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Learning disabled were physically and sexually assaulted in units

David Brindle
Wednesday January 17, 2007
The Guardian

The NHS faces being stripped of its responsibility for learning
disability services after inspectors today issue the second damning
report in six months into the care of some of the most vulnerable
members of society.

People with learning disabilities had been subjected to physical and
sexual abuse at a hospital in London, according to an investigation by
the Healthcare Commission. One member of staff was jailed for six
years last summer after being charged with rape of a woman resident
who was considered unable to give consent due to her low mental age. A
second staff member had been given a suspended sentence for a sex
offence against the same woman a year earlier.

The report by the official healthcare watchdog into conditions at
units run by the Sutton and Merton primary care trust also reveals
that inspectors found another woman resident “for many years” had her
arm tied to a splint for most of the day, apparently to prevent her
putting her hand in her mouth and developing sores.

The investigation found people with learning disabilities living at
Orchard Hill hospital in Carshalton, south London, and other units run
by the trust had been treated in outdated and infantilising ways.
Living conditions were impoverished, routines arranged for the
convenience of staff and organised activities at the hospital provided
for less than five hours a week.

The commission’s findings follow its report last summer on abuse of
learning disabled people in services run by the Cornwall Partnership
NHS trust.

There, one man who had no speech, sight or hearing was tied to his
wheelchair or bed for up to 16 hours a day, ostensibly to stop him
harming himself. The commission is launching an audit of learning
disability services across England and will inspect 200 of them. Fiona
Ritchie, who heads the commission’s work on learning disability, said:
”People have lived like this for too long.”

But ministers are poised to step in before the commission uncovers any
more scandals, by ordering that the NHS surrender its lead role, and
will pass more than £2bn in funding to local councils.

A policy review within the Department of Health is nearing completion
after Ivan Lewis, care services minister, told parliament he intended
to strengthen local government’s role.

Rob Greig, the government’s co-director or “tsar” for learning
disability, told the Guardian: “This is another case where the NHS has
been shown to fail in commissioning services for where people live and
how they get support. My personal view is that the NHS should be
transferring responsibility to local authorities and focusing on
commissioning good-quality, mainstream healthcare for people with
learning disabilities.”

Sutton and Merton PCT is already preparing to hand over its role,
other than in the area of personal health. Caroline Taylor, its chief
executive, said: “I don’t think the PCT is the best organisation to be
providing learning disability services. Most people who use the
services primarily have social needs rather than healthcare needs.”

Councils control more than £3bn of learning disability services, but
the NHS in some parts of England has clung to the lead role and not
established working partnership arrangements with councils despite the
evolution of community care and the closure of long-stay hospitals.

Bleak house

A damning report into one of the last long-stay hospitals for learning
disabled people could be the final nail in the coffin for NHS
involvement in the service. By David Brindle

Wednesday January 17, 2007
The Guardian

When we sit down to eat, most of us do not have a large sheet of blue
tissue paper wrapped around our shoulders as an outsized bib. Yet when
healthcare inspectors came calling, staff at Orchard Hill hospital in
Carshalton, south London, had no compunction about being seen to do
this to some of the disabled adults they were caring for - and then to
feed them “at a speed that would not allow for any enjoyment of the
food”.
The episode encapsulates what the inspectors uncovered at Orchard Hill
- which will shortly be the last remaining long-stay hospital in
England for people with learning disabilities - and at other
facilities run by the learning disability service of Sutton and Merton
primary care trust (PCT). Institutional abuse was found to be
prevalent in most parts of the service, but it was abuse largely of an
unthinking kind, practised by staff who knew no better. “The overall
model of care ... promoted dependency,” the inspectors conclude in
their inquiry report, published today. “The culture was such that
staff concentrated on what people could not do, rather than what they
might be able to do.”

Several staff were heard referring to residents as “the children” or,
in the case of women, “girls”, and one senior staff member used the
term “babies” in conversation with the inspectors. The records of one
resident with communication difficulties were found to state that
”staff do not require communication training because the client does
not speak”.

Another set of records identified a need to find a mosque for the
resident in question. The report notes: “Staff said that this had not
happened, but that the person concerned seemed to enjoy the singing at
the local church.”

The report may prove the final nail in the coffin of NHS
responsibility for learning disability services. While it may not be
as immediately shocking as last year’s inquiry findings into abuse of
learning disabled people in Cornwall - and in this instance, by
contrast, the Healthcare Commission was asked to investigate by Sutton
and Merton itself - the picture is none the less a disturbing one of a
service that had been isolated from the mainstream, neglected by
senior management and stuck in a care timewarp. In the words of David
Congdon, head of campaigns and policy at learning disability charity
Mencap: “These are practices that were outdated 20 years ago, let
alone now.”

The NHS in England is already under notice to get out of provision of
hospital and “campus” accommodation for learning disabled people by
2010, meaning that almost 3,000 people must be rehoused, but the
prospect now is of the NHS being stripped also of the job of
commissioning services for this client group - other than for their
physical health - in parts of the country where it still does. This
would mean more than £2bn a year being transferred from the NHS to
local government, giving the latter overall control of some £6bn of
learning disability services and ending what many see as the
historical anomaly of the health service being responsible for people
who may be profoundly disabled but are not ill.

Ministers are committed to strengthening local government’s role, and
an internal Department of Health review, due to conclude by March, is
known to be leaning towards taking all responsibility away from the
NHS, fulfilling a vision set out more than 30 years ago.

It was in the mid-1970s that the health service last looked as if it
might lose this role. The then Labour health minister, David (now
Lord) Owen, was forecasting “more scandals, more [departmental]
circulars, but very little ... executive drive” if responsibility
stayed with area health authorities, the PCTs of their day. He
favoured creation of a “mental handicap executive” to oversee
establishment of a new caring profession within local authority social
services. An inquiry led by Peggy Jay was set up in 1975, but its
report was not published until 1979, by which time Owen had long since
left health, and a dying Labour government was in no state to take on
vested medical and nursing interests.

Almost all of England’s long-stay learning disability hospitals have
now closed: about 180 people remain to be moved out, including 93 at
Orchard Hill, where closure has been delayed in part by two legal
challenges. But what today’s report suggests, as did the one about
Cornwall, is that systemic problems are not confined to the old
hospitals, nor even to the hospitals and NHS campuses (clusters of
houses with some shared facilities), but may be found wherever the
health service retains lead responsibility for commissioning learning
disability services and has not developed true partnership
arrangements with local government.

Although standards were found to be somewhat better at Sutton and
Merton’s community houses, where 59 people live and where some good
practice was observed by inspectors, the houses are by no means
exempted from censure. Indeed, the houses were the settings for some
of the 15 serious incidents that are reviewed in the report and that
occurred over 36 months to November 2005 - including the rape of a
woman resident by a member of staff, who was jailed for six years last
July. A year before that attack, a second staff member was charged
with committing a sex act with the same woman and was subsequently
given a suspended jail term. Both men were dismissed.

Despite such incidents, the PCT appears, at least until last year, not
to have had learning disability services at the forefront of its
concerns. The inquiry report notes: “Performance reports to the PCT’s
board did not include any mention of the learning disability service
and focused on A&E and acute services. Issues identified in the
minutes of the learning disability quality committee were not reaching
the PCT’s governance committee and were not therefore reaching the
PCT’s board.”

Rigid routines

Given this, it is scarcely surprising that the inspectors found most
of the accommodation for learning disabled people to be unsuitable,
that staff were under strength and lacked training and specialist
input, that routines were rigid and activities limited - one survey
indicating that Orchard Hill residents spent less than five hours a
week outside their living areas - and that staff were often unaware
they were using physical restraint, on which there was no policy.

Congdon says this reflects a wider malaise. “The impression you get is
that where learning disability services are tacked on to organisations
that have got much broader responsibilities, no one is very interested
in what’s going on,” he says. “Consequently, you get outdated
practices carrying on for ever and a day.”

Rob Greig, national co-director or “tsar” for learning disability,
seems to concur. “I am absolutely appalled by what has been
identified,” he says. “My sympathies go out to the people and their
families for what has happened, which should not have happened, and
it’s sad to see that these things are still happening in services
nowadays. But we need to emphasise that these failures and this abuse
have occurred, as in Cornwall, in outdated NHS residential provision
that was either institutional in nature or run in institutional ways.

”Like the abuse in Cornwall, this occurred in services that were being
run by the NHS, rather than the local authority and NHS working
together in partnership. It’s greatly to be welcomed that the PCT and
the local authorities now have a jointly appointed senior manager and
are putting together a joint strategy, but the lesson is that the NHS
should not be doing these things on its own.”

The Healthcare Commission gives credit to Caroline Taylor, the PCT’s
chief executive, for inviting it to investigate shortly after her
appointment in November 2005. She says the report and its
recommendations are fully accepted. “At a time when the PCT was faced
with many pressures, we took our eye off the ball and paid too little
attention to the day-to-day running of the learning disability
service,” she says. “We now have new management in place, with new
systems, and we won’t fail our residents from now on.”

System of reporting

A measure of the state that the service was in is that the PCT has
acted to increase staff numbers in learning disability by no fewer
than 147. It has also transferred responsibility for commissioning
services to the Sutton and Merton local authorities, “to allow the PCT
to concentrate on providing the service, with a new, regular system of
reporting to the board”.

Orchard Hill is now scheduled to close by 2009, with most of the
people living there moved out by the end of next year. A timetable is
being drawn up for closure of Osborne House, a campus-style site in
Hastings, East Sussex, where the PCT provides care for 30 learning
disabled people. According to the government’s national commitment,
this should shut by 2010.

What role the NHS will by then have in respect of learning disability
across England is now uncertain. After Cornwall and Sutton and Merton,
the starting point for any rethink will be that services must never
again be allowed to slip out of sight or mind. As Greig says, today’s
report highlights “the absolutely central importance of services being
open to the wider world so that the people who live there - and the
staff - are interacting with the local community and can see and
experience real life”.

www.healthcarecommission.org.uk

__._,_.___

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