§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pope.]
7.48 pm§ Mr. Tom Brake (Carshalton and Wallington)I am grateful for the opportunity to raise this important matter and will briefly outline the services that are on offer at Orchard Hill in case the Minister is not familiar with the establishment.
Orchard Hill is a campus-style hospital run by the South West London Community NHS trust for people with learning disabilities. It is one of two remaining sites in London for such people. It has a 47-acre site in Carshalton next to the site of the old Queen Mary's hospital for children, which closed some years ago. At present, it is home to about 110 people, most of whom have lived there for all their adult life. The people at Orchard Hill tend to have greater disabilities than most—many have mobility problems or are incontinent, some are blind and most require nursing assistance. The majority are over 30 and nearly 90 per cent. have been at Orchard Hill more than 20 years.
As well as being a place where people live and are supported by trained staff, the hospital site has other facilities for people with learning disabilities, not all of which are managed by the trust. For instance, they include short-term, in-patient beds for the assessment, treatment and respite care of people with learning disabilities. There is a further education service, providing a wide range of courses; there is a structured curriculum, with the flexibility to meet individual needs—including communication, physical education and life skills—and specialist courses for students with sensory impairments as well as courses on the arts and sciences.
Orchard Hill can be classed as a unique college for people with learning disabilities. Also on site, there are day services and an experience park. There is a dedicated health centre and a hydrotherapy pool. Some of those services are used by people from the wider community.
There are, however, some difficulties. The campus is old-fashioned and, by contemporary standards, the buildings offer poor accommodation for the services provided. Residents lack both privacy and homely environments. Although some residents' families consider the care provided as adequate, others consider that the service reflects the running down of Orchard Hill. The Minister will agree that that matter needs to be addressed.
In 1999, a consultation document was produced on services at Orchard Hill for people with a learning disability. Orchard Hill was under threat of closure. Worried parents took the matter to a judicial review and the decision on Orchard Hill was quashed by Mr. Justice Jackson. It is likely, however, that the South West London Community NHS trust will introduce similar proposals, taking into account the criticisms made by Mr. Justice Jackson. It is for that reason that I requested the debate. For the sake of residents at Orchard Hill and their relatives, it is essential that any further plans to make changes are carried out correctly and appropriately by the trust.
I seek reassurance from the Minister that plans will proceed in the manner that will—most important—identify and meet the medical, social and sensory needs 195 of each individual, confirming whether, in fact, they need a medical or a non-medical model of care; assess the psychological impact of moving; minimise the anxiety of relatives; improve current standards of care; and provide a relevant service for the future. The Minister will no doubt agree that we have progressed from Victorian policies for the care and treatment of people with learning disabilities that centred on the use of large institutions.
The most recent guidance for people with learning disabilities is contained in "Signposts for success in commissioning and providing health services for people with learning disabilities", published by the Department of Health in 1998. Orchard Hill can meet many of the recommendations set out in that document. An exception, however, is the recommendation that people with learning disabilities should ideally have experience of community services that are not institutional in style.
Why has the South West London Community NHS trust proposed changes for Orchard Hill? In part, no doubt, it is in response to Government policy. However, many other reasons for change are put forward.
Without a major source of capital investment, the viability of the site will increasingly be challenged; it would be unacceptable for residents to remain on a site that was in permanent decline. Change is happening anyway, because the population at Orchard Hill is an ageing one. People are discharged at the request of a relative or of health authorities and, sadly, several residents have died.
As the cost per capita rises, it is becoming increasingly difficult to maintain quality. The hospital site is mostly made up of older buildings. That is not an appropriate environment in which to provide care and many professionals are reluctant to work in such settings.
Of course, the new generation of people with learning disabilities expects that services will be more community based and less institutional in style. All national health service bodies have a duty to seek services that make the best use of limited resources.
In 1998, a project board was set up to look at the options for change at Orchard Hill. It soon became clear that a single model would not be practical. A proposal was made to minimise the disruption to clients with the highest need by retaining some existing bungalows while offering new opportunities to the more able residents by creating some new residential services. It was proposed to use land already owned by the trust and to use the independent sector to offer places to the majority of residents. It was thought that such an approach could be more easily tailored to fit individual needs.
The response of relatives to the proposals was generally negative. A third were opposed to the proposed changes. A third said that they might support them if the final arrangements were suitable for the individuals concerned. A third were undecided. Apparently, only one person supported the plans, while 68 per cent. of the next of kin felt that the changes presented no opportunities for residents.
Why was the response so negative? There are several reasons. Next of kin are concerned that the plans will result in the loss of staff who have intimate knowledge of the residents. Most were concerned about the location of future homes, especially as some residents will become the responsibility of the health authority that originally placed them at Orchard Hill. Next of kin were worried 196 that individual placements might not meet the needs of individuals and that monitoring of the independent sector might be deficient. The consultation process carried out by the trust did not appear to address those concerns. That needs to be corrected in future reviews.
It should not be forgotten that the people at Orchard Hill are severely disabled; the majority have a mental age of between two and five. The site benefits from its surroundings of wide open spaces—a fact that I can vouch for, having visited it on many occasions—and from the safe environment in which people who are hyperactive can release energy and walk safely. Relatives are concerned that those important benefits will be lost—to the detriment of the residents.
At the judicial review, Mr. Justice Jackson quashed the consultation process because of a flaw in the decision-making procedures; the health authority had not taken into account the promise made to so many residents that Orchard Hill was a "home for life". Although I realise that a public authority cannot be expected to keep all the promises of its predecessors when considering actions that would take the opposite direction to such promises, they must still be taken into consideration. Furthermore, the process was deeply flawed because the trust had neglected to carry out individual assessments of need.
Mr. Justice Jackson questioned the backbone of the plans for change when he queried whether
institutionalisation is the real problem for these particular individuals.That is a worrying observation and undermines one of the trust's major reasons for undertaking the project.For ageing parents of residents, many of whom have contacted me, their sense of security for the future has been shaken. Any future plans must proceed sensitively and appropriately. Given that, in the past, the trust has shown a serious operational deficit, and bearing in mind the Government's calls for care in the community, there is an impression that change is being driven by a cost-cutting exercise and a top-down agenda for the future of learning disability services nationally and by the reconfiguration of all such services locally. I should like to see evidence that change is being driven by all that is in the best interests of users, patients and the general public.
During the Orchard Hill project, one of the proposals considered was for a care village environment. The situation at Orchard Hill almost fits such criteria already. However, the team considering the proposals did not believe that Orchard Hill adhered entirely to the Government's policy of care in the community. The team was concerned that a ghetto might be created and that the services provided in the village and in other mainstream facilities raised issues of access and integration. However, I question whether the care village proposal was given sufficient consideration.
As the Minister may be aware, Baroness Caroline Cox and Lord Malcolm Pearson recently published "Made to Care: The Case for Residential and Village Communities for People with a Mental Handicap". The paper states that the policy of integration was associated
with the swing of another pendulum away from a "medical model" of care towards a model of "social care" based on the assumption that most mentally handicapped people are not ill, but have largely "social needs".That swing has obscured the fact that the health needs of people with mental handicap tend to be greater than those of the general population. Many suffer from multiple handicaps, which need medical care and clinical expertise.197 Baroness Cox acknowledges that, although a move into the community has been successful for many people—because they have gained independence, autonomy, dignity and self-esteem—it does not mean that de-institutionalisation is the most appropriate or suitable option for everyone.Initially, those who have been discharged from long-stay institutions have been the people who have been the least disabled and the most independent. Now it is likely to be those who are severely disabled and who require a more complex pattern of care.
Are village communities a viable option? I believe that they are. They can provide humane individualised care and offer many advantages. Continuous nursing care can be provided most appropriately in such communities. It is important to bear in mind that people who are highly dependent and vulnerable might find that living in a house in a busy suburban area is more confining than living in a village community.
Financially, the capital costs of moving someone from a hospital to a specially adapted house in the community, without health, recreational or educational services, is about £50,000, while a hospital site can be converted to a purpose-built village, using existing facilities, for about £20,000 per resident. Those figures were provided by Rescare, the National Society for Mentally Handicapped People in Residential Care, and they should not be ignored. Will the Minister use this opportunity to confirm whether he and his Government support the concept of village communities?
Future proposals for Orchard Hill should not be about substituting good care for possibly ill-thought-out Government policy and potentially unsound monetary gain. The aim of the Orchard Hill project should be to secure a better future for its existing residents and to ensure that the local national health service and Sutton council develop better and more flexible models of service provision for local people.
I am seeking a guarantee from the Minister that any future changes at Orchard Hill will improve the quality of life of the residents, not just maintain it at its existing level. I should also like the Minister to provide an assurance that, whatever the future of Orchard Hill, its residents will continue to have easy access to open space, with the high level of security that they currently enjoy. Should any of the Orchard Hill residents be moved, the new neighbours who will be living close to them should be educated and prepared to welcome them. I also want an assurance that alternative services to those that are currently available on site will be in place prior to the movement of residents; that the services that are currently free will remain free; that there will be equity between people of similar needs, regardless of their location; that adequate transport arrangements will be in place; and that the resources will be available for care in the community.
Before any action is taken, it needs to be understood how those changes might affect the resources available to a new generation of service users who might be looking for similar facilities.
I have spoken at some length, but it is a subject that affects the lives of some of the most vulnerable people in my constituency. I hope that the Minister will follow the 198 developments at Orchard Hill very closely, and will ensure that the review process on which the trust is about to embark is transparent, and provides the best care and education for Orchard Hill residents.
§ 8.3 pm
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate the hon. Member for Carshalton and Wallington (Mr. Brake) on securing the debate. I am grateful to him for indicating in advance some of the issues that he intended to raise. I hope to cover most of those this evening; if I do not, I shall certainly look at the Official Report and write to the hon. Gentleman on any points that are left outstanding.
I welcome the opportunity to discuss the provision of health and education facilities at Orchard Hill and to mention briefly some of the wider issues concerning the development of services for people with learning disabilities. This is a very important issue. First, I am well aware that, for those using Orchard Hill and their relatives, this must be a very anxious time, and I am concerned to ensure that we provide the highest quality care and support for them now and in the future.
I shall start by covering some of the background to the services and to the situation at Orchard Hill. As the hon. Gentleman said, Orchard Hill hospital was developed next to the old Queen Mary's hospital for children. The service built up on the site when, in the early 1970s, children often could not be transferred to St. Ebba's hospital in Epsom because no beds were available. Slowly, the number of adults with learning disabilities grew, and in the late 1970s it was agreed to have a unit for adults with learning disabilities in the grounds of St. Mary's. That became Orchard Hill hospital. Moving to more recent times, Queen Mary's hospital closed in 1993, although the Orchard Hill site was retained.
Services for people with a learning disability have obviously changed considerably over the years in which Orchard Hill has been open. In the summer of 1999, Merton, Sutton and Wandsworth health authority issued a consultation document on the future provision of services for people who live at Orchard Hill. The consultation period ran until mid November and the health authority considered the responses in January 2000.
The relatives of three patients challenged the decision and were granted a judicial review at the High Court in July. Relatives were concerned about the fairness of the consultation process, the health authority's decision to close Orchard Hill and the health authority's failure, as they saw it, to take account of all the relevant considerations before taking its decision.
The judge ruled that the decision was unlawful on the third point: that the health authority had failed to take account of relevant considerations. Let me say this now: Ministers are always concerned when relatives feel compelled to have recourse to the law in such circumstances. That is particularly the case when the matter concerns vulnerable and disadvantaged members of our society, although I was pleased to hear that the health authority had provided advocacy services for the people with a learning disability and their families, to help them to make their case.
Let me move to the heart of the case. The judge felt that there were a number of grounds on which the health authority did not have adequate information. There was 199 evidence from correspondence and notes of meetings of prior promises of homes for life to patients and their relatives, and previously declared policy about the site. The judge declared that the indicative assessment that had been undertaken was not capable of supporting the health authority's decision on the future provision of services and that, at the very least, a public authority must take earlier promises into account when considering a course of action. Finally, he was critical of poor financial information—the hon. Gentleman mentioned that issue.
I am pleased, although not surprised, to hear that the hon. Gentleman is keen to ensure that the future of residents at Orchard Hill is secured and considered in a sensitive, open way and through individually discussed and negotiated care plans; so am I. He made several very important points. Let me begin to address them.
First, the health authority clearly needs to review its actions following the judgment. I believe that the health authority received the final written judgment only a few weeks ago, at the end of September. The health authority is committed to ensuring that people with learning disabilities, their relatives, trust staff and others are kept informed of future developments concerning Orchard Hill through a news sheet, letters and meetings. The authority is committed to discussing with them the need for further consultation.
The hon. Gentleman is keen, as are the Government, to ensure that any changes to people's services are based on thorough, high-quality assessments, and that any decisions are based on the overall best interest of the individual client. The health authority is leading a review of the assessment process, in partnership with a large number of stakeholders, including the relatives.
First, the new process will ensure that there is detailed information on the needs of individuals in terms of their individual and collective need for continuing health care services. Secondly, it will ensure that there is detailed information on the broad range of social care services needed by the individuals and the population of people living at Orchard Hill. Thirdly, it will ensure that there is detailed information about the assessment of the psychological impact on individuals that may be caused by moving them away from Orchard Hill. I believe that those were the three points on which the hon. Gentleman sought specific assurances from me.
I am sure that the hon. Gentleman will understand that these detailed assessments and the development of individual care plans will take some time. Until that process has been completed for all the residents, the health authority would not be in a position to consider again any preferred locations for future services, or the future of Orchard Hill. The health authority expects to be in a position to do so by the middle of next year. I realise that that may seem a long time, but it is obviously necessary for the assessment process to be thorough and comprehensive.
The hon. Gentleman is also anxious that future services fully meet people's needs, are provided equitably and are planned and provided in a timely and sensitive manner. I agree with the hon. Gentleman that that must be the case. Indeed, it must also be the case that the services that are provided are available and appropriate for a new generation of service users. We know from research that members of the new generation, rightly, have higher expectations and hope to live close to their families.
200 We also know that there are increasing numbers of people with complex disabilities, and we must ensure that these services are available and appropriate for them.
The hon. Gentleman referred to the models of care for people with a learning disability. The Government are strongly committed to ensuring that people with a learning disability have the right to choose the kinds of services and accommodation that they prefer. We issued fresh guidance to local authorities and health authorities in July 1999 to confirm that, and we wish to ensure that commissioning policies reflect the diversity of needs and the rights of individuals to make an informed choice about where they live, when their preferred choice can meet assessed need and when it is affordable.
We also acknowledge that small-scale domestic accommodation can often provide a high quality of care. Such accommodation can offer more potential for social inclusion and enhanced rights. However, as in any society, some people choose—for a variety of reasons—to live in alternative communities. Indeed, the survey commissioned by the Association for Residential Care as part of the work on the forthcoming White Paper on learning disabilities found 73 such communities already in existence. People with a learning disability should also have that right and choice wherever possible, and we are very keen that this option should be open to them and that their preferences are, wherever possible, respected.
The hon. Gentleman will be aware that nearly £3 billion a year is spent on health and social services provision for learning-disabled adults. We are keen to ensure that the current resources are spent effectively and efficiently in a way that delivers best value to people with learning disabilities wherever they live. However, as my hon. Friend the Minister of State announced last week, we are also looking at ways to ensure that the resources currently used to support former old long-stay patients, such as many of the people at Orchard Hill, are retained for learning disability services. As the hon. Gentleman says, educational opportunities for people with learning disabilities are provided on the site by Orchard Hill college. Those services are for those resident in Orchard Hill and for those living in the community.
Education services for people with a learning disability are very valuable. It is only in the past 30 years that people with a learning disability have received mainstream education. The Government have been very concerned about improving basic skills provision, and the Moser report recommended that further consideration be given to the needs of people with learning difficulties and disabilities. As the hon. Gentleman may know, the Government recently published a report entitled "Learning to Succeed" and announced £1.5 million for further developments in this sector. This, we hope, will lead to significant improvements in the teaching of basic skills for people with a learning disability. The initiative, together with the new Disability Rights Commission, will help to bring high-quality education to everyone with learning disabilities, no matter where they live.
It is the aim of Orchard Hill college to continue to provide a wide range of educational opportunities for people living at Orchard Hill and, increasingly, for those living in the community. We support such initiatives and it is our aim that such services continue to become better integrated with mainstream adult educational services.
201 At a wider level, the Government attach great importance to improving services for people with learning disabilities. One of the core principles set out in the NHS plan is that services will be shaped around the needs and preferences of individual patients, their families and their carers. That must apply just as much to people with learning disabilities as to anyone else. Guidance issued to health and local authorities back in 1992 was based on principles of person-centred planning, choice and involvement of both service users and their family carers. Those principles have stood the test of time, but they have not been applied consistently. They will provide the foundation for future service development.
In October last year, my right hon. Friend the Secretary of State for Health announced that we would be developing a new national learning disability strategy. At the conference of the Association of Directors of Social Services last week, it was announced that the national learning disability strategy would be published as a White Paper in the early months of next year.
It has been 30 years since a Government took a comprehensive look at learning disability services. The need for this new strategy is long overdue. People with learning disabilities are among the most socially excluded and vulnerable groups. It is now time to make sure that help and support are in place to foster independence, provide new opportunities and deliver quality services. 202 The new national learning disability strategy is intended to do just that. It will seek to eliminate the inconsistencies that we know currently exist, and it will ensure that the delivery and the quality of the services on offer improve. It will make a real difference to many thousands of people, and the strategy has been developed across Government and not just in my Department.
The hon. Gentleman raised several questions at the end of his remarks and I hope that I have dealt with most of them. If I have not, I shall write to him. He asked about charges, and I can assure him that NHS health care will, of course, remain free at the point of delivery. He asked about the level of security available for individuals. That must be got right and it will be based on an assessment of need. It is certainly our intention—overall and in the case of individual residents—that the quality of services should be improved and not just maintained as a result of the decisions that will ultimately have to be taken.
I have described how the health authority has responded to the outcome of the judicial review, but I hope that I have also been able to put the local issues into their wider context. I know that the health authority will welcome the hon. Gentleman's continued interest in this matter, and I will ensure that he is kept informed of future developments.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes past Eight o'clock.