§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]10.26 pm
§ Mr. Peter Bruinvels (Leicester, East)
I am especially pleased tonight to initiate this short Adjournment debate on residential care homes for the elderly, which is a matter of great concern to hon. Members on both sides of the House and which has become a growth industry over the years.
I first became especially worried about residential homes in December 1985. Although the new Registered Homes Act 1984 provided for every home to be inspected not less than twice in every 12-month period, it did not prescribe a minimum number of beds. Similarly, although it required the person registered to provide adequate professional, technical, ancillary and other staff and to make adequate arrangements for patients in the home to receive medical and dental services where necessary, it did not really define what was adequate or professional.
On looking through the papers and assessing the numbers of such homes, I was horrified by the tremendous growth in residential care homes. Although I am not in any way criticising private enterprise, it seems especially easy for anyone to set up a residential care home. I welcome the presence of my hon. Friend the Parliamentary Under-Secretary of State for Health and Social Security on the Front Bench tonight, and I particularly wish to draw her attention to the private sector homes in England. I am satisfied that local authority homes appear to be properly policed, but it seems that private sector homes are not always properly assessed. In 1984 there were 4,090 such homes with 50,168 residents. In 1985 the number of homes had risen to 5,200 and the residents to 69,000. By 1986, on the provisional figures that my right hon. Friend the Minister gave me on 27 November, there were 6,303 homes and something like 80,000 residents.
Residential care homes are a very successful industry. It is a growth industry and one in which I would expect the quality of care provided in the homes to be of the utmost in usefulness, kindness, love and great care. My hon. Friend the Minister's predecessor made it quite clear that there would be an examination of the standards being set locally by the authorities concerned and of the extent to which the legislation is being implemented, in ways that seek to develop constructive partnerships between the statutory, voluntary and private sectors of residential care.
However, one must obviously look at the provisions of the 1984 Act and at the role placed on the local social service authorities and the district health authorities respectively. I want to see the improved arrangements for registering and inspecting all residential care homes brought forward. I know that they came into force on 1 January 1985, but I am not convinced that they are as thorough in their investigations and examinations as the Act originally intended. There is a difficulty, because we are reducing Government interference in many areas. "Building Businesses not Barriers" makes specific reference to the registration of such homes and their inspection.
In no way do I wish any registered home to have fewer than two inspections per year. It is welcome that the 120 overall fees for such homes have risen—the annual fee has been increased to £15 a place, the annual registration fee to £100 and the initial registration fee to £550. Therefore, proprietors of homes should expect at least quarterly inspections by representatives of the DHSS or local authorities. I believe that local authorities should carry out the first inspection, and that thereafter the DHSS should keep a watching brief.
I know of many instances where local authorities have telephoned homes and said, "We are coming next week, stand by for inspection." Although I do not wish the element of surprise to be Gestapo-like, the inspections should be carried out regularly and without too much advance notice. I want homes to demonstrate love and care and attention at all times. The requirements are quite clear. I want residential homes to be bright, bustling and happy. Safety should be a priority, with no loose rugs, unexpected steps to gardens or bathrooms, awkward stairs or old wiring.
Age Concern has studied the problems in such homes. There should be a proper fee structure for residents, who can so easily be taken advantage of. Some elderly people, as their age advances, become somewhat of a burden in the family home and it becomes necessary for them to be put in residential care. I am happy to state that no residential homes in Leicester take advantage of the elderly, but dangerous precedents could be established. Homes should show kindness and provide proper professional help.
I know of homes that maintain that full medical staff are available 24 hours a day. Certainly, registered nursing homes would be required to meet that criterion. However, the Registered Homes Act 1984 also implies that properly qualified medical staff should be in attendance at all times. It is no good just having a doctor on the board and his name appearing on the headed paper—medical staff should be available at the home. The proprietors of registered homes—who should live on the premises—should make the position quite clear. I know of cases of staff being dressed up to look like nurses, which gives a false impression to the inspectors and prospective residents alike.
I understand that poaching has occurred—where residents are visited by nice old ladies saying, "Come on, let's go and have a nice strawberry tea". They take them to another residential care home, and the next thing is that that elderly person has been "poached" and easy money is made.
Because there is no stipulation as to the minimum number of beds required in a residential care home, sometimes beds are moved out of rooms when the proprietors know that the inspectors are due to visit, to make what is really a double room look like a single room. That is absolute deceit and easy pickings. I know of a case in the Birmingham area where an elderly gentleman is being charged £16,000 a year by a residential care home. I find it incredible that he is kicked out of bed at 6.30 am and forced back to bed at 6 pm, does not have good food and is lucky if he meets other people during the day. Something must be done to guide prospective residential care home proprietors as to the requirement and comforts that should be available to all prospective residents.
I asked my hon. Friend's predecessor to introduce a band of price ranges for facilities. I know that it is unusual for a Right-wing Tory Member to call for Government interference, but I believe that a minimum and maximum charge should be stipulated for providing permanent 121 residential accommodation. That residential charge should be in a band from £125 that the DHSS allows to perhaps £160. I ask my hon. Friend to look at this, because £240, which is a regular charge, is incredible for the services provided, some of which are questionable.
It is clear that too many of these homes are registered too soon. On my way in the mornings, I pass two large terraced houses. Over three months, they have become a residential care home, but that is too quick. While it is worthwhile to register and establish homes, this must not be done too quickly. At the moment the number of old people is increasing rapidly. I do not want them to be taken advantage of, and I want to see such precautions as proper fire escapes. Health and safety officers have a right of entry, but perhaps do not go to such places often enough, particularly as so many are now being established. The officers should be allowed in to get on with checking.
Many of these old people are disabled and should not be put in upstairs rooms. They can be taken up and down by lift, but they might be trapped up there. They must be treated with humanity and kindness at all times. Many residential care home proprietors show much more love, kindness and decency than some relations. That is a sad fact of life.
On the coldest day of the year, with Big Ben stopping at four o'clock for a few minutes, we should remember that elderly people need as much warmth as possible—not just blankets but proper facilities. I look forward to inspections and investigations taking place in the winter. At the moment, many of these places seem to be inspected only in the spring. Let us ensure that conditions are examined at the worst time of the year. I am not arguing for cold payments, I reassure my hon. Friend the Minister.
Another factor is that many people are living longer. Britain has a reputation for an increasing number of people living over the age of 65. Residential care will be a growth industry and it is important that we provide maximum as well as minimum requirements to ensure that inspections are carried out at all times, although that is already required under section 17 (ii) of the Registered Homes Act. There should be more inspections, and I urge my hon. Friend to look at this and at the charges. It would be a great service to the public if she were to introduce a system of minimum and maximum charges both for residential care homes and nursing homes.
The type of accommodation is varied. In some of the advisory documents it has been made clear that some people would like to share, but they should not be charged £16,000 a year if they do so. Multi-occupancy and connecting rooms should be considered. There is no ratio of single to double occupancy. No two people are the same, as the local authority circular of January 1986 pointed out. We must look on our elderly people with even greater respect.
We should consider how to strengthen the Registered Homes Act 1984 to do something about the lack of safeguards. It will mean a substantial increase in the cost of running the homes but a big increase in health and safety checks, which is important. I would like to see 24-hour medical cover, and qualified nurses, who know how to cope with emergencies, on the premises. I do not want people dressing up as auxiliaries when they are not.
I should like a scale of maximum and minimum charges to be published. That would ensure that no elderly people or their relations are caught out by having to pay for hidden extras to get the basic service. Private enterprise 122 should continue to thrive, but old people's homes should be exempted so that there is the best possible control over them. I am not in favour of NUPE's idea of midnight visits, but the inspection system must be updated as a matter of urgency. It is no use telephoning a residential care home and saying, "I should like to visit you; what time can I come?" There should not be too many unannounced visits, but proper visits must be made.
I welcome the increase in fees. Proprietors of residential care homes will realise that, once they are registered, there are effective safeguards. If registration and licensing are made a little harder, they will be worth far more.
In the east midlands there is a very good organisation that looks after residential care homes. I congratulate it and Mrs. Heather Cowley. Nevertheless, we must ensure that all these homes are up to the same standard and that it is not made easy for buildings to be converted overnight into brand new residential care homes. This is a growth industry. We must do everything in our power to protect the elderly. They are living longer. I look forward to many other hon. Members on both sides of the House saying that they are in favour of additional help and support being provided for the elderly.
Only 650 people have gone into residential care homes in Leicestershire. Proprietors of residential care homes have written to me. The proprietor of a home in Eastbourne says:People are openly advertising and taking three elderly people with no supervision and possibly not even paying tax. This is a situation that needs to be looked into. May I add that whatever the room size, the facilities offered, it is the owners and their attitudes to the care, dignity and quality of life of those people in their area that really matters.Letters of support have come from the Isle of Wight community health council. It has asked for updates on the way to curb the increase in private residential care homes which has been unleashed. There is also a letter from the South Warwickshire community health council. It is extremely worried about the growth in the number of residential care homes.
I welcome the fact that the private enterprise sector has resulted in many more new proprietors of residential care homes, but I urge my hon. Friend and her Department to look carefully at the way in which the elderly are cared for. The Department of Health and Social Security will pay most of the price, but it should not be a blank cheque. It might price itself out of the market. The elderly must be given the best possible help, love and attention, and the safeguards that I have outlined will ensure that when an elderly person enters a residential care home he is given love, care and attention by properly trained staff. There must be regular inspections and the fees charged must be such as to provide for elderly people the kind of service that will enable them to live in dignity for the rest of their lives.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
I congratulate my hon. Friend the Member for Leicester, East (Mr. Bruinvels) on his success in Mr. Speaker's ballot and for choosing such an important subject. He has already shown great interest in this topic. I read his November article in Social Work Today with great interest. I assure him and all concerned of the importance that the Government place on voluntary and private residential care homes and 123 on their having proper standards, and I am sure he agrees that they have a vital role to play in the provision of community care.
I was a little sad that my hon. Friend used the word "horrified" when he referred to this growth. That growth and development have been meeting a considerable need and it is good to see the private sector doing it so well.
Let me deal with a number of the points that my hon. Friend raised. He mentioned control on charges by homes. There is no control on those charges any more than there is for any other services and we would not wish to see any. The amounts paid are a matter between those running the homes and the residents or the relatives of the residents who are meeting those charges. The charges could be expected to reflect the services and the facilities available as determined by market forces, in which my hon. Friend and I have considerable faith.
In our view, it would not be proper to introduce a system of minimum and maximum charges for the provision of services paid for privately. I know that my hon. Friend is a keen supporter of a free market and, as he is aware, many of the residents of these homes are well able to pay the prices set, especially if they have disposed of a property before entering a home. The same applies to what my hon. Friend called poaching. That is a private, commercial matter between homes and it is not for the Department of Health and Social Security to intervene.
In one case of misrepresentation in a home for mentally handicapped people in Manchester, the registration of that home was cancelled and an appeal by the owner of the home against that cancellation was not upheld. We are aware that where there may be serious misrepresentations we have the right and the power to act. The payment of supplementary benefit is another matter and I shall now deal with that.
My hon. Friend mentioned growth in the number of homes as a whole and growth in the number of residents. I am sure he will not mind if I refer to the number of supplementary benefit board and lodging claimants in independent homes in Great Britain, because it gives an idea of the increasing responsibility of the Department. In 1978 the number of residents claiming board and lodging allowance was 7,000. The amount being spent was £6 million and the average payment was £15.70 per resident. By 1984, the number of claimants was 42,000. Spending had risen to £200 million from £6 million, and the average payment was £91.50 per resident. These figures relate to Scotland as well as to England and Wales. We do not yet have information for 1985, although the Audit Commission recently estimated that some £500 million was now in payment. We are not in entire agreement with the Audit Commission about how it arrived at its figure, but there is no doubt that the amount has increased quite substantially.
The growth in these numbers was not entirely unexpected and to the extent that it meets a need not previously met it is welcome, but it showed us the need for better targeting of the benefit and improved expenditure control. For that reason, a number of studies were set in hand and the amounts to be paid were set at maxima around the country. A working party is currently looking at the arrangements for financial support of residents in all types of residential care homes—local authority. voluntary, and private. That working party is chaired by 124 the Department's official, Mrs. Joan Firth. Our aim is a system of financial support which is responsive to the needs of individuals and which gives better value for public money. The working party will report to Ministers and to local authority associations around Easter this year.
A series of pilot studies have been undertaken by Professor Bradshaw from York university and they have been conducted in four areas—Lothian, Clwyd, Devon and Sefton—to see if the local authorities could advise us on whether a system of assessment could be introduced to see if supplementary benefit claimants in residential homes are most appropriately cared for in that setting and whether the homes' charges are reasonable in the light of the services provided. We expect that report to come to us by Easter.
As my hon. Friend knows, the limits placed on the supplementary payments to residents were reviewed last year following a study of homes' costs by the management consultants Ernst and Whinney. Their report is in the Library. As my hon. Friend may well know, as a result of that report some maxima were increased. The limits for the elderly were set at £125 per week with a London limit of £142.50 and a new category for the very dependent elderly eligible for higher rates of attendance allowance and for the blind was set at £140 with a London rate of £157.50, and a further category of younger physically disabled has been set at £197.50 for London and £180 for the rest of the country. Therefore, we have set maxima of the payments that we are prepared to meet from supplementary benefit. The Ernst and Whinney study produced a usable response from only about 23 per cent. of the homes that were contacted, but the study showed that at least some homes were using the supplementary benefit figures as maxima, whereas many others were not. However, the other studies should tell us more about that.
I share my hon. Friend's interest in and concern about standards. I am sure that we agree that the vast majority of homes offer an excellent standard of care—often far higher than those of the local authorities which we are asking to supervise them. Since 1948, residential care homes have had to be registered with local social services authorities. That registration is not automatic. The registration authorities must be satisfied, among other things, that the person applying for registration is fit to run a particular type of home and that the facilities, staffing and care provided are up to the standard required. The authorities can insist on alterations before granting the registration, and it is the local authority's responsibility, under all the legislation going back for a long time, to ensure that reasonable standards are maintained. It is required to carry out at least one inspection a year. It need not give notice or make an appointment. It can visit at night and in the winter. Indeed, some home proprietors have been complaining about late-night visits, although I agree with my hon. Friend that they may need to be done in that way.
The homes are also subject to environmental health officers' standards and fire service requirements, and the home proprietors have had occasion to complain about that, too. They are also subject to the Inland Revenue, like any other business, and anyone not declaring income may have a nasty surprise in store.
My hon. Friend asked about realistic registration fees. Under the Registered Homes Act 1984, the initial fee is £550, plus £100 for a manager, where relevant, and a further charge of £15 a place annually. A typical home 125 with 30 or 35 places is certainly paying about £500 a year to the local authority. The penalty for offences has been increased from a maximum of £500 to £2,000. There is a national list of council registrations which is updated quarterly, and there have been 82 residential care home appeals to the Registered Homes Tribunal against local authorities' refusal to register a home or decision to cancel or amend a registration. So far, nine appeals have been upheld, 28 dismissed and 22 withdrawn.
In addition, a non-statutory code of practice, "Home-Life", which is in the Library, has been drawn up by an independent working party and forms the basis for the recommendations that we request the registering authorities to make and to carry out in their inspections of private homes.
My hon. Friend will be aware that some of his suggestions would require primary legislation. Since the law has been in operation for only two years—it came into force almost exactly two years ago—it would be wise to see how it has operated during those two years and how its objectives can be carried forward before we start to amend and reorganise it, especially since we are talking about so many homes and individuals.
Some concern has been expressed about the minimum of four residents for registration. In practice, that has been the minimum for a long time. It was thought that the line had to be drawn somewhere and that it should remain there. The 1985 costing study by the social services inspectorate showed us that local authorities were hard pressed in processing new registrations and inspecting existing homes that had to be registered even before we set them further tasks. If we were to ask them to inspect the tiniest homes, they might be put under such pressure that they would miss problems in homes on which we have asked them to keep an eye.
My hon. Friend asked about staff and standards. Unless the private residential home is dually registered as 126 a nursing home, in which case it must be registered with the health authority and the rules about nursing and other staff are slightly different, it is not required to have staff with medical or nursing qualifications. The care normally provided in a residential care home is broadly equivalent to what might be given by a competent and caring relative able to respond to emotional as well as physical needs. Therefore, a medical and nursing qualfication is not considered necessary. Any professional health care needed by a resident would be provided by his or her general practitioner or the community nursing service, as appropriate, and under its supervision. To ask for 24-hour medical cover for an ordinary residential care home would be going over the top, except in so far as someone who was ill did not receive such cover from his general practitioner.
On top of all of the other studies that I have mentioned, my right hon. Friend the Secretary of State has asked Sir Roy Griffiths to do a review of community care. Between Griffiths, Firth, Bradshaw and the review of residential care currently being chaired by Lady Wagner, this sector is probably being investigated more than almost anything else.
In the light of all of those studies, some of which are to report to us very shortly and some of which are to report to us later—such as the Wagner report which will come in 1988—I would prefer to see how the current legislation, which is relatively new, is carried out in practice and ensure that we do not change something before it has had time to settle in.
In those ways, the sector is being studied and encouraged to expand and develop in satisfactory and suitable ways to provide a good standard of care. We will take careful note of all of the recommendations, including those of my hon. Friend, and I am most grateful to him for raising this most important issue.
§ Question put and agreed to.
§ Adjourned accordingly at five minutes to Eleven o'clock.