MPs call for ban on admission to long-term institutional care for autistic people and individuals with learning disabilities

• Immediate action needed on use of ‘restrictive practices’ at inpatient facilities

A wide-ranging Report on the treatment and care of autistic people and those with learning disabilities has found that a lack of adequate community provision has led to many experiencing unnecessary admissions to and intolerable treatment in inpatient facilities. MPs describe the situation as a scandal, given it is happening ten years since the notorious case of Winterbourne View.

Assessment and Treatment Units, where the average length of stay is six years, should be replaced by person-centred services which would only admit people for short periods of time and be located close to their homes, says the Committee.

Despite the work of successive governments to support autistic people and those with learning disabilities, at least 2,055 are currently held in secure institutions, where they can be subject to abusive restrictive practices and kept a long distance from family and friends. The Report finds the Government’s actions to date to be insufficient to tackle the scale of the problem.

Rt Hon Jeremy Hunt MP, Chair of Health and Social Care Committee, said:

“It is a matter of national shame that ten years on from the appalling practices uncovered at Winterbourne View, still far too many autistic people and individuals with learning disabilities are detained in secure units.
“Despite commitments by governments over the years, the totally inadequate level of community provision means that autistic people and people with learning disabilities are wrongfully admitted to inpatient facilities and detained for a shocking average of six years. With two thousand people remaining in such institutions it is time to recognise that a voluntary approach to reducing the numbers has failed and long-term admissions should now be banned with alternative community provision set up in their place.
“We also want to see immediate action on the use restrictive practices by staff – we’ve heard harrowing descriptions of the use of physical restraint, long-term segregation and seclusion in inpatient facilities. None of this is worthy of a 21st century healthcare system and we call on Ministers and NHS England to act with urgency on our recommendations.”

ENDS

Report’s key recommendations to Government and NHS England & Improvement:

• Assessment and Treatment Units (ATUs) should be closed within two years and replaced with person-centred services, based on the principles of the ‘Trieste model’ of care
• New long-term admissions of autistic people and people with learning disabilities to institutions should be banned in the majority of cases
• Government should conduct an assessment of costs of moving care and support to the community for individuals detained in inpatient units and provide investment to match
• Use of restrictive practices on autistic people and people with learning disabilities in inpatient facilities to be published twice a year
• Independent review of deaths of all autistic people and people with learning disabilities in inpatient and community settings should be mandatory

A full list of conclusions and recommendations can be found in the attached Report

Community support system ‘broken’

Autistic people and those with learning disabilities have the right to live independent, free and fulfilled lives in the community and it is an unacceptable violation of their human rights to deny them the chance to do so, say MPs. However, ‘totally inadequate’ levels of provision for community services result in many people being avoidably admitted to inpatient settings where, too often, they do not receive the support they require and there are no specialists in their condition.

Funding ‘significantly below the level required’ to meet needs

The Report finds community support and provision for autistic people and people with learning disabilities, and financial investment in these services, to be significantly below the level required to meet the needs of individuals and provide adequate support for them in the community. MPs say this is deeply concerning and call for fixing it to become a greater priority for both the Department of Health and Social Care and NHS England & Improvement.

Ministers should assess the costs of providing community support for autistic people and those with learning disabilities currently held in inpatient units in order to identify how much extra funding needs to be made available, with the Government providing investment to match the costs.

Despite successive commitments by governments and NHS England & Improvement to reduce the number of autistic people and people with learning disabilities in inpatient settings, and prioritise community support, a more radical approach is urgently needed to unlock funding for community provision.

MPs say financial incentives in the healthcare system must also be redesigned - removing a disincentive for local authorities to use or expand provision and so increase numbers and costs - to discourage them from seeking to ‘offload’ autistic people and people with learning disabilities on to the NHS or place them in inpatient facilities.

Assessment and Treatment Units

MPs describe as ‘shocking’ the six year average stay in an ATU, often because appropriate community provision is not available. The Report calls for all ATUs to be closed within two years, with a ban on the majority of new long-term admissions of autistic people and those with learning disabilities to institutions. It recommends the development of new person-centred services, based on a model of care developed in Trieste, Italy, with a quicker admission and discharge system for inpatient facilities, a limited number in inpatient facilities for lengthy durations, and an emphasis on well-resourced community support and the dignity of autistic people and people with learning disabilities.

Restrictive practices in inpatient facilities

Evidence data on the high use of restrictive practices highlighted the need for immediate action, with the inquiry hearing that within the month of March this year 4,355 restrictive interventions were reported, more than a quarter involving individuals under the age of 18. Physical restraint was the most common intervention, including prone restraint, which could involve many members of staff around or on top of an individual, in some instances for long periods of time. Anti-psychotic medication, long-term segregation and seclusion with individuals kept in isolation for long durations often in "cell-like conditions”, were also used. One witness described being "transported in cages and handcuffs”.

When questioned about the continued use of restrictive practices, Minister Helen Whately told MPs: “I find myself asking, as I am sure others listening today are, how this is still happening in our system. We have known for some years about problems in the system and in inpatient units.”

The Report welcomes the Government's announcement that it will bring into force the Mental Health Units (Use of Force) Act 2018 in November 2021. However, to address concerns that restrictive practices remain commonplace in many inpatient facilities, MPs call for two further reforms: that the use of restraint on individuals in inpatient facilities is published twice every year; and that all providers are required to meet with both families and commissioners within a month of each incidence of restraint, whether chemical or physical, to explain why it happened and what measures are being taken to prevent a reoccurrence.

Mandatory review of deaths

The Report notes ‘too many incidences’ of autistic people and people with learning disabilities dying in inpatient settings with families and friends facing difficulties to get independent reviews into deaths. MPs call for independent reviews of such deaths to be mandatory, extended to those in community settings,ensuring there is a structured way to make sure any learning that emerges is disseminated across the system with clear actions following.