Homes for the Elderly (Hansard, 8 March 1989)

§ Mr. Malcolm Moss (Cambridgeshire, North-East)

beg to move, That leave be given to bring in a Bill to regulate quality of service and standard of care of homes for the elderly and for other purposes. The elderly proportion of our population is increasing quite dramatically as people live longer through better diet, improved living standards and a higher quality of health care. In 1987 there were some 9.3 million people aged 60 and over, of which 3.4 million, or 36 per cent., were 75 or over. By the year 2027 there will be an increase of 33 per cent. in the over-60 group, to 12.4 million and an increase in the over-75 group of 44 per cent., to 4.9 million. This will mean greater pressure than ever before on care and nursing facilities for the elderly.

Parelleling this increase in the elderly population in the past decade has been the massive rise in the cost of caring for elderly people in residential care homes and nursing homes. Estimates for 1988–89 suggest that the cost will break through the £1 billion barrier for the year, representing a fortyfold increase in costs since 1980. In May 1988, the annual figure was £878 million, compared with just £18 million in 1980. The current bill is rising by a staggering £200 million a year. This is probably the fastest growing area of public expenditure within the Department of Social Security.

This upward trend raises the obvious question whether this represents the best value for money for the taxpayer, commensurate with the most appropriate type of care in all circumstances for the elderly. Paradoxically, finance through social security benefits is available for what appears to be the most expensive type of care.

Residential care takes its rightful place as part of the provision of care within the community, a subject which was highlighted in three major reports last year. In March 1988, we had the Griffiths report on community care, followed by Lady Wagner's independent review of residential care, and both these followed on a report by the Committee of Public Accounts, "Community Care Developments", published last April. Before that, we had the report of the social services inspectorate's inspection of the implementation of the Registered Homes Act 1984, entitled "Certain Standards". The subject is, therefore, in the forefront of much research and investigation, a lot of it Government-commissioned.

All these reports highlighted similar problems. There was an enormous variation in the quality of care and standards of service in residential and nursing homes between different local authorities and between local authority provision and that of the voluntary and private sectors in the same statutory area. There was no general agreement on whether these variations should be tolerated or even allowed in the first instance. The social services departments of local authorities, as the registering authorities, were in many cases ill-equipped to fulfil their functions of registration and inspection.

There was little co-operation between public and private sectors, few joint approaches and little coordinated planning. The main deficiency was the absence of rights and privileges for the elderly residents, the 902 customers, who often seemed simply to feature as statistics and rarely as human beings with the right to a dignified retirement.

The Registered Homes Act 1984 was intended to ensure regulation of standards in private and voluntary residential care homes, while allowing for local development, flexibility and co-operation. The Act has brought some much needed discipline and structural form to the operation of residential care homes and nursing homes. However, it has failed to meet some of its objectives, especially in developing a relationship between the social services departments and the private sector. II has also failed to eliminate completely the scandals of disgracefully run homes, of which there are enough examples for us to demand changes to that Act to strengthen its regulatory powers.

The most recent statement on the issue was the report entitled "Residential Care for elderly people: a consumer viewpoint", recently published by the National Consumer Council and submitted to the Department of Health. Building on many of the recommendations of Griffiths and Wagner, it put the case for the consumer right at the heart of the issue. It is that emphasis on consumers' rights that is fundamental to the changes to the law proposed in the Bill.

The Bill proposes that the responsibility for registration is taken away from the social services departments of local authorities, principally because they have been placed in the invidious position of having to monitor registration requirements and standards, which in some cases their own homes fail to reach. Conflicts of interest inherent in service-providers monitoring their own standards is a general problem. Instead, the task of registration will be taken over by a new independent authority, to be called the residential homes inspectorate. That body will also be responsible for conducting regular inspections of all homes—not less than twice a year—in a systematic way, using procedures set by the Secretary of State.

For the first time all homes—the local authority homes included—will need to achieve the registration requirements and be subject to regular inspection. The Bill also widens the scope to embrace nursing homes and mental nursing homes, as well as residential care homes, as defined in the 1984 Act.

In the 1984 Act, homes with fewer than four residents were excluded from the legislation, and that has given rise to real fears and criticism. The Bill proposes to bring all homes into the registration process, including those with four residents or fewer, unless. at that smaller size. the home is not run for reward. That will still allow small units caring for relatives to exist outside the registration process.

It is estimated that in East Sussex alone there are 3,000 unregistered homes of that size. I believe that a time bomb is ticking away and a scandal is waiting to happen.

The Bill brings in a new clause to strengthen the regulatory powers of the Secretary of State, so that he shall make regulations to establish minimum and universally applicable standards of care and service. The Centre for Policy on Aging's code of practice, as set out in its 1984 publication, "Home Life", which has already been endorsed by the Secretary of State, shall provide the basis for detailed regulations and those shall apply equally to nursing as well as residential homes. Those nationally determined standards will form the basis for the residential homes inspectorate's registration and inspection responsibilities.

903 Focusing yet further on the consumer dimension, the Bill's other proposals introduce the requirement for comprehensive information about homes—information concerning their style, the regimes of life and internal rules. That information would be made readily available to customers and potential customers.

That will be achieved, primarily, by the mandatory requirement to publish and distribute a brochure or handbook about the home. Requirements on content and presentation will be established by the Secretary of State and their implementation will be monitored by the inspectorate. Each home will be required to set up a well publicised charter of customer rights and a complaints procedure. The inspectorate will have powers to investigate complaints and adjudicate on them. It will be mandatory for each home to set up self-evaluation procedures with proper training of staff, together with a regular performance review.

The Bill will not answer the vexed question of who makes, and under what procedures or organisation, the decision that care for an elderly person is best delivered in a residential home, as opposed to them receiving community care in their own homes. The Griffiths report made recommendations concerning community care and the Minister's statement in February gave on grounds for optimism that that report will soon be brought before the House for full debate. Care for the elderly in homes is, however, a vital and rapidly increasing ingredient in the provision of community care, and improvements in overall quality of service and standards, universally and independently monitored, are long overdue.

The majority of homes achieve adequate standards, but that is not good enough. The best are excellent, and the best practice should be encouraged to become the norm.

As Sir Roy Griffiths said: Community care is a poor relation, everybody's distant relative and nobody's baby. It is time that that baby was adopted.