Residential Care Homes (Hansard, 18 October 1994)

§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

I beg to move, That leave be given to bring in a Bill to further regulate ownership, control and standards of private residential care homes; and for connected purposes. I should like to ask the House to entertain the idea of a Bill which, even at this late stage, would enable us to amend the Registered Homes Act 1984 with certain specific changes. I want to introduce national standards for the care of all residents in private or local authority homes or receiving domiciliary or day care. I should like also to improve the registration of residential care homes, to extend the registration to domiciliary care and day units, and to set up an independent inspectorate with responsibility for inspecting all private and local authority homes at least four times a year. I want to specify the ratio of inspectors to beds, and to include all homes, irrespective of size, on the register. I want to stipulate the minimum requirements for the qualifications of staff and principals, and the ratio of trained staff to residents. It is not widely realised that this week the other place has taken decisions on part of the Deregulation and Contracting Out Bill which would have a direct effect upon residential care homes.

In the light of some of the dreadful cases that have recently come to our attention, the House has a special responsibility. We have only to consider the Frank Beck case and what happened to those in residential care homes in Buckinghamshire who were allegedly raped and subjected to the most appalling abuses, to realise that our legislation is far from perfect and that the sooner it is improved the better.

Nursing homes are currently registered differently from residential care homes. Under the Registered Homes Act residential care homes, whether private, voluntary or public sector, are registered and inspected by local authorities. But private, voluntary and a handful of NHS nursing homes are registered and inspected by health authorities.

Residential care homes are not required to employ nurses. By contrast, nursing homes must have in charge either a registered medical practitioner or a qualified nurse, and there should be sufficient staff on duty to provide skilled nursing to all residents.

Why am I asking for the minimum requirements of national standards? First, it is clear that there are great differences between one county and another in the interpretation of the existing law. Even on the simple business of inspectorates, a Royal College of Nursing survey found that in one health authority one full-time and two part-time inspectors were inspecting 167 homes with 4,110 beds. However, in another health authority that makes inspections a priority, a full-time and a part-time inspector were covering only seven premises with 269 beds.

As soon as we begin to read, even in the daily press, about the cases that consistently come to light, we realise why so many people are deeply concerned about what happens to some of the frailest and the most at risk in our population. Those who suffer from Alzheimer's disease, the mentally handicapped and those who, although 146 retaining their mental faculties, are not able to care for themselves, must be protected whether they are cared for in residential care homes or even in their own homes.

There has been a call to Parliament to institute the same sort of protection for those who go into people's homes to care for them and we should include that in our legislation. It is extraordinary that we demand that those who work in local authority homes should be suitably checked by the police to make sure that they are fit and proper persons while we do nothing to make sure that private units and agencies carry out the same checks on their staff.

One of the difficulties is that private care homes do not have the right to ask the police for that information. If they do, they will discover that it takes anything up to six weeks before any kind of information is forthcoming. In that length of time many people can be quite badly injured through being treated in unsuitable circumstances by unsuitable staff.

The Deregulation and Contracting Out Bill that is going through the other place contains regulations about fire and the care of people in private homes. However, the Department of Trade and Industry has proposed that the registration and inspection process should be subject to review, presumably—because it is being discussed during proceedings on the deregulation Bill—with a view to removing the few current controls.

I have strong reservations about the idea that self-regulation will do in relation to the circumstances that are discussed time and again. Self-regulation would not protect the disoriented person who died when left alone in a bath while the care assistant went out for a cup of tea. Care for the mentally handicapped would not be sufficiently regulated by self-regulation as many people have been subjected to physical and mental abuse.

What is needed is a totally independent inspectorate which, above all, is properly funded. Inspectors must be properly trained and must have the right to investigate the circumstances that are brought to their attention. There must be a proper ratio of the numbers of beds to inspectors and inspectors must have the right to insist on nationally agreed standards that are not imposed, but agreed by all those who are directly involved. Those nationally agreed standards should be available to all and easily checked. Looking beyond the work of the inspectors, I believe that it is clear that many local authorities are failing fairly disastrously in the job that they have been called upon to undertake.

Why do I ask for a minimum of four inspections a year? The simple reason is that members of the press told us that when they asked local authorities how many homes in their care had been inspected, they discovered not only that many of them were inspected only once during the year, but that many authorities were unable to provide accurate information and had no idea which of those homes were to be visited only on a biannual basis. That is not only frightening but it is very distressing for the people concerned and for their families.

Independent inspectors should have the right not just to look at what is happening in our homes, but to publish that information and to make sure that it is available to the families of anyone requiring care for their loved ones. It is quite horrifying that the Government are suggesting in their new guidelines for the national health service that in future people can be moved automatically 147 from the NHS into private care homes without their agreement, yet their relatives would not have an automatic or simple way of checking up on the quality of care within the homes that their own relatives were in.

Inevitably, when one considers what a battle it is for many parents of mentally handicapped people or those who have elderly and frail relatives to deal with the problems of bureaucracy and the day-by-day problems that they encounter in the safe management of their own families, it is essential that the House should regulate not only private and residential care homes, but the way in which independent private agencies work.

There are no names on the Bill other than mine for a particular reason. I hope that the whole House will associate itself with it and that all hon. Members will take it as their Bill. I beg leave to ask for it to be considered.