HC Deb 24 January 1996 vol 270 cc317-24
Madam Deputy Speaker (Dame Janet Fookes)

Before the House debates the next topic, I want to point out that although the Adjournment debate embraces different topics, technically it is one debate, so that any right hon. or hon. Member who wants to speak twice should seek the leave of House. That is the case for the hon. Member for Hastings and Rye (Mrs. Lait).

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Mrs. Jacqui Lait (Hastings and Rye)

I am grateful for that guidance, Madam Deputy Speaker and I hope that, with the leave of the House, I may be permitted to speak again. I am grateful for the opportunity to raise the subject of rest homes for the elderly, and to the Under-Secretary, my hon. Friend the Member for Battersea (Mr. Bowis), for kindly taking time out from a busy day to respond to my concerns.

I have long taken an interest in rest homes for the elderly, and the debate was provoked by a document from the Centre for Policy on Ageing, "Home Life II", to which I shall refer later. First, I refer to the bed blocking that occurred over Christmas because social workers, for all sorts of valid reasons including flu, were not available to ensure the appropriate care. Many of my constituents involved in the rest home sector made the sensible proposal that in such cases, there is no reason why a hospital could not discharge into a rest or nursing home, for respite-type care over a brief period, people who could so benefit. Hospital beds would not be blocked, but available for more crucial cases, and social workers would have adequate time to make an assessment. I should be grateful if my hon. Friend the Minister could throw that suggestion into the melting pot of ideas when his Department considers the matter.

Dame Elaine Kellett-Bowman (Lancaster)

Does my hon. Friend's constituency encounter the same problem as Lancashire, where the Labour-controlled county council keeps open expensive county homes rather than use more efficiently run and cheaper private homes?

Mrs. Lait

My hon. Friend anticipates my next point. That problem exists in East Sussex, as in other counties. Sometimes it is caused by people being inappropriately allocated to nursing homes, rest homes or domiciliary care. General practitioners have reported seeing bed sores of considerable size and complexity on elderly residents in rest homes who should be in nursing homes. Similarly, there are people in domiciliary care who should be in rest homes. At one stage, Lancashire county council was maintaining people in domiciliary care in their homes on packages costing £1,000 a week. I understand that that practice has come to an end, but in Hertfordshire, payments to private sector nursing homes have reduced from £370 to £350. Some nursing homes have been allowed residential care beds, with an insistence on the same staffing levels, and are paid only £250 a week. It is not difficult to anticipate the problems as county pressure increases on the private sector to reduce nursing home fees to £250 to cater for Hertfordshire residents, while county-owned beds will be considerably more expensive.

As my hon. Friend the Minister knows, East Sussex is currently wasting £4 million a year by overpaying itself to the extent of £100 per week per bed. The solution is to split the purchaser from the provider. As long as the present system remains—whereby social service departments are providers and inspectors and they let the contracts—we shall continue to receive justified criticisms from the private sector.

The Centre for Policy on Ageing was instrumental in producing the Government-sponsored report "Home Life", which set out rest home care standards that are generally accepted and agreed. Subsequently and under the same chairman, Lady Avebury, the centre established a further working party to produce "Home Life II". In fairness to the working party, Lady Avebury and the centre's director, Gillian Dalley—who has been helpful in advising me—I shall quote from a letter that Gillian Dailey wrote to me, referring to the draft which has been circulating without the Advisory Group's authorisation. She wrote also to everyone who commented on the draft: The draft of the revised document which many of you have seen was an interim draft not intended for public circulation because further work and editing was going on. I completely accept that explanation, but when the draft entered the public domain of the rest home sector, it caused those of my constituents who are rest home owners and others throughout East Sussex promptly to contact me, because of the history of Government sponsorship of "Home Life". The fear was that the Government had sponsored "Home Life II" as well.

The interim draft included the recommendation that every rest home room should measure 12 sq m, excluding bathroom facilities, and that 15 sq m would be better. In Hastings and St. Leonards, we are in the process of raising a large sum to help our local voluntary association for the blind to provide rooms that measure 10 sq m—the current standard. It does not take a big leap of the imagination to appreciate the effect on the private, public and voluntary sectors of a requirement for rest home rooms measuring 12 sq m or 15 sq m.

The interim draft's other recommendations include: Residents should not be thought of as objects of charity to be entertained through carol singing or children's plays, or be recipients of harvest festival goods or Christmas presents. That is one of the draft's more ludicrous suggestions.

Dame Elaine Kellett-Bowman

And patronising.

Mrs. Lait

My hon. Friend is right.

One of the interim draft's more impractical suggestions is: Commodes should only be used as a last resort. Portable chemical toilets are a better option. I am sure that many hon. Members are aware of the down side of chemical toilets.

Dame Elaine Kellett-Bowman

Certainly those of us from rural areas.

Mrs. Lait

Those of us from rural areas are well aware of the down side of portable chemical toilets, and I am sure that we would not want many of them in rest homes.

Rest home owners anticipate problems with recommendations such as: The window cill should be low enough so…resident can see out when seated or lying down. There should not be horizontal bar obstructing vision. Many rest home residents are a bit dodgy on their pins and it does not take much imagination to realise the risk of nasty accidents in the absence of window bars. That apart, many rest home windows are of Victorian or Edwardian design. Their replacement would not only involve expense but require extraordinarily long and complex planning negotiations. Further, the document states: Annual accounts should be readily available to residents, relatives, inspection units and other organisations involved. In one sense, I have no difficulty with that. I just hope that local authority homes could provide that information, because one major criticism from the private sector is that local authorities cannot do so.

The recommendation in the document that strikes terror into hearts of my local rest home owners is: Homes which fail to meet these standards will be required to make changes in order to meet them. That is the most draconian requirement that I have come across in the guidelines. The National Care Homes Association, the East Sussex Registered Rest Homes Association and many others to whom I have spoken point out not only that the recommendations are expensive, but that they are inappropriate in a number of cases and are not suitable for many residents of rest homes. They are prescriptive and coercive. They do not allow for innovation, change and local interpretation by the people who run the rest homes and who are expert in providing good standards of care, as most people involved in the sector know.

The document is a motherhood-and-apple-pie wish list. I am told by the Centre for Policy on Ageing that it is amending the list. If anything like it was ever to emerge into the light of day officially, that would not just kill off the private sector, but the voluntary sector could not comply with its requirements. The public sector in its present state certainly would be unable to comply in most cases. I rather suspect that the public sector would try to comply at enormous cost to the public purse. That might mean a wider provision of beds by it. It would not utilise the expertise of the private sector, which would be forced out of the business.

If one is a conspiracy theorist, one can perhaps work out some of the thinking behind the document. However, I believe in a broad and wide provision of rest home and nursing home care and I do not wish to see anything done that would make the private or voluntary sector less competitive and less able to offer the high standards that those sectors now offer.

I am conscious, because of the research that I have done, that alternative work is being down by bodies such as the Residential Care Forum, which may produce some standards that people will find more compatible and easier to provide. We know from the past that, when guidelines come out, they are treated so often as law. Registration officers and social services insist that the guidelines are met. Too often, the guidelines are entirely physical and do not take into account elements such as the friendliness of a home and the involvement by owners and staff in ensuring that residents feel that they are living in their own homes. That is one of the keys to providing the best standards of care in the rest home sector.

I should be grateful if my hon. Friend the Minister could repudiate the report and ensure that the Government will not in any way encourage such guidelines to be used in the rest home sector. If any further standards are to be encouraged by the Government, they should be produced in collaboration with the key people in the sector—the owners.

Dame Elaine Kellett-Bowman

My hon. Friend referred to the voluntary sector. I am sure that she is aware of the superb work done by the Abbeyfield Society. In Lancaster, we have been fortunate for some years to have a go-ahead chairman, Mr. Chirnside. Many Abbeyfield homes are doing a superb job, but they would find it very difficult to comply with those guidelines, even the modern ones.

Mrs. Lait

My hon. Friend makes an extraordinarily good point. I was tempted to mention all the people who provide such good care, in both the voluntary and the private sector. Many organisations, some very large and some small, have helped me in my research, but I was conscious that I would like the Minister to have as much time as possible to reply. Therefore, I am afraid that I refrained from commending many of the people who produce such good care in that sector.

1.14 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)

I thank my hon. Friend the Member for Hastings and Rye (Mrs. Lait) for raising this subject. In another place, this would be called the dinner-hour debate, and it is perhaps appropriate that we take this half-hour to consider care for some often vulnerable people in our society who need to be looked after safely and of course with common sense. That is the flavour of the debate and of my hon. Friend's speech.

I have noted the comments of my hon. Friend the Member for Hastings and Rye and of my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) about bed blocking and the inefficient use of the independent sector by some social service departments in providing or obtaining good-quality care for people who need residential care.

The debate gives me the opportunity to put the record straight on a matter that I know has been brought to the attention of and exercised the minds of a number of hon. Members in the House and one or two in another place. As I have said, I have noted the comments that have been made today, and my hon. Friend the Member for Plymouth, Sutton (Mr. Streeter), who is in his place, has also written to me about the subject.

I can assure my hon. Friend the Member for Hastings and Rye that the draft publication known as "Home Life II", which has so upset owners and managers of residential care homes, is nothing whatever to do with my Department. The publication is the work of a group set up by the Centre for Policy on Ageing, which is a wholly independent organisation. The document is not the result of a Government working party, we are not funding it and we are not associated with any of the draft recommendations in it. I hope that that is clear. There has been some misunderstanding because of the origins of the original document, "Home Life".

My hon. Friend the Member for Hastings and Rye has quoted sensibly from the draft document and has drawn to our attention some of its absurdities. There are others. The requirement that residents' bedrooms should have not only television and radio, but music centres strikes me as strange for a residential home. My hon. Friend referred to the mention of carol singing and Christmas presents. She might also have referred to the fact that the document claims that An objective measure of food acceptability is to weigh and record plate waste. The requirement on window sills and horizontal bars has been mentioned, but the document also suggests that every room, irrespective of personal need, should have a remote control system for closing windows and drawing curtains. As my hon. Friend said, the document is a wish list that goes beyond sensible borders.

The document also contains a glossary, which includes such gems as gender—all words indicating one gender must always include both genders and singular/plural—words indicating singular or plural always include the other". And again: Life is always taken to include all aspects of life, physical, medical, social, cultural, spiritual, economic". The term "relatives" is primarily used to describe people living outside the home whether they are related or not. It certainly includes friends". Perhaps my favourite quotation is: Positive/negative—statements often have an equivalent negative/positive statement. The opposite is always assumed to hold even if it is not stated. If you can work that out, Madam Deputy Speaker, I congratulate you.

We know that this is a draft, not a final document, but it has caused unnecessary concern among home owners and people living in homes. That is unfortunate. As I said, the document has nothing to do with our Department; I hope that it is now being revised in accordance with the commonsense response from my hon. Friends, among others.

There are some things in the document with which we would all agree and many others that are unexceptional—but I share the concerns about some of the contents. A number of statements in the document are far too prescriptive. They attempt to play nanny or to interfere in the lives of residents in an unnecessary way. There are some ludicrous examples, too, of political correctness. We have not been asked to endorse the publication and there is no question of that endorsement being given to the sort of ideas that we have heard discussed today.

If there is a "Home Life II", there must have been a "Home Life I". There was: it, too, was produced by the CPA, and that one we did endorse. It subsequently became widely used as a standards document by homes and regulatory authorities. But that was in 1984 when the Registered Homes Act was being introduced, and there was a widely recognised need for standards in homes to be improved.

Since "Home Life" was first published, a number of other, similar documents have been published. I could cite a range of them, including "Homes Are For Living In" and the "Caring For Quality" series published by the social services inspectorate. Any successor to "Home Life" will need to find its own place among those and other new publications being planned, for example, by the Residential Care Forum.

Whether or not we endorse particular documents that try to define standards for homes, we all recognise how vital it is that homes provide quality care. But I believe that that can be done while avoiding unreasonable and costly demands—of the sort my hon. Friend has highlighted—being placed on homes, and unwarranted interference occurring in the lives of residents. Homes, after all, are for living in. Moreover, the wish to see quality care should not lead us to too much prescription. We are committed to keeping the regulatory burden on homes to the necessary minimum, without loss of safeguards for residents.

We believe that much can be done to maintain and improve the quality of care by a sensible dialogue: a partnership between homes and authorities—and above all, between homes and authorities on the one hand and residents and families on the other.

Local standards for homes should be drawn up by authorities only after full consultation with providers, and those standards should be published. Such a process means that homes know what is expected of them and authorities have a clearer appreciation of what it is reasonable for homes to do. It also means, in accordance with the citizens charter principles, that potential residents will be provided with more and better information about homes.

Guidance about the local development of standards and other regulatory matters was issued to all authorities by my Department last September.

Dame Elaine Kellett-Bowman

Does my hon. Friend agree that while we are always seeking information from private homes, it would be no bad thing to get rather more information from the county homes?

Mr. Bowis

My hon. Friend is right. As she will know, we require county homes to be inspected against the same standards as are expected of the independent sector.

Critics of our determination to improve regulation of homes have, I believe, been proved wrong. We did not abandon the law. We took steps to restore a sense of appropriateness to regulation—keeping things in proportion, cutting paperwork, seeking consistency in enforcement practice within and between authorities, and targeting enforcement effort. All that will benefit everyone. Residents will benefit by not having their homes unnecessarily examined or invaded in an unco-ordinated way by a range of bodies. They will also benefit from care staff not having their attention unnecessarily diverted; and of course taxpayers will benefit from better value for money.

I am not suggesting for one moment that we should go soft on poor homes in any sector: far from it. We expect regulatory authorities to take all necessary steps to bring low-standard homes up to scratch. The law provides authorities with all the powers that they need to take enforcement action in the light of the evidence concerned. We expect them to take similar action—this answers the point made by my hon. Friend the Member for Lancaster—when their own homes are not up to scratch.

Our community care reforms are now in place. Our community care development programme is about moving on from consideration of structural changes. I hope that this will reassure my hon. Friends. We now want to concentrate on improving the quality of life of the people who rely on services. That is certainly true of care homes. Better outcomes for residents mean listening to what they say, involving them as far as possible in decisions about their care, and allowing them to exercise choice and control. Residents must be valued and their needs not subordinated to the needs of the home or the opinions of local authorities or inspectors.

Mrs. Lait

My hon. Friend referred to the need for residents to be given choice. Is he confident that all social service departments are giving residents and prospective residents the widest possible choice of homes to go to? Is he aware that social services still exhibit some restraint when offering choices to prospective residents?

Mr. Bowis

The answer to the first question is no, and to the second question, yes. The problem is that they do not offer enough information about all the options that are available. I should like some improvement in that area. Assessment and care plans should ensure that residents get the care that they need. Privacy, confidentiality and sensitive treatment are all essential. Much can be achieved by the idea of partnership between the home and its residents.

Mr. David Hinchliffe (Wakefield)

I came to the debate to listen to a speech by the hon. Member for Hastings and Rye (Mrs. Lait) about standards of care in homes, but the debate might have been better entitled, "The business interests of private care home owners". I was saddened to note that, in a 14-minute speech, the hon. Lady did not mention residents' interests once.

We are talking about vulnerable people, and I am pleased to hear the Minister, at least, talking about their interests. The current review of the 1984 legislation is worryingly underpinned by a belief in deregulation that forgets the fact that people in care homes—I have talked to some of them—feel demeaned when they receive third-hand apples and oranges at harvest festival.

Madam Deputy Speaker

Order. I am sorry, but this is a short debate—and interventions should in any case be short.

Mr. Bowis

I am sorry that the hon. Gentleman did not go on to criticise the nonsense in the draft document—unlike my hon. Friends—but I suppose that that shows the differences between our parties.

My hon. Friend the Member for Hastings and Rye did talk about the interests of residents. As the hon. Gentleman knows, the SSI recently published a report—"Responding to Residents"—based on an inspection of local authority homes. There are many important lessons in it for all homes in respect of providing individualised care for residents. For many elderly people, it is important that homes do not become too restrictive—as the document under discussion seems to be—or lead to a loss of continuity or contact with their past lives. Relatives and friends should be encouraged to participate in the life of the home and how care is provided. A friendly, domestic environment should be maintained, and there should be opportunities for contacts with the wider community to be developed in accordance with residents' wishes. They should be allowed to have their own possessions around them. There should be sensible policies on risk taking, and encouraging residents to pursue leisure activities or to go outside if they feel that they can and wish to do so.

Many good homes provide such care now, and others are working to get there. A review is under way on inspection and regulation. I believe that it will open up some of the debates on how we should seek those qualities and standards in the future. We have seen considerable growth in the independent sector in recent years. One of the concerns that the review has is that we do not wreck the quality of the homes with a whole panoply of regulation. We are exploring that area in the review so that providers can be treated even-handedly.

I believe that I have had the opportunity to clarify our stance on the CPA's draft and to emphasise our concern to see standards in care homes maintained and improved, in full collaboration with providers—

Madam Deputy Speaker

Order. We now come to the next topic for debate.