Healthcare Watchdog's Investigation Finds Neglect Of People With Learning Disabilities In Sutton And Merton, UK

Main Category: Psychology / Psychiatry
Also Included In: Autism;  Mental Health
Article Date: 21 Jan 2007 - 16:00 PDT

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The Healthcare Commission today released a report detailing how outmoded, institutionalised care had led to the neglect of people with learning disabilities at Sutton and Merton Primary Care Trust.

The report described some of the environments in which people lived as impoverished and completely unsatisfactory. Staff were not properly trained or supported to provide an acceptable level of care, and inadequate levels of staff meant that people were often left day in day out with little to occupy their time. There were failures in management and leadership at all levels, from managers to the trust's board.

Anna Walker, the Commission's Chief Executive, said: "The standard of services at Sutton and Merton was simply not acceptable in the 21st century. Orchard Hill Hospital is an institution and should be closed as soon as it is possible to place residents in appropriate alternative care settings.

"We have examined care plans for people who will continue to live at the Hospital until they are moved to different services. We acknowledge the considerable improvements made by the trust in the meantime, in particular the substantial increase in numbers of staff. We will, however, continue to monitor the trust closely during this time."

The impetus for the investigation came from the Sutton and Merton PCT itself, which wrote to the Commission in January last year to request an independent investigation of its services for people with learning disabilities.

The trust was concerned by a number of serious incidents. The Commission's investigation team found that, in most cases, the trust had followed correct procedures for the protection of vulnerable adults when responding to these serious incidents.

The report, however, details a series of failings by the trust to provide safe and adequate care for people with learning disabilities. The overall model of care promoted dependency. People were cared for rather than supported to be as independent as possible. The views of people with learning disabilities were seldom heard and few staff had any specialist training in ways of communicating with people with learning disabilities.

There was inadequate specialist support for people with behaviour that challenges, and there were few outings or meaningful activities, which exacerbated behavioural problems and led to increased risks. Most of the environments that people lived in were unsatisfactory with inadequate access for disabled people, poor decoration and furnishings and insufficient space for hoists in bedrooms and bathrooms. In some instances, limited space compromised the privacy and dignity of people with learning disabilities.

There were serious deficiencies in meeting the requirement for people to have an up-to-date person-centred care plan. There was no robust system for monitoring the service either at the managerial or board levels. Constant change in the trust, including seven chief executives within 10 years, created a lack of continuity and follow-up action of managers.

Inappropriate use of restraint was identified as a serious matter of concern. In one case, a woman had routinely been restrained for many years through the use of an arm splint, which was applied to prevent her putting her hand in her mouth. Such practices have long been deemed inappropriate and harmful.

Ms Walker said: "Some of the findings are classic examples of staff being unaware that certain practices are no longer acceptable and could in some cases constitute abuse. This report should not be seen as a condemnation of individual members of staff, some of whom even worked on their days off to ensure adequate cover. But they were often not sufficiently trained or supported to provide adequate care."

This latest report comes just over six months after a report which detailed neglect and physical, emotional and financial abuse of people with learning disabilities at Cornwall Partnership NHS Trust. The Cornwall report prompted the first national audit of learning disability services, currently underway in England.

The Commission today announced that the learning disability audit will include the inspection of up to 200 NHS and private services. It will aim to identify any problems in the sector, as well as examples of best practice. It will also produce guidance on what a modern learning disability service should look like. The findings are expected to be published by the end of this year.

Ms Walker said: "The Sutton and Merton case is very different from what was uncovered at Cornwall. But it is the second report of neglect of people with learning disabilities within the space of just six months. This confirms that we are right to be concerned about the quality of care for people with learning disabilities throughout England.

"Credit must be given to the trust and particularly to the Chief Executive, who on taking up to the post, asked us to undertake an investigation knowing that it would be made public. The trust has worked with us at every stage of the investigation and this should be commended. But clearly it does not excuse the neglect of the people with learning disabilities in its care.

"The Trust was providing institutionalised care which sacrificed the needs of vulnerable individuals in favour of the needs of the service. It is simply not good enough."

The Commission's report contains 25 recommendations and the trust is required to prepare an action plan within nine weeks to address these. The Healthcare Commission will closely monitor the plan's implementation.

Ms Walker said: "I'm pleased to see that the trust has already taken significant steps to address our concerns, such as putting in place person-centred care plans, increasing numbers of staff and providing more effective training."

The Trust has developed a plan to relocate most of the people living at Orchard Hill Hospital by the end of 2008 and to close the site by 2009. A schedule for the closure of Osborne House is also being developed.

-- More information about Sutton and Merton Primary Care Trust
-- More information about learning disabilities

The Healthcare Commission started work on 1 April 2004. The organisation was created under the Health and Social Care (Community Health and Standards) Act 2003.

The Healthcare Commission is chaired by Professor Sir Ian Kennedy and has a board of 14 commissioners. Anna Walker is Chief Executive of the Commission and leads a senior management team of six. Its staff are based in London, Nottingham, Leeds, Bristol and Manchester.

The Healthcare Commission's role is complemented by specific new arrangements for the inspection of healthcare in Wales that also began on 1 April 2004. Responsibility for local inspection and investigation of NHS bodies in Wales rests with the new Healthcare Inspectorate Wales (HIW), based within the National Assembly for Wales.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The HPSS Regulation and Improvement Authority (HPSSRIA) undertakes regular reviews of the quality of services in Northern Ireland.

http://www.healthcarecommission.org.uk

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