(Worsley and Eccles South)
(Lab)
The abuse of autistic people and people with learning
disabilities is not raised frequently enough in this House. I am
glad to have secured this debate today to outline some of the
issues and to stress the urgency of the situation. The
Government’s record on the scandals I am about to describe has
been appalling. I would like to begin with the experiences of two
young autistic women who were detained in in-patient units
commissioned by the NHS.
Sir (South Swindon) (Con)
I am very grateful to the hon. Lady for giving way. Before she
goes into those two harrowing cases, the Government set
themselves a target to reduce the number of people in mental
health detention—let us call it that—by half by March next year.
At current progress, they will not hit that target until 2028.
What would be her words to the Government to ensure that they get
on with it and start releasing people back into the
community?
I thank the right hon. and learned Gentleman for his
intervention. That is very much the sentiment I will be
expressing in this debate tonight, but I would go further and say
we cannot just accept continual targets. I will remind Members
that the original target was to reduce to zero the number of
people in inappropriate in-patient units, and I shall say that
that is the target we should get back to.
As I said, I would like to begin with the experiences of two
young autistic women who were detained in in-patient units
commissioned by the NHS. Their stories were told recently in a
powerful Channel 4 “Dispatches” programme, on which they and
their families spoke with immense bravery about the abuses they
faced. I encourage all Members to watch it.
Amy is a 22-year-old autistic woman who was, until recently,
detained at the Breightmet Centre for Autism in Bolton, run by
ASC Healthcare. The unit is supposed to provide care tailored to
the needs of autistic people that would not be available on a
general psychiatric ward. While she was detained at the
Breightmet Centre, Amy said that her eating disorder actually
worsened and that “it’s all about punishment”, not treatment. Amy
reported that not a day went by when staff members did not use
restraint and that the threat of violence was used to make
patients conform. She said:
“They’ve chucked me about…they will nip you, they have pulled my
hair out, they will push your wrists down. When I tell them it
hurts they do it more”.
After staff at Breightmet were told that Amy had spoken out in
the Channel 4 documentary, they took her phone away from her.
When she got it back, she sent photos of dark bruises covering
her arms.
Amy was moved to a different hospital and the Care Quality
Commission has taken further enforcement action against the
Breightmet Centre, stating that
“if there is not rapid, widespread improvement”
it
“will start the process of preventing the provider from operating
the service.”
The CQC reports there are still 12 patients at the Breightmet
Centre, and I am deeply concerned that they may be having similar
experiences to the abuse suffered by Amy. It should not have
taken a TV programme for the CQC to take action, because the
Breightmet Centre has been placed in and out of special measures
since 2019. Amy had to return there even after the CQC rated it
as inadequate in 2022—it was rated not safe, effective, caring or
well-led.
Danielle is another young autistic woman who told her story to
the Channel 4 “Dispatches” programme. Like many autistic people
admitted to in-patient units, Danielle has spent not weeks or
months but years detained. In one unit she was 320 miles away
from her family. Her mother Andrea reported that Danielle had
lost half her life—13 years—spent in hospital in-patient units.
While she was held at the Littlebrook Hospital in Dartford,
Danielle was placed in solitary confinement for 551 days—more
than 18 months. She was locked in a room with just a mattress on
the floor and drugged heavily. According to the UN’s special
rapporteur on torture and other cruel, inhuman or degrading
treatment or punishment, confinement lasting for more than 15
days and lacking meaningful engagement constitutes torture.
Danielle endured that for 551 days, a punishment not even
inflicted on violent criminals. Yet Kent and Medway NHS and
Social Care Partnership Trust paid to impose that treatment on a
young woman whose only offence was to be autistic in a society
that does not understand or support that diagnosis.
Solitary confinement in those units is so commonplace that data
on the practice is collected and published by NHS England and
broken down by the kind of restraint used, from chemical
injection to prone physical restraint and seclusion. From those
datasets we can see that more autistic people and people with
learning disabilities are held in solitary confinement now than
three years ago. That is a failure of care, and people such as
Danielle are paying the price.
Danielle’s story gets even worse. Her mother Andrea told the
“Dispatches” programme that during her stay at Littlebrook
Hospital, Danielle was taken by staff members to areas away from
cameras. She was then molested and raped. That is no isolated
incident. Further investigation by the “Dispatches” team found
that 18 reports of sexual assault and 24 reports of rape at
Littlebrook Hospital were made to the police between 2020 and
2023. No charges have been brought in any of those cases to date,
including Danielle’s case. The programme later showed Danielle on
a ward in a general hospital being surgically fed through a tube,
because she is now refusing to eat. Danielle’s mother said:
“After 13 years of trauma and neglect, she can’t see an end to
it, so she’s been starving herself. She just wants this to
stop.”
As the Minister hears these stories and listens to the words of
those parents speaking out, I wonder whether she really believes
that the right support is being given to autistic people. I hope
that she can pledge action to help Danielle. I understand that
Danielle needs housing so that she can move back to the community
with support. Will the Minister look at her case, to avoid
Danielle being shifted from facility to facility? Her life seems
to be at risk. I have discussed the case with the family’s MP,
the hon. Member for Maidstone and The Weald (Mrs Grant).
(Strangford) (DUP)
I commend the hon. Member for Worsley and Eccles South () on bringing this subject
forward. She has outlined two tragic and poignant cases, and I
commend her on the respectful way that she has done so. In
Northern Ireland, the Muckamore inquiry recently brought to light
the abuse of people in care. I had a mother in my office whose
heart broke when it happened to her child. Some 2,045 people are
detained in in-patient settings, and a lot of families only want
the best for their loved ones. Does the hon. Lady agree this
problem does not just pertain to the individual but affects the
entire family circle? That is the wider aspect that we need to
look at.
I very much agree. What the hon. Gentleman says is true; I have
seen many reports from Muckamore and I know that there are
similar issues. It is desperate for the parents and the families
because they rightly sought help for their children, but they
ended up being abused and their lives are ebbing
away—particularly those with eating disorders, who are not
getting the support that they need.
The truth is that the abuses experienced by these two young women
have been mirrored in similar scandals across the country. There
was a toxic culture of abuse at the Edenfield Centre, revealed by
BBC “Panorama” last September. There were the preventable deaths
of three adults with learning disabilities held at Cawston Park
hospital, who were subjected to torture and neglect, including
the appallingly named “crucifix restraint”. At Cygnet Yew Trees
hospital, staff members were arrested after reports that they
kicked, slapped and dragged around the autistic women and women
with learning disabilities being held there. Before that was the
BBC “Panorama” exposé of the scandal at Whorlton Hall, which I
cannot discuss in any detail due to ongoing legal cases.
All those reports were preceded by the scandal at Winterbourne
View, revealed by BBC “Panorama” in 2011. Members will remember
the scale of the outcry when that programme was broadcast. There
was a feeling then that something might change. I remind the
Minister that the coalition Government actually committed to
closing all inappropriate in-patient beds for autistic people and
people with learning disabilities by 2014.
At one time, reports and investigations into the scandals gave
rise to the hope of change, but despite the relentless efforts of
journalists, charities and activists, the criticisms reported in
the CQC’s inquiry into Winterbourne View all that time ago are as
true today as they were 12 years ago: there is a
“systemic failure to protect people or to investigate allegations
of abuse”.
Each of the scandals I have outlined across the decade, from the
events at Winterbourne View to those at the Edenfield Centre,
shows striking similarities. I encourage Members and the Minister
to read the safeguarding adults review on Whorlton Hall and to
decide whether anything has changed since the inquiry into
Winterbourne View, despite all the promises of action.
More recently, we seem to have entered a phase of total apathy.
Each scandal that hits national TV or the press results in a more
muted and defensive response from the Government. As calls to
address repeated failed targets grow more desperate, less and
less appears to be happening to rectify the situation.
In February, NHS England quietly published a report analysing
1,770 individual reviews of the care of autistic people and
people with learning disabilities, including children, who were
detained in in-patient services. The report was commissioned
following the tragic deaths of Joanna, Jon and Ben at Cawston
Park. It found evidence of high levels of restrictive practice,
that people’s medication was not always reviewed in a timely way
and that more than half the people were being detained a long way
from home. Most concerningly, the report found that 41% of people
did not need to be in hospital at all. NHS England stated that
many people could not be discharged because there was no adequate
care provision in the community and because staff did not always
have the training necessary to support people’s transfer from
hospital. These findings are a deplorable indictment of the
Government’s failure to act.
We are now 13 years on from the inquiry into Winterbourne View
and not a single Government target to reduce the use of
in-patient beds has been met, as referred to by the right hon.
and learned Member for South Swindon (Sir ) in his earlier
intervention. After the coalition Government’s ambition to close
all in-patient beds by 2014, a succession of watered-down targets
have been announced over the years, none of which has been met.
As the right hon. and learned Member said, the goal is now to
close 50% of in-patient beds by March next year, but it looks
impossible for the Government to meet even that much-delayed
target. The latest data indicates that bed numbers will reduce
not by half but by around only a quarter in 2023, compared with
the 2015 benchmark.
Over the last three years, even the meagre progress made earlier
has stagnated. The number of autistic people and people with
learning disabilities in mental health hospitals has actually
increased since the publication of the Government’s Building the
Right Support action plan last July, which was meant to drive
cross-Government action.
There is also a problem with the data itself, whereby data for
past months is retrospectively amended, sometimes by quite large
margins. That makes it difficult to understand with any accuracy
how many people are being detained. Getting the data right really
matters. When the risk of abuse is as high as the evidence
suggests, it is a dereliction of duty to have so much variation
in data collection. How are the Government supposed to measure
progress when the targets keep shifting?
A similar story can be told when it comes to financial investment
in the Building the Right Support agenda. The Government’s own
review from last summer stated that
“the limited ability to analyse financial data…to provide a
national perspective is a significant barrier to the effective
oversight and management of the BtRS programme overall.”
An answer to my written parliamentary question confirmed that the
Department of Health and Social Care did not hold data on how
much money had been spent on developing community services for
autistic people and people with learning disabilities, either
since 2015 or since the Winterbourne View scandal in 2011. The
data that was provided instead of the data I asked for showed
that investment in community services had actually fallen between
2021-22 and 2022-23, from £62 million to £51 million, and that
funding for discharging long-stay patients has remained frozen,
despite the fact we now have rocketing inflation, meaning soaring
costs to providers. That financial picture is clearly
unacceptable.
In her response, the Minister may want to point to the draft
Mental Health Bill. While the draft Bill includes some provisions
to address the detention of autistic people and people with
learning disabilities, concerns have been raised by charities
that the Bill must be significantly strengthened if it is to
achieve its aims. There are also concerns that the Bill will take
years to come into force and will not end the scandal on its own,
without urgent investment in both social care and mental health
services.
In the meantime, last year’s Building the Right Support action
plan is woefully inadequate. Not only was it published a full 11
years after Winterbourne View, but it is vacuous, it is
unambitious and it has been derided by organisations working in
the sector. I believe that to call it an action plan is absurd.
Instead of a fully funded strategy for caring for people at home
rather than in hospital, the Government have established the
Building the Right Support delivery board, which is responsible
for monitoring the commitments in the Building the Right Support
action plan. After so many years of allowing mistreatment to
continue, it seems pathetic that the best system of
accountability the Government can come up with is a delivery
board that I have discovered has met for only six hours in the 22
months since it was established.
We know from more than a decade of reports and evidence that
investment in social care, in community support and in the
workforce is critical to reducing the number of autistic people
and people with learning disabilities who are detained in
inappropriate in-patient settings. However, the Government have
just announced that they are halving the already pitiful £500
million budget for the social care workforce for the next three
years. I believe that that will have a severe impact on a
workforce who are already overstretched and are operating with a
vacancy rate of 11%. I ask the Minister what assessment her
Department has made of the repercussions that the cut to the
social care workforce budget will have on the quality of
care.
I could go on listing the repeated failures of successive
Conservative Governments to do anything about the matter. The
fact is that well over 2,000 autistic people and people with
learning disabilities are still being held in inappropriate
in-patient units. Approximately one in 12 are being held in units
rated inadequate by the CQC. Some 40% have been there for more
than 10 years. Fewer than ever have a planned date of discharge.
Many people are being detained far from home. The risk of abuse
is shockingly high, as we saw in the cases highlighted by Channel
4’s “Dispatches” programme, yet at every turn Government
Ministers have lacked any humility. Nor have they made any
apology for their abject failure to get a grip on this national
scandal.
I hope the response this evening will be different. Will the
Government now finally stop choosing to ignore the issue? Will
the Minister instead offer assurances that her Department will
take urgent action to end the inappropriate detention of autistic
people and of people with learning disabilities, which is
destroying the lives of so many people detained and their
families?
5.32pm
The Parliamentary Under-Secretary of State for Health and Social
Care ()
I thank the hon. Member for Worsley and Eccles South () for securing an Adjournment
debate on this really important issue. I hope she will see from
my response that we are by no means complacent about it. It is
appalling to see reports of the care and treatment that some
autistic people have experienced, and we absolutely take them
very seriously.
As the Minister responsible for patient safety, I have made it
clear to the House that everyone in an in-patient mental health
facility is entitled to high-quality care and treatment and
should be safe from harm. These are very vulnerable people who
should feel safe and looked after in any in-patient setting: that
applies to all patients admitted, but particularly to people with
a learning disability and autistic people.
When in-patient care is absolutely necessary, it needs to provide
a therapeutic benefit. It should be high quality, it should be
close to home, and it should be as unrestrictive and for as short
a time as possible—we have been very clear about that. Abuse
cannot and will not be tolerated. That is why we are committed to
taking steps at a national level to prevent the abuse and poor
treatment of people with a learning disability and of autistic
people in in-patient settings.
As we announced in January, the Government have commissioned a
rapid review, independently chaired by Dr Geraldine Strathdee, of
mental health in-patient settings. The review is focusing on how
we use data and evidence, on how we respond to complaints, on how
we listen to feedback and on how whistleblowers can raise the
alert to identify risks to safety in in-patient settings.
I have met many Members across the House with concerns about
in-patient care in their constituency. We absolutely take the
issue seriously. We want to ensure that the right people get the
right information, so patients get the care and support they
deserve, and to ensure that if there are concerns, we can
identify them as early as possible.
There is obviously a considerable amount of detail in both what
the Minister is saying and what I covered in my speech. However,
the Breightmet Centre in Bolton, where Amy was detained, has been
in and out of special measures, and it is inadequate. Amy was
sent back to the unit and abused further, although the centre had
been declared inadequate across all its settings. I am therefore
finding it difficult to align what the Minister is saying with
the actual situation. The list of scandals that have emerged
since Winterbourne View extends across the country. We keep
finding extra hospitals in which people have been abused,
including Littlebrook Hospital in Kent. The CQC is taking some
action, but these places are still open, they still have
patients, and patients are being abused. How does what the
Minister is saying line up with the reality out there?
As I have said, we instigated a rapid review in January to
examine the national picture across England because we wanted to
see what was being done in in-patient settings. This will include
looking at the data concerning the use of restraints, the safety
of patients, how concerns are flagged and how many patients are
being treated out of area, because that does increase the risk.
However, the review—which will report very soon—does not prevent
us from investigating further particular concerns about
particular in-patient units, and once it has been published we
will come to the House to update Members in response to many of
the points that the hon. Lady has raised about specific
in-patient settings.
As I have said, there has already been a review. NHS England
published a report on the 1,770 individual reviews of the care of
autistic people and people with learning disabilities, including
children, who had been detained. As I also said, that report was
commissioned following the tragic deaths at Cawston Park, and
revealed that there were high levels of restrictive practice and
that 41% of people did not need to be in hospital at all but
could not be discharged.
Does the Minister not accept that things are going seriously
wrong, and that there is not the necessary provision in the
community or the necessary training of staff to work with people?
I cited the case of Danielle, and I hope the Minister will look
at that case, along with the hon. Member for Maidstone and The
Weald (Mrs Grant), because it is an example of someone being
moved around for 13 years of her life, from one inappropriate
facility to another. We are destroying lives, in many cases young
people’s lives, because this often starts with children and
teenagers.
I will come on to what we are doing to try to keep people out of
hospital, and to get others discharged. We fully recognise that
there are too many people in in-patient settings at present, but
we also want to ensure that when people are in an in-patient
setting and need to be there, the service is safe and they do not
come to harm.
NHS England has established a three-year quality improvement
programme which seeks to tackle the root causes of unsafe,
poor-quality inpatient care. We all acknowledge that there has
been practice that has caused harm to patients. We want to see
the picture across the country, and then look at specific trusts
that are not providing the standard of care that patients and
their families expect. is overseeing independent
care and treatment reviews relating to people in long-term
segregation, and a senior intervener pilot has been undertaken to
help individuals in the most restrictive settings to be moved
towards discharge. Work is being done to examine the specific
units about which we have concerns.
The CQC, which the hon. Lady mentioned, has a central role in
identifying cases of poor in-patient care and taking immediate
action when that is necessary. We acknowledge that some settings
are not delivering the high quality of care that everyone
deserves, and we want to ensure that we are setting standards so
that units, integrated care boards and commissioners are aware of
the standards that should be expected and can raise concerns when
they are not being met.
As I said towards the end of my speech, around one in 12 of the
2,000 autistic people and people with learning disabilities being
held in these inappropriate units are being held in units rated
by the CQC as inadequate. The Breightmet Centre in Bolton, run by
ASC Healthcare, has been in and out of special measures and is
rated inadequate. Why is the Minister allowing people to be held
in those units? She is talking about setting standards, but that
is not an adequate standard. Would it not be a good place to
start to say that no one with autism or learning disabilities can
be held in a unit that is rated inadequate? That is an incredibly
low bar.
Admissions to services that are rated inadequate are an absolute
last resort, and they should be being done with patients and
their families being consulted and consenting to being placed in
those units. We are minimising the number of new admissions to a
unit that has been rated inadequate and we are working with the
CQC to see how those units can be better supported to improve the
quality of the service they offer.
The hon. Lady touched on funding. We are investing £121 million
in this financial year across community support for people with
learning abilities and autistic people as part of the NHS
long-term plan. We are recruiting 27,000 mental health workers
and we are on track to meet that target to increase the support
available in the community. It is absolutely the solution to look
after people in their communities with the care that they need so
that admission to hospital—which, as she points out, is often not
just for days or weeks or even months—is the absolute last
resort.
The hon. Lady touched on the Building the Right Support action
plan. We are drilling down on implementing the actions. We have
short-term and long-term actions, and some of the work has had an
effect already. At the end of February this year, the number of
people with learning disabilities and autistic people in a mental
health in-patient setting was 2,045, so we are seeing a
reduction. That is a net decrease of 860 people, or 30%, since
March 2015. Unlike someone with a physical health need, which can
be quite complex in terms of planning their discharge, it is not
just a case of finding people homes; they often have to have the
right support in those homes. It is not just a case of providing
them with support, because they often need complex support. The
in-patients who still need to be discharged are the more complex
cases, who, as the hon. Lady has pointed out, have often been in
hospital for years. Adapting to moving back into the community is
not an easy process for them, and that is why it is taking time
to get them the packages of care that they need.
I just wonder how the Minister can reconcile the figures as if
they were increasing when I have told her that we found, through
written parliamentary questions trying to get to the financial
picture, that the investment in community services actually fell
between 2021-22 and 2022-23, from £62 million to £51 million.
With rocketing inflation and soaring costs to providers, that
funding needs to increase.
I recommend that the Minister consider the issue of dowries, as
was suggested in the Health and Social Care Committee’s report on
this issue a few years ago. Time and again we find situations
where a county council or urban council responsible for social
care does not have the funding to provide that support. Millions
and millions are being spent. We do not even know how much these
placements cost, but some of them are very expensive. I am sure
the Minister is aware of how expensive they can be. Decades ago,
when we discharged people from long-term psychiatric
institutions, a dowry accompanied them. We talked about
Danielle’s case. If there were a system of dowries, Kent County
Council could have the funding to provide her with housing and
support. I have never understood why such a system has not been
brought in. We included that in our Select Committee report.
Cost-shunting is really a factor here. Local authorities do not
have to fund an NHS England place, and that is part of the
problem, yet we never get around to tackling that.
The hon. Lady is right; a number of organisations are responsible
for caring for people in the community, and it is often about
pulling those organisations together. That is why we have the
integrated care boards, which now have responsibility for looking
after people with learning disabilities or autism and helping
with their discharge.
It is not just about responsibilities; it is also about the
budget to go with those responsibilities. If the budgets were
transferred from NHS England, which is shelling out millions for
these inappropriate units, to the ICBs, I could see it working.
It certainly worked all those years ago for discharges into the
community. I was a councillor and vice-chair of social services
in Trafford, and we might get a dowry of £1 million to settle
someone from a long-term psychiatric hospital. That is the sort
of funding we need to be thinking about, and it does not
happen.
A key reason why we sometimes find it hard to discharge someone
from an in-patient setting is the housing element. We have
capital funding available. I recently met ICB chairs and chief
executives to encourage them to ask their local
councils—particularly district councils, which do the planning
element—to consider the funding that is available. The county
councils, the upper-tier authorities, are often responsible for
care, so it is about joining up the funding, but we are not
building the right type of housing to support people back into
the community. The capital funding is there. Sometimes one of the
frustrations is making sure that the money flows with the patient
so that they are able to get the care they need, but sometimes
the money is there and it is about joining up the services to
make it happen.
Is the Minister saying that there is unspent money that could be
used or transferred to local authorities? If so, how much is
available? I have asked written questions about this, but it
seems to me that the money has tailed off. Whether it is money to
help pay for housing or money to pay for workforce improvements,
the Government have halved the funding. People need housing and
they need support, and those elements have been cut back.
There is capital funding available to build supported housing for
people with a learning disability or autism, which is why I
recently encouraged a number of ICBs to make bids for funding at
a local level.
We have made good progress on reducing the number of people with
a learning disability in mental health hospitals. We are not
where we want to be. Of course, we want every person who is able
to be discharged to be either at home or in the community. I
recognise that there is work to be done, but the number of
in-patients with a single diagnosis of a learning disability and
the number of in-patients with both a learning disability and
autism are down from March 2015.
I am very happy to keep the hon. Lady updated on the work we are
doing. We will be meeting the Building the Right Support team
again very soon for an update on progress, but I recognise her
point. The two elements for me are that we need to get more
people out of hospital, whether by providing the care and support
they need through the 27,000 extra mental health staff and by
focusing on building resilience in the community, or, when
someone needs to be an in-patient, by making the experience as
safe and as therapeutic as possible. I have previously made it
clear from the Dispatch Box that we will not accept poor care in
in-patient settings. Once the independent rapid review reports
back very soon, we will set out the next steps to improve safety
in such settings.
The Minister has mentioned the Building the Right Support
delivery board, and I have said that I see it and the plan as
vacuous and unambitious. It has been derided by the organisations
in the sector that work with it. There is not a lot of confidence
in it. I have also quoted to her something that we found out by
asking questions about it: the delivery board, which is meant to
be driving cross-departmental Government action on this important
area to those 2,000 people and their families, has met for only
six hours in the 22 months since it was established. How is that
enough? It is not exactly a powerhouse is it, with six hours of
meetings in all that time?
The work goes on in between the meetings. The meeting reports
back to update members of the board on specific areas, but the
work is happening on a daily basis to both improve the safety and
quality of the care that patients are receiving, and to get
patients home where they are able to be discharged. That is our
absolute focus. I will be able to update the hon. Lady further
once the rapid review is completed very soon, and I absolutely
take her points on board.
I do not want anyone to be in an in-patient setting unless they
absolutely have to be, and if they are in such a setting they
should be receiving good-quality, safe care, so that family
members and friends can be reassured that their loved one is
being looked after well. No one wants that more than me.
Question put and agreed to.
