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Dr. Howells: That gives rise to the question whether there should be a schedule of unfitted conduct. Would it be a precondition of a disqualification undertaking and how long might it be? I think that a schedule of unfitted conduct would not be a precondition, but as a matter of practice the Secretary of State would agree the unfitted conduct before accepting an undertaking in accordance with practice post the Woolf civil justice procedure reforms. However, for a variety of reasons, that might not always be possible. For the Secretary of State only to be able to accept an undertaking in cases when a schedule has been agreed would be unduly restrictive and could delay putting in place the protection that the Company Directors Disqualification Act 1986 is intended to provide. It might also increase costs if there is a difficulty in agreeing to a schedule.
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.
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.
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
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.
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
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.
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.