injustice, the prejudice against the weak and vulnerable and the preferential treatment for projects that jump the queue. I hope that the scandal at Muckamore begins a process that delves into every corner of society to find who else is at the end of the queue waiting for help and crying out for the services that they need to develop their lives to the best of their abilities. If Members do that, they will do no more than honour the Good Friday Agreement, which was not designed to simply distribute justice or injustice equally, but to acknowledge and accept that everyone is equal. That includes those who have had to stay in Muckamore much longer than necessary because there was no room for them at the inn.

It is a long time since I first visited Muckamore Abbey Hospital, and I regret that I did not keep up those visits, but it was difficult. I am sorry that it has taken so long to discover that people who should have been back in the community and accepted as equals are still there. During the intervening years, something happened that had nothing to do with the staff, but has a lot to do with direct-rule Ministers and civil servants who have demonstrated their prejudice against the vulnerable in a dreadful way that brings shame and a cry for change.

It is a lesson that Members can learn. Those Members who are returned to a new Assembly must come back with a different attitude — one that profoundly favours those in society who are weak. After all, is that not what government is about? Members can support projects that are exciting, but only when the people whom we are charged to care for have been looked after.

I congratulate Dr Paisley for tabling the motion, and I am deeply touched by other Members who have made positive contributions — by and large, in a non-party-political way — and who have raised their voices in support of those who cannot do so for themselves.

Iris Robinson (DUP)

This has been an interesting and important debate, and I thank the leader of my party, Dr Paisley, for his assistance in pursuing this timely debate.

A failure to plan for adequate services may have contributed to the practice of denying individuals who were detained at Muckamore the right to liberty and the right to a family life. I visited Muckamore Abbey Hospital some time ago, and I was impressed by the commitment of the staff. At that stage, concerns about inadequate funding for the resettlement of patients were already real.

The situation at Muckamore has been prominent in the press, but there are other hospitals in Northern Ireland where the same problems might well exist. There are three specialist learning disability hospitals in Northern Ireland — Muckamore Abbey Hospital, Longstone Hospital and Lakeview Hospital — and they currently provide assessment and treatment services. There are few community-based services available, and that increases the reliance of people with a learning disability on those three specialist hospitals.

‘Equal Lives’, the learning disability report from the Bamford Mental Health Review, defines a learning disability as one that includes the presence of a significantly reduced ability to understand new or complex information or to learn new skills, with a reduced ability to cope independently, which started before adulthood with a lasting effect on development.

Children, as well as adults at Muckamore, require individual packages of care suited to their capabilities. Those care packages may include intensive personal care for an individual, including feeding, cleaning, dressing and medication. Care packages also represent extensive support for the family to help them cope with their added responsibilities. As a society we rely on families to provide 24-hour service. It is the failure to provide services in the community that has caused the delay in discharges at Muckamore.

One big problem that has arisen at Muckamore is the difficulty faced by agencies when the services required are life-long, rather than single treatable health problems. The fact that learning disability services are, in the main, provided by the family rather than by social services means that services for people with a learning disability have been a low priority for the Government and their agencies. As a result, the small number of individuals in hospitals and their families have put up with conditions that would not be tolerated anywhere else. The ‘Equal Lives’ report outlines the problems that people with a learning disability and their families endure.

Some parts of the report relate specifically to the situation at Muckamore. The report states that:

“Questions do need to be asked however with regard to the inequalities that may exist in Northern Ireland detailed in Table 2. For example are statutory services in breach of the Disability Discrimination Act and Human Rights Act if they:

•         

fail to provide adequate community support for a person with challenging behaviours?

•         

maintain a person in hospital because they do not have a facility in the community for a client to resettle to?”

Recommendation 27 states:

“Resettlement of long-stay patients from hospitals within the context of supported living principles must be progressed as rapidly as possible. By June 2011, all people living in a learning disability hospital should be relocated to the community. Funds need to be provided to ensure that on average 80 people will be resettled per annum over the 5-year period from 2006 to 2011.”

Members have made some important points, and I will go through them in the order that they were made. Dr Paisley rightly said that the recommendations to re-integrate people with special needs into the community have to be acted upon and reinforced. He also said that care packages must be in place so that all people are allowed the dignity of a home address, and he emphasised the core need for additional beds for children who have very complex needs.

Mr Bell of the Ulster Unionist Party emphasised that this motion is dealing with the most vulnerable people in society, so it is important that Members are doubly sure of the provision that is being put in place.

Sue Ramsey of Sinn Féin highlighted the fact that the media, particularly the BBC, should be congratulated for how it alerted the public to how bad the service for children and adults with special needs is at Muckamore. I join her in commending that media reporting. I also agree that it is time to address that failure and put it right. A review should be carried out immediately and its recommendations implemented without delay.

Carmel Hanna of the SDLP reiterated how important it is that young people know the exact nature of their treatment, the footprint of their stay in hospital, and the back-up care that is available when they return to the community. She also emphasised the need for early intervention. My DUP colleague Paul Girvan said that lip service is of no use; delivery is what matters. When the Assembly gets up and running, as it will when all the boxes are ticked, that will be a priority. Rev Bob Coulter, for whom I have a high regard with respect to health issues, re-emphasised how voiceless vulnerable children and adults are. He said that we need more funding and better planning to provide for specialist staff.

Mr O’Dowd said that we all bear responsibility for the lack of improvement at Muckamore. I remind him that we had a Sinn Féin Minister of Health, Social Services and Public Safety in the previous Assembly. Mental health problems existed then as they do now. I have no doubt that whoever holds the health portfolio will treat mental health and the Bamford Report with the urgency needed to successfully address the needs of those very vulnerable people.

When we get our Assembly back, it will be because all of the boxes are ticked, and it will be an Assembly where all Members are democrats. No member of the future Assembly will try to employ both the Armalite and the ballot box.

Mr Dallat praised the work of staff who gave his late brother Gerard the care and attention he needed. He also queried what had happened to bring Muckamore to its current state. Many explanations have been given and I hope that, after the elections, local people will have local representatives in charge of the Assembly, to take decisions that affect them. I appreciate all the comments that have been made by Members. This is a very important issue. Mental health has been treated, as another Member said, as the Cinderella service. In many cases, when funding was short in the budgets of each trust, money was pilfered from mental health — in the nicest possible way — for other areas of healthcare.

It is important that local politicians address the needs of the more vulnerable in society. I welcome the fact that there has been support for the motion from all of the political persuasions that are represented in the Assembly. A united voice makes a difference and reaches the ear of the Government. In future, the Government must ensure that those with learning disabilities are not at the bottom of the pile when it comes to allocating resources. Sufficient funding must be provided for community services to allow those who require hospital stays to reintegrate into the outside world. We need to target specialist nursing staff and clinicians — and all involved in healthcare who can ease the burden of those with mental illness — and give them access to all of the services that they need.

The extensive work that went into compiling the ‘Equal Lives’ report must be utilised, and its recom­mendations acted on by the Government as soon as possible.

Question put and agreed to.

Resolved:

That this Assembly expresses concern that more than 100 adults and young people with learning disabilities have been forced to remain in Muckamore Abbey Hospital, Antrim — some for periods extending to several years — because appropriate care within the community is not available; demands a full inquiry into the situation to ensure it cannot occur again; recognises the frequently undervalued contribution of staff, families and carers; and calls upon Government to implement urgently the recommendations of the Equal Lives Learning Disability Report of the Bamford Mental Health Review.