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Inspectors have identified "institutional abuse" of people with learning difficulties in a second NHS trust, six months after the damning report into abuse in Cornwall.

The Healthcare Commission investigation into services for 186 people with learning difficulties at Orchard Hill long-stay hospital and 11 campus homes run by Sutton and Merton Primary Care Trust, south London, found a "failure of management" at all levels.Care at Orchard Hill - the largest remaining long-stay hospital in the country - encouraged a culture of dependency, with strict mealtime regimes and exercise for some residents limited to four hours a week.

Some residents shared rooms, depriving them of their "privacy and dignity". Their views were "seldom heard" and there was a lack of specialist services.

The campus homes were unsuitable for the needs of their current 55 residents and there were no policies on restraint or advocacy services.The report also found staff shortages, above-average sickness levels and inadequate training. It also said "institutional abuse" was prevalent throughout the service - meaning individuals' needs were sacrificed to those of the institution.

Launching the report yesterday, the commission fleshed out its plans for an audit of learning difficulties services, which was announced following the report into Cornwall Partnership NHS Trust last July (see box).Department of Health national director of Valuing People Rob Greig said he suspected that NHS campuses would be the areas where "causes for concern" might be uncovered in the audit. But he said he would be very surprised if it unearthed abuses on the scale of this report or the more serious Cornwall inquiry.

The Sutton and Merton report found risk management was not "effective". It said very few staff had adult protection training and staff did not always report incidents. It listed 15 serious incidents between 2002 and 2005, including the rape of one female resident by a male worker, who was subsequently jailed. Seven staff were dismissed for physical or sexual abuse over that period and the report said that while none of the incidents could have been foreseen, there were "weaknesses" in the trust's response.

The inspection was at the request of chief executive Caroline Taylor, appointed in November 2005, the trust's seventh in 10 years. The report praised improvements made since then, including increased staffing levels, new management structures and training. Taylor said the trust accepted the findings and said they were a result of a "system of care set in a culture of the last century".


The closure of Orchard Hill has been delayed by judicial reviews brought by relatives of residents concerned over transfer arrangements and the trust has already missed two targets for closure. Its next is April 2009, but Mencap and the British Institute for Learning Disabilities said it was "far from certain" this could be met without more resources.

THE WAY AHEAD FOR LEARNING DIFFICULTIES SERVICES
● Healthcare Commission audit
NHS and private residential services not registered by the Commission for Social Care Inspection will be audited. The Healthcare Commission will review organisations’ self-assessments and will then inspect between 160 and 200 services. It expects to report back by the end of the year.

● Recommendations for Sutton and Merton PCT
Staff must be given mandatory training and all service users have a personcentred plan by the end of October. Restraint policy to be developed and use of straps and splints only to be used as a “last resort”. Review advocacy services and develop systems to make it easier for people to complain.

● Long-stay hospitals – where now?
There are 115 people still in the five remaining long-stay hospitals, most in Orchard Hill. Four other hospitals – Prudhoe, Northgate, Ridge Hill and Gloucester Centre – have 25 people. The Department of Health says all are expected to be transferred to alternative accommodation within weeks. It is estimated that a further 3,000 residents live in campus-style housing.