Winterbourne View Hospital and the Transforming Care Programme

Backbench Business – in Westminster Hall at 3:00 pm on 10th June 2021.

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[Esther McVey in the Chair]

Photo of Esther McVey Esther McVey Conservative, Tatton 3:15 pm, 10th June 2021

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate.

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Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South 3:16 pm, 10th June 2021

I beg to move,

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.

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.

Photo of Esther McVey Esther McVey Conservative, Tatton

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.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean 3:29 pm, 10th June 2021

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 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.

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.

Photo of Helen Hayes Helen Hayes Labour, Dulwich and West Norwood 3:40 pm, 10th June 2021

It is a pleasure to see you in the Chair today, Ms McVey. I am grateful to my hon. Friend 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, 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.

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.

Photo of Jack Lopresti Jack Lopresti Conservative, Filton and Bradley Stoke 3:45 pm, 10th June 2021

It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate 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 Members’ 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.

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.

Photo of Darren Henry Darren Henry Conservative, Broxtowe 3:51 pm, 10th June 2021

It is a pleasure to serve under your chairmanship, Ms McVey. I thank 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.

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 in my local community 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.

Photo of Duncan Baker Duncan Baker Conservative, North Norfolk 4:02 pm, 10th June 2021

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 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.

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.

Photo of Paul Bristow Paul Bristow Conservative, Peterborough 4:07 pm, 10th June 2021

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 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.

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.

Photo of Huw Merriman Huw Merriman Chair, Transport Committee, Chair, Transport Committee 4:11 pm, 10th June 2021

It is a pleasure to speak under your chairmanship, Ms McVey. I join other hon. Members in this Westminster Hall debate by thanking Barbara Keeley for leading it. The note that I passed to you, Ms McVey, was to apologise and to hope that you had received notification beforehand that I was running from the main Chamber to speak here. I very much hope that that was the case, but I apologise both to you and to the hon. Lady.

I begin by paying tribute to our former friend and colleague, the late Dame Cheryl Gillan, who chaired the all-party parliamentary group on autism and was a long-standing advocate for the 700,000 autistic adults and children and their 3 million family members and carers. I now chair that all-party parliamentary group, but I very much wish that I was sitting here, as I would tend to be in these debates, watching Dame Cheryl and listening to her advocate so finely for all of that community. She will be remembered for her passion, drive and kindness.

For more than a decade, Dame Cheryl worked tirelessly to ensure that Government and Parliament took more account of autistic people and the need to improve the support for them. She began her campaign for an autism Act in England in 2008 to tackle the lack of support for autistic people and to improve the understanding of autism. That landmark law—I think it is quite remarkable that she got it delivered—remains the only legislation aimed at supporting one particular group of disabled people. I am deeply saddened that Dame Cheryl passed away before getting to see the new autism strategy, which is set to be published shortly—I hope imminently. I hope that she would have been very proud of what gets delivered.

Following the passing of the Autism Act 2009, Dame Cheryl campaigned hard on so many of the crucial issues. Even during her illness, she fought hard to take on these issues, ranging from diagnosis to waiting times, teacher training, employment and, importantly, the subject that we are talking about today—health, mental health, and those who feel imprisoned by the system. It is a topic on which so much more needs to be done and, in Dame Cheryl’s memory, I very much hope that it will be.

As other hon. Members have said, it is 10 years since the appalling abuse and neglect of some of the residents of the Winterbourne View home were exposed. There were shocking levels of violence, degrading treatment and taunting. It was a scandal that led to widespread acknowledgement that a significant number of people with autism and with learning disabilities, or with both, were stuck inappropriately in in-patient settings. However, the latest monthly data show that 2,040 autistic people and people with learning disabilities are still in in-patient mental health hospitals, of whom 1,150 are autistic.

That means that since 2015, the number and proportion of identified autistic people in in-patient facilities has actually increased, from 38% to 56%. A lack of appropriate community support and issues with legislation have meant that a growing number of autistic people are ending up in mental health hospitals against their will and that of their families. Once a person has been admitted to an in-patient unit, they will stay there for an average of 5.6 years, and they will be on average over 60 miles from their home.

The National Autistic Society, which provides the secretariat for the all-party parliamentary group on autism, has continued to hear of alarming cases of over-medication, seclusion and unnecessary restraint. That is completely unacceptable in 2021. Autism is not a mental health condition, and hospital is not the right place for the vast majority of autistic people. Hospital wards can be noisy, bright and unpredictable. Without reasonable adjustments to the environment, and without the support of professionals who understand autism and how to adapt these people’s care, wards can be completely overwhelming for them.

For autistic people who are particularly sensitive to sound, light or touch, the experience of being in an in-patient setting can dramatically increase their level of distress and lead to further restrictions, making it even harder to be moved into the community. It becomes a perpetual cycle, unless something breaks that cycle. Even then, there is a challenge in finding the right type of mental health and social care services in the community for autistic people to move into. It is not right that thousands of autistic people are developing avoidable mental health conditions because they cannot access the support they need early on. To end the travesty, there must be commitment and significant investment in better social care and mental health services that work for autistic people.

I am the last Back-Bench speaker, so I will add my list, too, for the Minister for Care. I have worked with her over the years and know that she is absolutely dedicated to this cause. Without wishing to keep her at the ministerial level at which she is, we need consistency in ministerial position to follow this through. I understand that she is setting up a report group to ensure that all those responsible for delivering outcomes do act. I absolutely support the call from my right hon. Friend Mr Harper that milestones need to be set. I had written that down before he said it, but I had not written down that they should be published. He is right. They should be published not just for us as Members of Parliament to hold the Government to account, but for the Government to hold to account those in the report group who have to deliver, so that there is no hiding place when it comes to what should be done by when. If there is a failure to meet individual timescales, more pressure and perhaps more resource can be added. The Minister will have all our support in holding their feet to the fire.

When will mental health legislation be amended? It will need to be amended. Indeed, it is not just an issue of moving the community from inappropriate settings into appropriate settings. Do we actually have those appropriate settings? Do those milestones include not just the transition but the provision that must be there? I will end there, because we want to hear from the shadow Minister and the Minister, but I very much support all the calls made by Dame Cheryl’s former colleagues that more must be done.

Photo of Esther McVey Esther McVey Conservative, Tatton

I thank Huw Merriman for acknowledging Dame Cheryl Gillan and all the work she did in the world of autism. I know we all share that view.

I will now call the Front-Bench speakers, mindful that we do want to hear from Barbara Keeley at the end to close the debate.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health and Social Care) 4:18 pm, 10th June 2021

It is a pleasure to serve under your chairmanship, Ms McVey. I thank my hon. Friend Barbara Keeley for securing this extremely important debate, marking the 10th anniversary of the Winterbourne View scandal. I want to say at the start that the repeated and abject failure to move people with learning disabilities and autism out of long-stay institutions and into the community, following what we saw at Winterbourne View, is the worst political and institutional failure I have seen in my 25-year experience of working in health and social care as a Member of Parliament and before I became an MP. It is essential that we understand the underlying reasons for this failure and what we will do differently so that we can put it right in future. That is what I really want to focus on.

Many hon. Members have spoken about the horrors that the BBC’s “Panorama” programme exposed at Winterbourne View in May 2011, with patients repeatedly abused, pinned down, slapped, soaked with water, trapped under chairs, threatened and taunted by staff. The incidents included a member of staff slapping a resident across the cheek and—forgive me, Ms McVey—saying:

“Do you want a scrap? Do you want a fight? Go on and I will bite your bloody face off.”

A member of staff claimed a resident “loved pain”, and then said to the resident:

“Simone, come here and I’ll punch your face.”

Staff gave a patient cold showers as a punishment, leaving her outside in near-zero temperature, pouring mouthwash in her eyes. Patients were shown screaming and shaking, one trying to jump out of a second-floor window to escape the torment but just being mocked by members of staff.

Straight after the programme was aired, the then Minister commissioned an in-depth review into what happened, the results of which were published on 10 December 2012—a day I remember extremely clearly, as the Government statement to Parliament was the very first time I had spoken at the Dispatch Box as a Member of Parliament and a new shadow Minister. The new Minister of State promised that all patients, 3,400 in total, would have their placements reviewed by June 2013, and that everyone who was there inappropriately would be moved into the community no later than June 2014. This was followed by the Government’s transforming care programme, which aimed to close up to half of in-patient beds by June 2014.

June 2014 arrived; the Government had failed to deliver. There were still 2,615 people in in-patient units, including 148 children. Sir Stephen Bubb was commissioned to do another review, which was published in November 2014. As a result, NHS England announced a three-year closure programme called building the right support. This had a slightly reduced target of reducing the number of in-patient beds by between 35% and 50% by March 2019. March 2019 arrived; the target was once again missed. The Government had missed even the more modest target of a 35% reduction. Instead of trying to really get to grips with the cause of the failure, the target was downgraded again, from between 35% and 50% to just 35%. Surprise, surprise: a year later and even the downgraded target was missed.

The grim reality is that there are still 2,040 people with learning disabilities and autism in in-patient units, including 215 children. The average length of stay is over five and a half years, and 355 people have been in these units for at least 10 years. Unbelievably, after everything that has happened, there has been little if any change in the number of people being admitted into in-patient units each month, when, as many hon. Members have said, one of the key priorities must be preventing people from going into hospital in the first place.

Far from closing large-scale units, the Government are opening new ones. Last year, a new 123-bed medium-secure unit, including 45 beds for people with learning disabilities and autism, was opened by Mersey Care NHS Foundation Trust. Mersey Care also got planning permission to build an additional 40-bed unit, going against the Government’s own recommendations. Report after report has shown continuing unacceptable treatment in these long-stay institutions. In one month this year—just one month—3,390 restrictive interventions were used, by which we mean physically restricting people or restricting them with chemicals—drugging or isolating them. In reality, that is a massive underestimate because, scandalously, we have data for only 31 of 56 NHS providers, and for one of 16 private providers. I have one question that I hope the Minister will answer: why is providing that data every month not a requirement for every provider in this country and will she consider making it available a requirement of Care Quality Commission registration?

The latest target set out in the NHS long-term plan is to deliver a 50% reduction in in-patient beds by March 2024, but unless we are clear about why the Government have failed to achieve anywhere near that over the past decade and what we are going to do differently, we cannot have confidence that things will change.

It is my view that the first reason for that failure is simply that this has not been a political priority. I am singling out not the current Minister but Ministers over a decade who have failed to grip the issue, failed to make it one of the repeated, unmissable priorities for the Department of Health and the NHS, and failed to secure the funding that the NHS and local authorities need to shift the focus of services fundamentally towards prevention and co-ordinate support not just between the NHS and local authorities but with housing and other community services. Will the Government consider the recommendation of the Joint Committee on Human Rights to set up

“a Number 10 unit, with cabinet level leadership… to ensure reform is driven forward”?

If we do not change that, we will not have that leadership in place.

Secondly, there are institutional failings. It is just too easy for services to keep doing the same thing—commissioning large-hospital services—rather than the difficult work of individual, personalised support in the community or at home. We do not have the financial incentives in place, or the accountability mechanisms, to do things differently. Mencap says that in my own region, the east midlands provider collaborative, which commissions these services, includes some of the very private providers that have been shown to have poor records of care. How is that allowed and who is responsible?

Thirdly, and I really believe this is the key to change, we have failed to put families at the heart of the process and not just to listen to their views but put them in the driving seat of change. There are many ways to do that, but I know, and I have seen, that one of the most powerful ways to get that change is personal care budgets given to families and developed in partnership with the services. The average cost of a weekly stay in an in-patient unit run by the NHS is £3,000. If we gave families greater control over that money, I bet they could find a better way to spend it on care for the people they love.

Last but by no means least, one reason why people with learning disabilities and autism and their families believe change never happens is that they feel they just do not matter, are not important enough, and are out of sight and out of mind. As Members here know, what has happened in those in-patient units is part of a much wider pattern of unacceptable inequalities in access to services and in health outcomes for people with learning disabilities and autism. For example, women die 18 years earlier than the average and there are much worse health outcomes in a range of areas.

I am afraid that with covid-19, and despite initial claims they were at no greater risk, people with learning disabilities and autism have death rates six times higher than those for the rest of the general population. Changing that requires concerted action across the board. We need to change how we train health and care professionals, and ensure absolute clarity at every level about who is responsible for change and how they will be held to account. The trouble is that this is everybody’s and nobody’s problem. That is why we cannot get change.

I say all that to be constructive. The Minister knows that I want to solve problems, not just criticise. I would be happy to meet with her and the families and providers, as well as her officials, to see whether we can put in place a more effective plan of action. I ask her one thing: can she tell me what the Government and NHS England now propose that is different from the proposals of 10 years ago, five years ago or one year ago? From what I have read, there is no difference. The trouble with that is that we will get the same result. That is not good enough for people with learning disabilities and autism and their families.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care) 4:28 pm, 10th June 2021

It is a pleasure to serve under your chairmanship, Ms McVey. I thank Barbara Keeley for securing this important debate, for opening the debate and for her committed campaigning for people with learning disabilities and for autistic people. I also thank all Members who have spoken powerfully today, both in the Chamber and virtually, and shown the strength of feeling on the issue among parliamentarians. I particularly thank my hon. Friend Huw Merriman, as he has taken on the role of chair of the all-party parliamentary group on autism following, as he said, the very sad death of our right hon. Friend Dame Cheryl Gillan. She is missed so much by all of us, both as a colleague and for her work for autistic people, which has made such a huge difference over the years, although there is clearly much further to go.

The appalling abuse uncovered at Winterbourne View has no place in our society, and I share the shock and anger that hon. Members have expressed today. It was rightly described as heartbreaking and disgusting by my hon. Friend Darren Henry, and it should never have happened, as my hon. Friend Jack Lopresti said. None of us accepts this kind of cruel and abusive treatment of people with learning disabilities and autistic people, and none of us wants people to be in-patients unnecessarily when they could be better off living in the community. I will use my time to talk about the work of Government, the NHS, the CQC, local authorities, and others we are working with to stop poor and—worse still—abusive care, and to improve care. As part of that, I will talk about what we are doing to reduce the number of people with learning disabilities and autistic people in in-patient units, which we know are rarely the best place for those people to be. As I do so, I will seek to respond to questions raised by right hon. and hon. Members.

First, I will talk about the approach we are taking to stopping abusive care. We are working with the NHS as care commissioners, local authorities, and of course the CQC, which plays a critical part. I fully support the much tougher approach that the CQC is rightly taking through its more robust inspection regime and updated methodology, which includes speaking more to patients and families and really digging into the culture of providers. It is in some of these closed cultures where there has been such concerning treatment of patients, and the CQC is taking a robust enforcement approach, including wasting no time in closing down services when it uncovers unsafe care. The sad truth is that this tougher approach by the CQC has exposed more cases of poor care, and I fully support the CQC in taking very robust action in those cases.

A significant number of people with learning disabilities and autistic people in in-patient units, about 59%, are autistic. As my hon. Friend the Member for Bexhill and Battle said, an in-patient unit is rarely a good environment for someone who is autistic, and can often be a really inappropriate one. I am clear that no one should be in an in-patient unit if it is not to their benefit—if they are not receiving some form of therapeutic treatment that helps them. Even then, their time in an in-patient unit should be as short as possible, and that unit should be as close to home as possible. Our target is to achieve a 50% net reduction in in-patients by 2025, from a base starting in 2015. Back in 2015, there were 2,895 people with learning disabilities and autistic people in in-patient units; that figure has come down to 2,035, which is a 30% reduction. England is divided into 44 transforming care partnership areas, 17 of which are on track to achieve the target, but that means that 27 are not on track. I take that failure very seriously.

My right hon. Friend Mr Harper asked whether our target of a 50% reduction is ambitious enough, and whether we should be aiming for zero in-patients. That is a question that I have asked myself, and I have also asked it of the NHS and of clinicians. It has been made clear to me that there are times when people with learning disabilities and autism may need to be in an in-patient unit, when they have a mental health condition that could benefit from in-patient treatment. As such, I do not think it would be right to say that it is never appropriate, but it should be rarely considered appropriate, and alternatives should be tried wherever possible. I must also mention to my right hon. Friend that just under 30% of the numbers I am talking about are individuals who are under Ministry of Justice restrictions, so that is another challenge to discharging them. Those are net figures, however, and in the period that we are talking about, there have been more than 10,000 discharges, so it is not a static population. Of course, given that reduction of 30% and more than 10,000 discharges, there have also been a large number of admissions.

When I became the Minister for Care, with this in my portfolio, I straightaway asked the question, right back at the beginning of the pandemic, why are we behind the target? Why have we not made the progress that we should be making? Why is it taking so long? What needs to be done to fix that and to get back on track? We need to have a plan that we can all be confident in—all of us in the Chamber and the families of in-patients.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

Before the Minister moves on, may I test her? She said that she asked whether the 50% target was right. After all those conversations and yes, accepting that there might be some need for in-patient units, is the Government’s position that the 50% reduction is the right end state, or is there a different number? If it is 50%, will she publish the analysis that sets out why that is the right number?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I can tell him that achieving the 50% will be hard. I am all for being ambitious, but in fact, from everything I have seen, achieving it will be hard, partly because some are more easily discharged—I pause as I say that, because it has been difficult to discharge many because we have complex situations here. We have seen some people continuing to be in-patients with long lengths of stay, and it has become almost harder and harder to find a way to find the right support for them in the community. Achieving the 50% will not be easy. I will get to the other part of my right hon. Friend’s question.

When I saw the position we were in and that we were not on target, I asked why and how come. Clearly, however, this is a complex system—it involves the NHS and local authorities doing things, and there are questions about housing supply, community schools and in-patient services. I therefore set up the building the right support delivery board, to which my hon. Friend the Member for Bexhill and Battle referred—I thank him for his supportive words. That board’s aim is to bring those involved together, because, much though we all like a clear line of accountability, to point a finger at somebody to say, “Solve this!”, the reality is that solving this involves bringing different organisations and different parts of our system together.

The delivery board has identified six priorities that we need to focus on to overcome the barriers to achieving lower numbers of in-patients: first, identifying the best practice models of care in the community. What does good look like? That may sound obvious, but getting the right answers is not the easiest thing to do. What is the right care for people in the community? First we have to find out what we want to see in all our constituencies that is available for that group of people.

Secondly, we have to focus on improving the transition into adulthood, in particular for autistic young people, because that is a particular problem resulting in in-patient admission. Thirdly, we have to reduce the number of people in in-patient care with judicial restrictions who, as I mentioned, are a significant proportion. Fourthly, we have to address some of the issues with funding flows and potential financial disincentives in the system, which hon. Members have mentioned, including the hon. Member for Worsley and Eccles South. Fifthly, we have to address the lack of available suitable supported housing. Housing is often cited as the most frequent barrier to discharge. Finally, we have to ensure that we have the right workforce.

Those are the priorities. Yes, we are working on a delivery plan, which will include milestones, such as my right hon. Friend the Member for Forest of Dean rightly called for—we all need to be able to see those. Specifically on the NHS role, since the pandemic, I have asked each of the 44 areas in the NHS to review where they are on delivering against our target and to come to me with what their trajectory is. Where will they get to over the coming months and years and, to the extent that they may be below the ambition, what actions will they take to close that gap?

I hope that that addresses my right hon. Friend’s question about my similar commitment to ensuring that we have clear milestones and targets, can see who is doing what, and have a grip on getting this delivered.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

Are the milestones in the plans going to be published?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

Yes, we plan to publish the delivery plan. We want to have time for the delivery board to feed into it, because we set that up earlier this year. It is complex and cross-government, so it takes a bit of time to bring that together, but broadly yes.

I want to touch on funding, because it was mentioned a number of times as one of the barriers. As part of the NHS England long-term plan, we are investing £40 million this year in improving community support and preventing avoidable admissions. There is an initial £31 million of funding for this issue as part of the NHS mental health covid recovery package. There is £11.35 million specifically to accelerate discharges from mental health hospitals, which includes funding to strengthen advocacy for people with a learning disability and autistic people, and £19.65 million to help prevent crises from occurring and to avoid admissions into in-patient care. There is also the £62 million community discharge grant, which is a fund over three years. The first tranche was issued last year, with a further £21 million to be distributed this year and next. That is particularly to cover some of the double running costs involved when a discharge happens. Someone may need care as an in-patient, but it also has to be set up in the community.

My right hon. Friend the Member for Forest of Dean also asked about the response to the CQC’s “Out of sight” review, which was requested by the Secretary of State for Health and Social Care and which reported back in October last year. It was a review of the use of restraint, seclusion and segregation. My right hon. Friend the Member for Forest of Dean asked when we would respond to it, and I can say that we will do so imminently. I hope he finds that reassuring, even if I cannot give a specific date.

I am mindful of the time, so I will wrap up. I thank all right hon. and hon. Members who have contributed to the debate. I know we are all deeply committed to ensuring that everybody with learning disabilities and autistic people get the care and support that they need. None of this is easy. Some of the individuals we are worried about have really complex needs, but I do not accept that as an excuse for poor or, worse still, abusive care. I will continue to work with the CQC, the NHS, local authorities and other Government Departments, and with the families and user representatives, who play a really important part and are part of the delivery board. I will work together with them to bring an end to this and make sure that autistic people and those with learning disabilities get the care and support that they need, and the support that their families need, to live their lives to the full.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South 4:43 pm, 10th June 2021

I thank the organisations and campaigners who supported the debate, including Mencap, Rightful Lives—particularly Julie Newcombe—Care England, Dimensions and the Equality and Human Rights Commission for their support and briefings, to which other Members have rightly referred.

There is not a lot of time left, but I have heard across the different contributions—I thank colleagues for them—a real desire for change. We do not agree on every last detail of that—not everybody agrees with my recommendation to have a commissioner—but there is a real hunger and desire for change. Across the contributions, a great deal was said about personalisation, changing cultures, having pride in the NHS and not binding us to its failings, to which Paul Bristow referred. My hon. Friend Liz Kendall rightly talked about putting families in the driving seat of change.

A decade after Winterbourne View, it simply is not acceptable that people are still detained, when they could and should be supported in the community. There is real agreement about that. I hope the Minister will listen to what has been said and ensure that the necessary resources and political leadership are delivered, so that we can ensure that the horrors of Winterbourne View are finally a thing of the past.

Question put and agreed to.

Resolved,

That this House
has considered the 10th anniversary of the investigation into the Winterbourne View Hospital and the Transforming Care Programme.

Sitting adjourned.