§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Willetts.]
§ 10 pm
§ Mr. Keith Vaz (Leicester, East)
Almost six years ago, I was fortunate enough to secure a debate during the summer Adjournment proceedings, in which I first raised my concerns about the crisis of underfunding and understaffing in the occupational therapy service in Leicestershire. I had high hopes that, because we had secured parliamentary time in the debate on 28 July 1989, the human misery and anxiety to which I referred during the debate would be time-limited, and that a combination of Government action and local authority efficiency would mean that I would not have to do so again.
Sadly, I must report to the House that—six years on—the situation appears not to have changed, and may have got worse. I am glad to have the opportunity of raising this important matter in the House.
I and others have been outraged by the treatment by Leicestershire social services of Alice Hawse. Those who are entrusted by a local authority with the overall responsibility for the care and support of people such as Alice Hawse should be ashamed of themselves that it has taken a parliamentary debate to ensure that they act to alleviate her suffering and distress.
In the world of today, those in public service must deal with a multiplicity of competing priorities. It is, of course, an unenviable task, but no sane or compassionate person who takes public service seriously would, in my view, have any problem in identifying the plight of Alice Hawse as a priority. She is an 83–year-old widow who lives in Braybrook road, West Humberstone, Leicester, on the Northfields estate. She has lived in that house for 60 years, during which time she has seen all of her seven children grow up there. She is elderly and infirm. She suffers from a complaint called restrictive air passages, which means that she has difficulty in breathing when she has to exert herself. In addition, she is registered as partially sighted and, in recent years, she has broken a hip as a result of a domestic fall. Those conditions add to her general disability and render her unable to carry out daily functions which all of us take for granted, such as bathing.
Like other pensioners, Mrs. Hawse relies on the help given to her by her family. It is for those reasons that, three years ago, her daughter and son-in-law left their own home to live with her to look after her. Because of her poor state of health, Mrs. Hawse finds it impossible to lift herself in and out of the bath. Her daughter has to help her bathe, and has lifted Mrs. Hawse in and out of the bath for several years. As a result, her daughter has a serious back complaint, and now finds the process extremely painful.
In May 1992, Mrs. Hawse applied to the social services for the installation of a walk-in shower, as she felt then—as she does now—that that was the most effective way of dealing with the situation. Once the shower was installed, she would be able to bathe alone and in comfort. That was three years ago, and she is still waiting.
In April 1994, I was visited at my weekly surgery by Mr. and Mrs. Bennett, Mrs. Hawse's daughter, and her son-in-law. They informed me that, after they had 123 contacted social services, there had been no effective response to their plea for help. I wrote to the social services department.
Mr. Steve Goodman, the divisional manager for Leicester city east, wrote to me on 29 April 1994. He said:it is unacceptable to me that service users are waiting so long for assessments. A range of measures are being taken to reduce the waiting times and I hope that service users will see the benefit in the near future.On the face of it, that was an admirable response.
Almost a year later, Mr. and Mrs. Bennett called again at my surgery. They said that social services had visited them four times and spoken to the family, but that nothing had been done. I regard that inaction as bureaucratic complacency of the worst kind.
I went to see Mrs. Hawse on Sunday 26 March. I looked at her bathroom, and she described to me the steps that had been taken. She told me that social services had offered her a hoist to hoist her into the bath. Any sensible person, on viewing the situation in which she found herself and the size of the landing and the bathroom, would know that that was not only the wrong option, but the expensive option. It was also impractical.
There is a much better solution. It is to create a walk-in shower on the ground floor, in a space that is readily identifiable. That would save Mrs. Hawse from having to climb the very steep stairs every time she wanted to bathe.
When the House last debated this matter, concern was expressed by both myself and the then Minister, the right hon. Member for Kettering (Mr. Freeman) about the national and local rate of vacancies in the occupational therapy service. Perhaps that is at the root of the problem.
Nationally, 15 per cent. of occupational therapy posts are currently unfilled. The vacancy rate in Leicestershire for full-time occupational therapists is 32 per cent. There are 17 full-time posts with eight full-time vacancies. The vacancy rate for part-time therapists is 15 per cent. There are 17 in post, with three vacancies. Assuming that two part-timers equal one full-timer, the vacancy rate of full-time equivalents is 27 per cent. That is a large figure.
Nationally, 3,343,000 referrals are made each year to social services. Just over one fifth—679,000—are for occupational therapy services. The Minister was present at a meeting to discuss the results of a survey conducted by the Association of Directors of Social Services. Following the meeting, Councillor Clive Jordan from the Association of Metropolitan Authorities said:We are running to keep still and even then we aren't getting there. We told the Minister we needed a concerted effort by central and local government including an investment strategy with the NHS and the Department of the Environment …Mr. Bowis seemed to be sympathetic.We shall hear tonight how sympathetic he really is, but we shall need from the Minister more than sympathy.
Mrs. Hawse is not alone in her difficult situation. Following an article in the Leicester Mercury highlighting Mrs. Hawse's case, several other Leicestershire residents came forward. I commend the Leicester Mercury for the sensitive and forthright way in which it has handled the matter.
124 I shall give just a few examples of the elderly people who have come forward. Olive Hutchins, aged 72, of Longstone Green, Thurnby lodge in Leicester, one of my constituents, says:Social services gave me a bath seat. I don't want to seem ungrateful but I know I could slip. I am frightened of falling and breaking my neck. I am housebound because of a spinal problem and am registered disabled. At the moment I cope by standing up and washing myself down because the bath is too low and actually so is the toilet. But I was turned down for a shower because they said I was not entitled to one.Mrs. Kathleen Perkins, aged 72, said:I wanted a special shower. I was given a stair lift to help me to the bathroom but no help once I was in there…I can't use the bath. I use a bucket to wash from and have trouble carrying the water from the bathroom to the bedroom.Mrs. Neale, aged 77, who is registered disabled and partially sighted, said:I bought my own electric shower after the social services turned me down for one two years ago. But it still means I need to climb in and out of the bath which I am unable to do.My daughter used to help me but she cannot now because she has a bad back. I have got a bath seat, but once I'm in, it is difficult to get out.We desperately need elderly people with experience and knowledge of our difficulties to advise social services staff.Mrs. Maureen Martins of Leicester, the grandmother of 10-year-old Simone McCollin, said:I look after my granddaughter who is physically and mentally disabled. At the moment I have to lift her into the bath but it isn't doing me any good and is getting more difficult as I grow older.I was told a year ago that my bathroom would be changed to a walk-in shower. I rang my housing association in January and they said they were waiting for a response from social services.The son of an 80-year-old woman contacted the paper, and said:My mother applied for a shower two years ago and she is still waiting. She has arthritis in her legs and arms and cannot use the bath. She needs to be given a strip bath. I know how Mrs. Hawse feels. The elderly cannot be swept under the carpet.There is the case of young Valerie Wrighton, who is only seven years old. Her parents have been waiting two years—almost a third of her life—for adaptations to their home. Valerie suffers from cerebral palsy and desperately needs the adaptations. Mrs. Wrighton originally contacted social services in August 1993—19 months ago. She was finally seen in October 1994. The excuse was that the papers had been lost. I wrote about the long delay in the case on 2 March, and she was visited on 13 March 1995.
Why should council tax payers be treated in that appalling way? Why should citizens with disabilities have to continue to endure discomfort on such a scale? Why has the benchmark for what constitutes a civilised society—our civilised society—been moved so callously? Those who run Leicestershire social services department need to take a long hard look at the situation.
I understand that their response is that they have thousands of satisfied customers, and these are only a very small number of cases, but I raise an important point of principle in the House today. Of course the director, Brian Waller, and his team can be proud of the pioneering work they have done in a number of areas, such as the creation of the first child rights officer, but there is huge scope for improvement in this area. There needs to be firm action.
125 These horrendous delays must be put to a speedy end. If they are not resolved within four weeks of this debate to the satisfaction of those concerned, I shall refer the matter to the ombudsman, and I will apply again and again for a debate until the matter is resolved.
Earlier today, a journalist asked me why I was using parliamentary time to discuss a very minor issue—his words, not mine—when the House must have other issues of much more earth-shattering importance to discuss. I told him, as I have told the House, that hon. Members are here to represent their constituents. When the day comes that this House is too busy to discuss the plight and injustices suffered by someone like Alice Hawse, we forfeit our right to be here, and Parliament forfeits its right to be the forum of the nation.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
I am grateful to the hon. Member for Leicester, East (Mr. Vaz) for initiating this debate. He asked for a sympathetic reply, so I shall do my best to be sympathetic to him and his constituents. He referred to a number of constituents, but, as the debate is on the case of Mrs. Alice Hawse, he will understand if I concentrate on her. He will no doubt wish to raise the other cases on other occasions if, as he said, he is not wholly satisfied with progress on those, too.
The debate enables me to restate some of the objectives of our community care policy, and to illustrate how it should work in practice.
The primary aim of community care is to ensure that vulnerable people, including those with disabilities, receive the type of care most appropriate to their needs. For some people, residential care will be the positive choice. Others will wish to remain in their own homes within the community. Under the new arrangements, they should be able to receive the support services that they need to make that a reality.
Our departmental guidance to local authorities makes it clear that we expect them to work alongside and consult clients and their carers in needs assessment. It is a matter for local authorities to meet needs according to local eligibility and priority criteria, and within available resources.
This debate highlights a case in which the social services department attempted to solve the problems of a client to fulfil their duty to meet assessed needs. The case highlights the key role of occupational therapists in the delivery of community care. A recent social services inspectorate report illustrated the need to bring down waiting times for assessments, including for aids and equipment, and they are coming down. That is evidence of the high priority that we give to ensuring that those vital services are available promptly.
In Leicestershire, occupational therapists have been regraded on to pay scales equivalent to social work colleagues, which has improved both recruitment and morale. The authority has also introduced improved management systems, achieving a more appropriate mix between qualified and support staff. Other strategies include improving partnerships with the voluntary sector and establishing more effective joint working practices with the NHS.
However, we acknowledge that improved working methods and management are not the only answer. As a result of our discussions with the local authority 126 associations, a survey on recruitment and retention of occupational therapists is under way. That will form a basis for further consideration with local authority and NHS interests. Our objective is to secure sufficient numbers of occupational therapists to meet the needs of all employers, including local authorities.
Leicestershire social services department has improved its staffing levels to 35 whole-time equivalent trained occupational therapists and 14 occupational therapy assistants. Recruitment within the authority is now good, and at April 1994, only two out of four divisions had vacancies, amounting to 1.5 whole-time equivalent occupational therapists and a half-time assistant.
The social services committee has established its own service standard for response times to referrals for assessment or occupational therapy services, which establishes a four-week response to priority cases where quick or less urgent attention is needed. Cases requiring immediate attention should be responded to within one week of the original request for assistance.
My inquiries into the specific case of Mrs. Alice Hawse, an 83-year-old lady who lives with her family, show clearly that Leicestershire county council has attempted to meet her needs in a variety of ways over a three-year period. I understand that Mrs. Hawse has not waited three years for a shower to be installed, as was suggested in the early-day motion. It is three years since she was first referred to Leicestershire social services department.
In the intervening period, the social services department provided bathing aids and an electric bath lifter. We all agree that, when re-referred in 1993, Mrs. Hawse had to wait an unacceptably long time—nine months—before being visited. That was due to occupational therapy staffing difficulties in the Leicester east division at that time, which have since been put right.
Despite the provision that has been made, Mrs. Hawse's family continue to press for the installation of a shower. In the light of that, further consideration is being given to such an installation as a possible further alternative way of meeting her needs.
As I have outlined, the authority has taken a series of positive measures that have been successful in improving the level and quality of service to all its clients. The community care reforms were designed to promote user choice, independence, and the ability, where possible, for people to remain at home or in their local community. To meet those objectives, it was—and remains—important to secure the most responsive and cost-effective range of services.
There is, of course, no central blueprint as to how each local authority should achieve that. Social services departments need to focus on the needs of their populations and to tailor the services they provide to those needs, and to offer the widest possible choice.
§ Mr. Vaz
When the Minister went through the circumstances of Mrs. Hawse' case, he stated that there was a delay of nine months between the time her case was referred and the first visit. Does he not accept that that was an unreasonable and unacceptable length of time? Does he not feel that it is incumbent upon him, as the 127 Minister, to give guidance to the social services department, so that such delay is not experienced in the future cases?
§ Mr. Bowis
I believe that I said that I thought that that delay was unacceptably long, and that, through the social services inspectorate, we have issued guidance on that matter. As I said, we want waiting times for occupational therapy and other services reduced.
There have been some significant shifts nationally in understanding and attitudes on the part of local authorities since the outset of the community care reforms. Social services departments are now actively encouraging real and informed choice in social care. Every locality is looking for a different range and pattern of services. Each authority must decide how to work with users and providers of services to provide that better balance and choice.
The key change that happened two years ago was the transfer of responsibility from the Department of Social Security to local authorities for those who were entering residential or nursing home care. That was no simple technical adjustment. By bringing together, under the aegis of social services authorities, the arranging and financing of community care, a massive potential for better and more innovative ways of doing things was released.
We shall encourage local authorities, with social services in the lead, to produce local community care charters by 1 April 1996. We think that the public has a right to know what community care services are available locally, and the standards of performance and delivery to which the relevant agencies are committed. Most authorities already set standards for occupational therapy assessment waiting times.
I said that Leicestershire has done that. The question is whether it meets its own standards and whether it should keep the pressure on to improve those standards in the future. No doubt local charters will build on that, which will improve local accountability and help guide people through the range of services and providers.
§ Mr. Vaz
On the issue of charters and the Government's commitment to the choice of individuals in respect to the type of services that they are entitled to expect, one of the key features of the case is that Mrs. Hawse and her family have stated continuously that they believe that a shower is the best solution to the problem. Social services keep on insisting, however, that a hoist to get Mrs. Hawse into the bath is the best solution.
The Minister has not seen the bathroom, but will he take it from me that social services' suggestion was not a practical solution to the problem? In such cases, social 128 services should listen carefully to the needs of the consumers. After all, they pay for the service, and their views must be taken into consideration.
§ Mr. Bowis
Short of a site visit, which I am not sure that you, Mr. Deputy Speaker, could authorise at this late hour, I am happy to accept the hon. Gentleman's description of the bathroom. I think that the hon. Gentleman's arguments are fair when he says that social services should listen to the individual and the individual's family. That is what community care is all about—placing the individual at the centre of decision making about ways to meet needs.
In the specific case, the circumstances of that family have changed, with the other members of the family moving in to live with Mrs. Hawse. That had an impact on the type. of need that existed and the way in which one might meet that need. Initially, the bathing solutions might have been acceptable—and indeed were, I understand, acceptable—to Mrs. Hawse, but once the family were there as well, the matter needed to be reconsidered, and that, happily, is what is happening.
Community care has the potential to bring significant benefits to a large number of people who are elderly, frail or vulnerable. The essence of community care is attitudinal and cultural change among all the key players—not only social services and health and housing authorities but private sector providers, the voluntary sector, users, carers and a wide range of other interests.
It means being responsive—the hon. Gentleman is right to use that term—to individuals who have needs, and, indeed, who have their own opinions on the way in which those needs might best be met to suit them. It means creative and innovative thinking being brought to bear to collaborate on solving problems and enhancing quality of life.
The case of Mrs. Hawse illustrates very well the wider responsibilities of the local authorities to meet the needs of elderly people living at home but in a home occupied by other members of the family. It obviously demonstrates the needs for sensitivity in responding to the needs and wishes of clients and carers and in providing appropriate packages of care.
Mrs. Hawse and her family have, I understand, already been visited at home by the area director of Leicestershire social services, and an appointment has been made for an occupational therapist to visit on 20 April 1995—two days away—to discuss the suitability of a shower. Social services appear to be taking appropriate action, therefore, to ensure that any outstanding matters in Mrs. Hawse's case are now speedily resolved. I have no doubt—indeed, we have had due warning this evening—that the hon. Gentleman will keep his beady eye on them to ensure that that does happen.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes past Ten o'clock.