Cawston Park Hospital: Norfolk Safeguarding Adults Board Review

Gillian Keegan Excerpts

Tuesday 21st September 2021 Commons Chamber

[The Minister for Care (Gillian Keegan)]

I thank my hon. Friend the Member for Broadland (Jerome Mayhew) for securing this debate on this deeply disturbing, upsetting and important topic, and for his continued work on exposing the failings at Cawston Park.

I would like to begin by expressing my sympathy for the families, friends and loved ones of Joanna, “Jon”, as he is referred to in reporting, and Ben. These are three people whose lives were cut short tragically and needlessly. The accounts of their experiences at Cawston Park Hospital, a place that should have been there to care for and support them, are heartbreaking. I can only imagine how distressing it would have been for their families and loved ones to read about the events leading up to their deaths. I send the families of Ben, Jon and Joanna my deep condolences, and I would like to invite them to meet me so that I can understand their experiences directly—I would be happy for my hon. Friend to join me in those meetings.

I would also like to thank those who have shared their experiences of the services and support at Cawston Park, and the Norfolk Safeguarding Adults Board for under-taking the review and preparing the final report. That is essential for shining a light on what has happened. I know that my officials are in dialogue with the board to identify how recommendations can be progressed as impactfully and as quickly as possible. I believe they met today.

The appalling care and practice uncovered at Cawston Park is completely unacceptable. Every person with a learning disability, and every autistic person who needs it, must receive safe and high-quality care, and they must be treated with dignity and respect. Both my hon. Friend and I have dearly loved family members who have Down’s syndrome and know many people with autism, and we are horrified to think that vulnerable people who put such trust in others for support would be treated in such an appalling way.

I recognise and acknowledge the frustration and strength of feeling about the issues raised today. The Department is working with the NHS, local government and the Care Quality Commission to ensure that we identify unacceptable care with urgency and take robust action immediately. I can confirm that Cawston Park closed in May, following action taken by the CQC, and all of the people who were in-patients at Cawston Park have moved either to a supported community setting or to an alternative hospital setting, where immediate discharge was not possible.

I appreciate that everyone listening will want assurance that anyone with a learning disability and any autistic person in one of those hospitals—any one of the 2,000 people he mentioned—is safe. NHS England’s reviews of each individual person’s care arrangements will ensure that there is a clear care plan in place with a clear path to discharge. Such treatment where there were no clear paths to discharge must not happen again.

More broadly, I welcome this opportunity to set out the work that is under way to eliminate poor-quality in-patient settings and properly invest in the community alternatives that people with a learning disability and people with autism deserve.

As the regulator for mental health hospitals, the CQC has a central role in identifying any cases of poor in- patient care and taking immediate action. The Department fully endorses the increased scrutiny by the CQC and its improved inspection approach, which includes spending more time with patients and their families to identify settings that are at risk of developing a closed culture. In particular, the CQC takes more account of what families have to say. The enhanced processes have revealed cases in which quality falls below the standards we expect. Where that is the case, robust regulatory action is being taken. We must not tolerate poor care and treatment, and any provider that cannot meet standards should be tackled immediately, including through closures.

In the report, families describe the excessive use of restraint and seclusion by unqualified staff. Any kind of restrictive practice or restraint should only ever be used as a last resort. The Department is taking action to increase the transparency and reporting of the use of restrictive practices, in response to the recommendations made by the CQC in its review of the use of restraint, seclusion and segregation. Increased transparency is a central aim of the Mental Health Units (Use of Force) Act 2018 statutory guidance, on which we have recently consulted. Work is now under way to commence the Act from November 2021.

As part our longer-term plans to limit the unnecessary detention of people with a learning disability and autistic people, we are seeking to implement once-in-a-generation reforms to the Mental Health Act. Under our proposed reforms, we will limit the scope to detain people with a learning disability or autism for treatment if there is no diagnosed mental health cause for distressed behaviour. To support that, the proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and that every local area understands and monitors the risk of crisis at an individual level. For those who continue to require in-patient care, we are clear that this should be for the shortest time possible, as close to home as possible and the least restrictive possible.

Alongside the longer-term plans to improve in-patient care and support, the situations outlined in the review of Cawston Park highlight the need for urgent action in quicker time. That will require cross-system, cross-Government action in a number of priority areas that have historically presented blockages to progress. The Government are taking action specifically to target such blockages, ranging from identifying best practice models in the community to ensuring that the right workforce with the right training is in place.

In closing, I thank Members for their contributions on this important topic and their commitment to ensuring that people with a learning disability and autistic people receive the high-quality care and support that they deserve. The CQC’s robust inspections are helping us to identify and prevent cases of unacceptable care, such as that of Cawston Park. It is our priority—and my personal priority—to reduce reliance on in-patient care. I have set out today the range of work that is under way not only to reduce in-patient numbers but to drive real change in the care that is available to people with learning disabilities and autistic people, to enable them to live fulfilling lives in the community, as we all want. All our actions will be shaped by the Norfolk Safeguarding Adults Board review report, to ensure that the experiences of Ben, Jon and Joanna are not repeated.

Question put and agreed to.