My Lords, I, too, congratulate the noble Lord, Lord Rix, on securing this debate. I am glad to see him back in his place and wish him and his wife well. He has a formidable record in this area and we are pleased to see him back here. He has been fighting for a long time for the rights of people like Simon, whom he mentioned.
There can be no more important issue for us as a society than how we treat our most vulnerable people, as my noble friend Lady Jolly and others emphasised. I, too, was impressed by the maiden speech of the noble Baroness, Lady Kidron. It was very moving and she absolutely rightly emphasised that this debate is about cases like that of Louise. If we cannot get things right for people like Louise and her family, we are not getting anything right.
I thank the noble Baroness, Lady Hollins, for her praise for the report issued this week. I assure the noble Lord, Lord Maginnis, of the huge commitment of my honourable friend Norman Lamb in this area. That commitment shines through in this uncompromising report. Stimulated by this terrible case, it does not just deal with Winterbourne View but looks at the whole sector with its radical proposals—which I am glad so many noble Lords welcomed. Noble Lords have, if anything, asked if those can be done and delivered, rather than questioning whether this is the right route to take. There is a firm and detailed timetable of action. I hope that noble Lords have marked that, including the noble Lord, Lord Hunt. I am sure that noble Lords will hold us to account. My honourable friend Norman Lamb will oversee this. He will leave organisations in no doubt of his commitment in this area.
The scandal that unfolded at Winterbourne View was devastating but it has spurred us into action. Straight after the abuse was exposed, the Government commissioned an in-depth review. Noble Lords have referred to the report published earlier this week. As we said then, the Winterbourne View abuse was criminal. Staff whose job was to care for people instead routinely mistreated and abused them—as my noble friend Lady Jolly, the noble Lord, Lord Maginnis, and others said. Management allowed a culture of abuse to flourish. Warning signs were not picked up, and the concerns of residents’ families, and of a whistleblower, went unheeded.
As I have said, this case made us look again at how we care for one of society’s most vulnerable groups of people. Winterbourne View provided care for people with either learning disabilities or autism, together with mental health problems or challenging behaviour. Around the country some 15,000 people have similar needs, of whom some 3,400 are in in-patient settings. Many people receive good care in these settings but—as my honourable friend Norman Lamb, the noble Lord, Lord Touhig, and others have said—hospitals are not where people should live. Across the country, far too many people with learning disabilities or autism are in hospital and staying there too long. As the noble Lord, Lord Rix, and others emphasised, we have known for a long time that with the right support the vast majority of people with challenging behaviour who also have autism or a learning disability can live happy, fulfilled lives, close to their families and in their own communities—as Simon now is. When someone needs to be in hospital, it should be for a short period, in a small unit as close to their home as possible. I, too, pay tribute to Jim Mansell for all the work that he did on this.
We know what change is needed. It is now time to make sure it happens. First, owners, boards and senior managers must take responsibility for their services. I assure the noble Lord, Lord Rix, that we will examine how corporate bodies and their boards can be held to account for the provision of poor care and for harm experienced by people using their services. We will consider both regulatory and criminal sanctions, and will set out proposals in this area in spring 2013. I look forward to the noble Lord’s comments on those proposals. Of course, the noble Lord, Lord Hunt, is right to focus on the corporate responsibility of Castlebeck and other companies. I am sure that he will also scrutinise with great care the proposals that we bring forward. In addition, we will explore whether we can introduce a test to ensure that directors are fit and proper persons to oversee care. The CQC will consider a best practice model of care as part of its regulation of services from 2013. It will also check whether all providers are following national guidance or similar good practice. Where standards are not met, it will take enforcement action.
We will also stop people being placed in hospital—unless hospital is actually the best place to be. All current hospital placements, as noble Lords have referred to, will be reviewed by June 2013. Everyone who is there inappropriately will move to community-based support as quickly as possible—and no later than June 2014.
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I assure the noble Lord, Lord Rix, and other noble Lords, of the involvement of parents and families in the review; they will have a key role. Additionally, every area will develop a plan to make sure that this group of people receives high-quality care. As a result, we expect to see a dramatic reduction in hospital placements. Noble Lords have made reference to that. The noble Lord, Lord Touhig, asked how we would ensure that we do not end up with people simply on the streets and the noble Lord, Lord Maginnis, and others hoped that moving to the community would ensure better care—putting a question mark over that.
I emphasise that the department has published good practice guidance and will be publishing further guidance and working with the CCGs and local authorities that are commissioning suitable care through joint improvement teams. As I mentioned, the involvement of families and advocates in what happens to family members is absolutely key. However, as the noble Baroness, Lady Kidron, points out, this cannot mean—must not mean—that families themselves find that they are the ones who are picking everything up.
The noble Baroness, Lady Hollins, and the noble Lord, Lord Hunt, asked about the timescale of getting people back home. We agree that the timescale is challenging, but we believe that it is realistic. It is vital—that is something which came through in noble Lords’ contributions. They have been waiting decades for this to happen. We must not slow it down now.
In terms of incentives to return home, we agree that people need to be in appropriate settings. The department will work with the improvement team to monitor very closely and report on progress nationally, including reporting comparative information on localities. A follow-up report will be published by December 2013 and repeated in December 2014.
I can assure the noble Lord, Lord Hunt, the noble Baroness, Lady Hollins, and others that this will be closely monitored. I can confirm to the noble Baroness, Lady Hollins, that parity of esteem does, of course, apply to this group of people. They deserve to have their rights respected—just like anyone else—and to have access to whatever mental health treatments they need. I also note what she says about the King’s College research networks and I will make sure that that is fed in to the department.
We will support a positive and open culture, where staff provide excellent care. As part of this, it is crucial that the staff working with people with challenging behaviour are properly trained in essential skills. We expect commissioners to assure themselves that providers are meeting proper training standards. Contracts should be dependent on assurances that staff are signed up to the proposed code of conduct that the Department of Health has commissioned, and that minimum induction and training standards for health and care assistants are being met. Noble Lords have referred to the regulation and training of workers in this area. A number of noble Lords expressed concern and it is indeed crucial that they meet these standards. Contracts within any remaining learning disability and autism centres or hospitals should be dependent on assurances that staff are signed up to these codes of conduct, which the
department has commissioned from Skills for Health and Skills for Care. As I say, minimum induction and training standards will be required.
My noble friend Lord Addington also asked about this. I assure him that owners, boards of directors and senior managers of organisations must take responsibility for ensuring the quality and safety of their services. This is also an area that we are looking further at. From April 2013, Health Education England will have a duty to ensure that the system of education and training is supplying a skilled and high-quality workforce.
I realise that I am running short of time. With regard to autism, I say to my noble friend Lady Browning that we are currently putting together our plans for a review, which will be a priority for the Government. We are working closely with people with autism and their families, with service commissioners and providers and with relevant voluntary organisations to assess what impact the strategy has had in improving support and outcomes for people with autism and to consider what further action is needed. We will pay close attention to what she says, given all her experience.
My noble friend also asked about the Mental Capacity Act. There was post-legislative scrutiny of the Act in 2011, when a report was laid before the House of
Commons. We absolutely agree that families are best placed to understand their loved ones’ wants and needs, and we are determined that there should be a closer partnership with families. There will be a further opportunity to look at this as we consider the Care and Support Bill. I am sure that my noble friend will look at it with all her experience and expertise, and we look forward to discussions on it with her.
All noble Lords agree that this is something that has to change—and change fast. I assure noble Lords of our enormous commitment, and of that of my honourable friend Norman Lamb. We will make these changes as quickly as possible. A concordat signed by more than 50 organisations set out the specific actions that each organisation committed to deliver. The NHS Commissioning Board and the Local Government Association will lead an improvement programme to supervise changes, and Norman Lamb personally will oversee progress. We must use the tragic events at Winterbourne View as the spur to make things better. There are places that are already getting this right. They show what can and should be done for all, and that a better life for people with learning disabilities and autism is within our grasp.