HC Deb 10 June 1996 vol 279 cc21-37

'.—(1) The Secretary of State shall, after consulting such persons as appear to him to have relevant knowledge or experience, by order introduce a scheme for the regulation of the provision of community care services under this Act with particular reference to the purchase by persons to whom payments are made under section 1 or section 4 of independent domiciliary care.

(2) A scheme under subsection (1) may include powers—

  1. (a) to require the registration of persons providing domiciliary care to persons in receipt of payments under section (1) or section (4)
  2. (b) to establish a system of inspection for the purposes of ensuring that the terms on which a person is registered under paragraph (a) above have been complied with.

(3) An order under subsection (I) above shall be made by statutory instrument which shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.—[Mr. Hinchliffe.]

Brought up, and read the First time.

3.31 pm
Mr. David Hinchliffe (Wakefield)

I beg to move, That the clause be read a Second time.

Madam Speaker

With this, it will be convenient to discuss new clause 11—Regulation of services provided by persons not classed as individuals—

'.—(1) The Secretary of State shall, after consulting such persons as appear to him to have relevant knowledge or experience, by order introduce a scheme for the regulation of the provision of community care services under this Act, with particular regard to the purchase by a person to whom payments are made under section 1 or section 4 of independent domiciliary care from a person who is not classed as an individual for the purposes of any enactment relating to community care.

(2) An order under subsection (1) above shall be made by statutory instrument which shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.

Mr. Hinchliffe

New clause 5 is intended to safeguard the welfare of those who will obtain various community care services through the direct payment provisions in the Bill. Clearly, they include some very intimate services. Direct payments will enable people to pay for bathing, washing, dressing, cleaning and a range of other services, including, in certain instances, the handling of a person's money by the carer.

We should ensure that the quality of such care is properly regulated and inspected. New clause 5 provides for the regulation of domiciliary care: those providing such care would be subject to registration. The new clause also provides a system of inspection to monitor the quality of care that will—I stress this—be provided in the privacy of a client's home.

The background of the new clause will be well known to the Minister, and also to my right hon. and hon. Friends on the Opposition Front Bench. For many years, there has been a serious anomaly in the provisions relating to domiciliary care. I refer to the lack of any form of registration and inspection procedures.

Way back in 1984, the House passed the Registered Homes Act, and more recently the Registered Homes (Amendment) Act 1991, both of which set out in detail statutory procedures that are designed to protect residents of care homes and nursing homes. The 1984 legislation, for example, requires the registration of all establishments providing care, and a named person deemed to be suitably qualified who is responsible in law for the operation of the establishment. Each establishment must have a named person who is recognised as being responsible. The legislation enables such homes to be inspected by local registration and inspection units. More important—it is not used often, except where serious problems arise—it provides for the cancellation of the registration and for the protection of residents who may be in the care home or nursing home at the time.

The anomaly, which the new clause seeks to address, is that although such provisions exist for people who live in care homes or nursing homes, there are no such provisions in law to provide for the inspection and registration of the care that is provided privately to people in their own homes. New clause 5 applies the principles of the Registered Homes Act to care that is provided through direct payments to people in their own homes. It would be highly irresponsible for the House to pass the Bill without proper safeguards on the quality of the care provided.

I underline the fact that I support very strongly the principle of direct payments, which is contained in the Bill, and I commend the hon. Member for Mid-Kent (Mr. Rowe), who has pressed the issue for many years and talked to me on numerous occasions about his concerns that policy should move in that direction. I know that he supports in principle my concerns about the lack of proper regulation of the provision of such care. The need for the registration and inspection of domiciliary care is long overdue.

When the House debated the National Health Service and Community Care Act 1990, amendments on the registration and inspection of domiciliary care, some of which had the support of hon. Members on the Government Benches, were blocked by the Government. Shortly after the 1990 Act became law, a 66-year-old woman in a wheelchair—I am not sure whether this happened in the Minister's constituency, but it was certainly not far from it—was murdered in her own home by the carer. It is to the credit of the agency that employed the carer convicted of the murder that it has been at the forefront of subsequent campaigning to bring about a proper statutory framework for the registration and inspection of domiciliary care. I know that it has, with a number of London boroughs, been involved in bringing about a voluntary scheme of accreditation in the London area.

Since the implementation of community care legislation in 1993, the Government have argued consistently that the contracting and purchasing arrangements that the legislation introduced provided appropriate measures to monitor the quality of the care provided. That is not the view of the local authorities arranging the contracts. They do not believe that the contracting system offers sufficient regulation of the quality of care, to put into practice proper safeguards for the vulnerable elderly and disabled people who are receiving it in their own homes. Whatever one's view of the contracting arrangements, many thousands of people, particularly elderly people, are not covered by them. They purchase their community care directly from individuals or private companies, and in certain areas, particularly those with a large elderly population, a huge number of people, particularly elderly people, are buying that care without any element of protection or inspection whatever. There is no way of monitoring the relationship between the professional carer and the person who is paying money to that carer. That leaves the possibility of exploitation and abuse wide open. That could be plugged by a proper initial measure attached to the Bill, followed by much wider legislation covering everybody affected by community care.

Cities such as Bournemouth in the south of England and Harrogate in my part of Yorkshire have considerable numbers of elderly people, some with more resources than average. They are directly purchasing care and are wide open to exploitation. They deserve the protection of the House.

The National Health Service and Community Care Act 1990 was aimed at increasing the number of private sector providers of care. The Government believed that increasingly local authorities would become enablers rather than direct providers. Since the implementation of that Act, there has been a marked reduction in the number of local authority home carers and a marked increase in the number of private sector home carers—but they are unregulated, unregistered and uninspected private companies.

I have calculated that during the first year following the community care changes—1992 to 1993—the number of households receiving care services from the private sector increased by 47 per cent. That is a marked increase in private sector involvement in the provision of community care. I am not saying that all private sector companies provide poor-quality care. However, I am concerned—and the private companies share my concern—that there should be, in the interests of those private companies, a proper registration and inspection company to root out the small number of people who should not be involved in the provision of intimate, personal care in the privacy of people's homes.

The Minister may remember that on 24 March 1992, before he joined the Department, I introduced a Bill under the ten-minute rule procedure to provide for the registration of domiciliary care agencies. That Bill had cross-party support and included among its sponsors the hon. Members for Mid-Kent and for Chislehurst (Mr. Sims). The Bill was given a Second Reading by 188 votes to one—the one being the hon. Member for Chorley (Mr. Dover), who has still to explain to me why he voted against it. I think he was late back from his lunch. Unfortunately, the Bill was subsequently blocked, but I have reintroduced it and it is due for its Second Reading in July.

When I introduced the Bill, the Minister's predecessor assured me—behind the Chair, immediately after I had spoken—that in principle he shared my concerns. He said that there would be a review of the registration and inspection procedures and that it would take account of domiciliary care. We are still awaiting completion of that review and we need to ensure some urgency—

Mr. Andrew Rowe (Mid-Kent)

I am listening with great attention to the hon. Gentleman, who was good enough to make some kind remarks about me. He said something which I think might well have been a slip of the tongue. If it was not, it was a rather important statement. He said that he was in favour of having a registration and inspection company. That is an interesting concept, but not one that I would automatically expect to come from the hon. Gentleman's lips.

Mr. Hinchliffe

It was probably a misunderstanding of my Yorkshire accent. If I did say that, it was most certainly a slip of the tongue.

My hon. Friend the Member for Darlington (Mr. Milburn) recently made it clear that the Labour party favours an independent inspection and registration unit. That is important. It is also important to point out that some Labour Members have been accused of being anti-private sector, although we have argued for many years—including during the period when the community care legislation was passed—that there are problems in having such inspection arrangements in local authorities and that, on occasion, there are subtle pressures on inspection units to go easy on local authority provision. To be consistent—I think that we are absolutely correct to be consistent on this point—we believe in independent units rather than in companies. That is what I was referring to.

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The hon. Member for Mid-Kent will remember that when I introduced the Registration of Domiciliary Care Agencies Bill—of which he is a sponsor—and subsequently, that all-party campaign was supported by virtually every individual and organisation concerned with the care of elderly and disabled people, and particularly by those concerned with the provision of domiciliary care.

I am sure that the principle of new clause 5, which was drafted rather hurriedly last week, will be supported by all those agencies, which include the Joint Advisory Group of Domiciliary Care Associations, the United Kingdom Homecare Association—which has more than 300 voluntary and private agencies as members, the National Association of Registration and Inspection Officers, the British Association of Social Workers, the Social Care Association, the Association of Directors of Social Services and Age Concern. It is important to reiterate that some of those organisations have, along with individual local authorities, developed local voluntary accreditation schemes for domiciliary care, and that all of them are still actively campaigning for a proper statutory system to register and inspect domiciliary care.

I am concerned about the Government's position on the issue. Knowing the Minister reasonably well, I suspect that he, too, is probably a bit uneasy about the Government's position. The deregulation theme pursued by the Prime Minister has been applied to certain areas where serious questions need to be asked—care deregulation, for example. The Government's dogma in that area, and their reluctance to legislate or to bring about by statutory instrument a proper system of regulation and inspection, are leaving vast numbers of extremely vulnerable people seriously at risk.

There are other policy changes of which the Government should be aware. Those changes make it even more urgent that, when the Registration of Domiciliary Care Agencies Bill is considered by the House, it is amended to include a proper registration procedure to protect people who are in receipt of direct payments.

The first change is that, as part of the deregulation initiative, on 3 January last year the Government removed the licensing of employment agencies. There are no longer arrangements to offer monitoring of employment agencies, although, on 3 January last year, some 3,000 licensed agencies included domiciliary care among their activities. So many organisations are obviously involved in the provision of domiciliary care in the private and independent sector.

Secondly, to illustrate the anomaly in the current legislation, I draw the Minister's attention to the nonsense of there being more private care homes that offer care not only inside but outside them, in a locality near the private care home. They are now registered for care in the home, but they are not registered or inspected for care in the individual's home in the community, which is where equally vulnerable people are in receipt of care.

That is nonsense. If a person is in a care home or a nursing home, there is some public accountability and some visibility of that person's care. People visit care homes and nursing homes and can see individuals sitting in lounges there. The same does not apply to people who receive care in their own homes. There is doubly cause for concern about that anomaly when care homes are only half registered in their work. Those who run private care homes whom I know would probably say that they realise that the present situation is nonsense and that they would be perfectly happy to be included in proper registration and inspection arrangements.

There are increasing signs that we are, rightly, moving more and more towards domiciliary care as an alternative to institutional care. The Minister knows of my concerns. I think that, from a policy point of view, we should move much more rapidly towards domiciliary care, but to do so, we need to ensure proper safeguards for people in receipt of that care. My worry is that those safeguards are not there.

There have been rapid advances to enable people to be cared for in their own homes. With improvements in communications technology, people can be monitored by telephone systems that are operated by a number of private companies and by local authorities. In some instances, through that telephone care network system, people can be monitored through the night. That means that many more people who are dependent can live in their own homes in the community. That trend reinforces the argument that the care provided for some very vulnerable people should be properly registered and inspected, as we suggest in the new clause.

Increasingly, there are moves towards housing models of care, which some of us discussed during the debate on dementia last week. That means that we should make checks on people who are not otherwise covered by a registration system. Sheltered housing, for example, is not covered by the Registered Homes Act 1984, yet I know of many people in sheltered housing schemes and in receipt of domiciliary care who are more vulnerable and more disabled than many people who are in care homes or nursing homes.

The Carers (Recognition and Services) Act 1995 has contributed to the push towards domiciliary care. We must recognise that as people are asking for increased packages of domiciliary care, that care should be properly regulated and inspected.

Other policy developments, with which the Minister is very familiar, raise questions about how we can operate a general social services council, which the Department of Health is currently looking at in some detail. It would be a form of registration for carers and social workers. How could that operate in relation to people concerned with domiciliary care if there was no proper regulation and inspection system for domiciliary care? How on earth would a complaint come to that council if the person providing care was not monitored through an inspection system? The whole thing does not stand up, and the Minister must accept that we lack proper provision in the area.

The Minister will have talked to his Home Office colleagues about what has been called a paedophile register. The Government may introduce such a register, but what safeguards will there be to ensure that somebody who is on that register is not providing care privately in a domestic setting? As far as I can see, that safeguard will not be there. The Minister must accept that the Home Office's policy initiatives look a bit silly alongside the lack of any attempt by his Department properly to regulate and inspect domiciliary care.

The whole purpose of the Bill is to enhance the ability of individuals to remain in their own homes and to make their own choices about securing care. People in receipt of care will be put in control of determining the nature of that care and how they acquire it. I believe that if the Bill is passed without an amendment relating to the quality of care—to the inspection of care—we shall be accused of being very irresponsible, because we shall have passed legislation that is not properly thought through. We are meant to be giving people control of their care. Is that seriously possible when the care recipient has no guarantee that a provider is operating at an acceptable or an agreed standard? We are putting a number of people at risk by not thinking the matter through, despite the good will on both sides of the House in support of the Bill.

The Bill as it stands allows the potential for abuse and exploitation. It allows for financial exploitation if people involved in the provision of care are dishonest and not properly monitored, which can happen. In my time working in local authority social work, I came across complaints about the provision of home care, such as elderly people being subjected by their carers to the alteration of wills, and pensions and benefits being taken by home carers. The vast majority of home care is provided by perfectly decent, honest and responsible people. But in every walk of life, some will try to take advantage of the vulnerable. I have come across instances of physical ill treatment of vulnerable, elderly people, a number of examples of sexual abuse of people who were being cared for in their own homes, and instances of poor-quality care.

I hope that the Minister has reflected on the contents of the Law Commission's report on mental incapacity. That reminds us all of the significant number of people in our society who require a good deal more protection in their vulnerability than the majority of us who happen to be physically and mentally reasonably able.

I hope that the Minister will not say that we have to await the results of consultation on "Moving Forward". Everybody knows that there is 100 per cent. support throughout the personal social services—whether in the private, public or voluntary sectors—for a proper system of registration and inspection of domiciliary care. I am afraid that I cannot accept the Minister saying that we should wait a little longer. I heard that excuse three years ago, and when the National Health Service and Community Care Bill was being discussed in 1989. We have waited long enough, we all know that there is a huge gap to be filled, and I hope that the Minister accepts that we need to do something about such an important issue.

Mr. Rowe

I shall be very brief. I hope that the House will grant me indulgence as I have to chair a meeting somewhere else for a short time.

I should like to respond to the hon. Member for Wakefield (Mr. Hinchliffe) by saying that I am greatly in favour of the idea of ensuring that people who enter other people's homes are reputable, proper people who behave in a responsible manner. I have some anxiety about the proposition that, if we are to give control over who is employed to disabled people themselves, we should set up a system whereby every individual who is chosen by a disabled person is monitored and scrutinised. That would be unworkable and a nightmare, and would create huge delays in the employment of people, when voluntary organisations frequently complain bitterly about the checks that they have to make on volunteers taking so long. I therefore have some reservations about the new clause.

A body like, for example the Federation of Master Builders—a voluntary membership organisation to which people of good will belong, and, certainly, to which agencies that contract should belong—would be a very much better way in which to deal with the problem. It could then be said that local authorities should not necessarily sanction the employment of agencies that do not subscribe to a reputable body. That would be a perfectly reasonable way in which to proceed. If that were linked, especially for contract agencies, with an insurance scheme, it would be even better, because it would give such agencies an even stronger incentive to ensure that good behaviour was the norm. So I am greatly in favour of the new clause's principle, but a little anxious about the idea proposed by the hon. Member for Wakefield.

There is growing evidence that some local authorities are quite disgracefully discriminating against private care homes. Were they to be given the opportunity to discriminate against private care contractors, that would cause anxiety.

I am conscious that I am showing discourtesy to the hon. Member for Wakefield by leaving the debate, but I end by saying to him that I support the principle, but not the proposal contained in the new clause.

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Mr. Alan Howarth (Stratford-on-Avon)

I am glad to follow the hon. Member for Mid-Kent (Mr. Rowe), who supports the principle and the essential objective that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) has in mind. The hon. Gentleman offered some thoughtful and sensible comments on the practicalities that the registration, inspection and regulation of domiciliary care agencies might involve.

It is important that the House debates the principle, and I want briefly to underline and emphatically support some of the most important arguments that my hon. Friend the Member for Wakefield made in his comprehensive speech. He has pursued this cause consistently, and with passion, great resourcefulness and enormous authority for a considerable number of years. The House listens to him with respect, as I am sure does the Minister.

It is particularly timely that we address the appropriate regulation of domiciliary care agencies in the context of this legislation to make permissible direct cash payments by local authorities to people in need of community care. There is no doubt that direct payments will lead to an increased demand for agency staff, and that makes the issue of registration and inspection one that we can no longer avoid considering and deciding upon. It is too serious and too important an issue.

As my hon. Friend the Member for Wakefield said, significant numbers of vulnerable people will be using such agencies, and they need confidence—as we do, on their behalf—that the agencies are reputable and that the people who will be employed by them and sent to provide help in the privacy of clients' homes are the sort of people who ought to be doing such work. That principle has been long accepted with regard to registered homes. As my hon. Friend said, surely it is grotesquely inconsistent that we do not take equivalent care where the interests of people receiving care in their own homes are concerned.

As the thrust of the proposal is that it will enable more people to have independence for longer periods of their lives, to live in their own homes and to have the maximum amount of personal independence within the community, it is an issue that should not be deferred any longer. It is an issue of quality, and while quality will of course depend upon the availability of funding, it will also depend on the safeguards that we are able to operate to ensure decent standards of service.

I understand why the Government do not want gratuitous bureaucracy—that view is widely shared by all parties. No one wants more regulation than is genuinely necessary, although we may have differences of view as to the variety of areas in which regulation might be needed and the extent to which it is appropriate to regulate. I do remember, and appreciated at the time, that when the Government were announcing their great crusade against regulation, they were careful—and wise—to say that they would not play fast and loose with health and safety, and that they had no prejudice against regulation where genuine issues of health and safety were at stake. We are considering one such issue—the regulation of domiciliary care agencies that are providing services to vulnerable and disabled people.

The Government need not fear that sensibly designed regulation would meet resistance and resentment from local authorities. The Association of Directors of Social Services has expressed its support for such regulation. I hope that the Government will accept that the use of private enterprise does not mean that they can wash their hands of the social consequences.

Most recipients of direct payments will certainly want to employ their own assistants directly and, at least in the first instance, will not wish to resort to domiciliary care agencies. However, many will need agency staff, whether it is for moments of emergency, for periodic respite to enable their normal employees to take time off or to supplement the ordinary support that they employ, perhaps for specialised tasks.

The Minister needs to consider thoughtfully and imaginatively—as is his custom in taking such decisions—what that should mean in practice. I put it to him that the level playing field that he is anxious to establish so that users of direct payments are not disadvantaged in comparison with other client groups requires such regulations as my hon. Friend the Member for Wakefield is proposing. Those assurances and safeguards will enable recipients of direct payments to have the same confidence in the quality and safety of the service and that the people who they will be admitting into their homes to perform perhaps intimate tasks on their behalf will be as suitable as those employed by the social services department.

The Minister may recall some of the research that has been published over the years on the operation of the independent living fund. Perhaps he will have read "Cash for Care" and "Taking Care in the Market" by Ann Kestenbaum, which contain evidence that beneficiaries of the independent living fund expressed concern about some of the deficiencies that not infrequently were found in the operation of domiciliary care agencies. Among the anxieties expressed were the failure of agencies to match their staff sufficiently well to the particular needs of individual clients and the lack of continuity of staff. Clients could not be confident that the same person would be coming to support them from time to time. That mattered very much in terms of their confidence, their dignity and their capacity to accept help in a relatively relaxed way.

The research also found cause for anxiety that agencies were neglecting training in order to keep down costs. The Government ought to accept responsibility to ensure that those employed by the agencies are not only without criminal records or otherwise plainly unsuitable, but have the training and developed capacity to carry out the work in question.

There would be no sense in introducing regulation with a heavy hand. Any regulation in these matters will have to be sensitive to the variety of small agencies in domiciliary care. It will also have to be realistic and sensible about those who are frequently employed in such work, who are often part-time workers. Nobody is arguing that an impossible set of standards should be imposed, but we have an obligation to ensure that, consistent with practical good sense, suitable staff are employed to assist people in their homes.

In Committee, the Minister said that he wanted to await the outcome of Mr. Burgner's review before he drew his own conclusions. He said that the Government would then come to a decision. Can he tell us how far that process of review has got? Has he received recommendations from Mr. Burgner and, if so, how is his internal departmental consideration proceeding? Will reference to the technical advisory committee form part of that internal consideration?

I should like to conclude by putting to the Minister the question that I put to him on Second Reading when I drew attention to the anomalous character of the VAT regime for domiciliary care agencies. Where an element of medically qualified supervision is provided, I understand that the services of an agency do not attract VAT and that it is not charged to the client. Where that is not the case, the services provided must incur VAT. I suggested that it might be an appropriate reform to exempt from VAT those agencies that satisfied a sensibly designed inspection regime of the kind for which we have argued.

On another occasion in our proceedings I was rather startled to hear the Minister say that it was always a pleasure to hold a discussion with the Treasury. I am not sure whether he has had all the joy that he might have wished and that which we all would have hoped for him in discussions with the Treasury about, for example, the treatment of people over the age of 65. Has the Minister had an opportunity since Second Reading to talk to his right hon. and learned Friend and others at the Treasury about VAT on domiciliary care agencies? If he has not had that opportunity, perhaps he will let us know whether he plans to seek it in time for the decisions that fall to be taken by the Government in November—assuming the Government are still in office—on the public expenditure round and taxation measures in the Budget.

Mr. Alan Milburn (Darlington)

The issue of regulation is an important one that bears directly on the provisions of the Bill. We debated it at some length in Committee and it is right and proper that we should do so again.

Regulation is important because the provisions of new clauses 5 and 11 offer dual protection. First, they protect the interests of public money and those of the taxpayer by ensuring that that money is properly spent. Secondly and more important, they ensure that disabled people in receipt of a direct payment who contract with a domiciliary care agency are afforded appropriate protection and, in particular, those new clauses ensure their right to be free from the risk of abuse.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe), who is a doughty champion of the rights of disabled people, has brought an important matter to the forefront of our minds. His new clause draws heavily on his ten-minute Bill, which provides a model that merits careful examination.

New clause 11 also provides protection from the possibility of abuse for those in receipt of direct payments for care in their own homes if they contract with an agency for domiciliary care services. As my hon. Friend the Member for Stratford-on-Avon (Mr. Howarth) said, the overwhelming majority of disabled people who take advantage of direct payments probably opt to employ a personal assistant. That person is perhaps a friend or a member of their family—probably a distant relative if the Minister has his way. Alternatively, by word of mouth, they may decide to contract individually on a one-to-one basis for the provision of a form of care with which they are happy. There can be no argument about that because the thrust of the Bill is to maximise the choice of disabled people.

Other disabled people will look to domiciliary care agencies to provide staff to assist them. One can envisage a situation where illness may get in the way. Even if the first choice of a disabled person is the employment of a personal assistant, in an emergency they may decide to turn to a professional, independent domiciliary care agency. There can be no objection to that either. In recent years there has been an upsurge in the range of services that domiciliary care providers offer to people in their own homes—whether they are disabled, elderly or suffer from mental health problems. In the main, the services of the domiciliary care providers are very good, but occasionally things go wrong and there are forms of abuse.

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Many people, particularly some of the disability organisations, are concerned that although it is all well and good to provide care in a person's home, there must be safeguards to ensure that the recipient of the care is not subjected to any form of abuse. We need to provide new mechanisms to ensure that all care provided is of the highest quality and standard possible. Such mechanisms would be helpful to those seeking to enter the market for the first time.

As my hon. Friend the Member for Wakefield said, in recent years there has been an upsurge in independent sector domiciliary care agencies, and the Bill may provide a further impetus to growth in that sector of the market. It is important that those seeking to enter the market for the first time understand what is expected of them—that they are aware of the quality and the standards that they will have to offer to get a foothold in the market.

Some form of protection is vital. I believe that local authorities will have difficulty in expanding the operation of direct payment schemes if some regulation is not in place. I say that for a simple but important reason: a significant element of direct payment is the control that it gives to the person in deciding how their care needs should be provided. That control is not fully possible when the care recipient has no guarantee that a care provider is operating at an acceptable and agreed standard.

The lack of regulation injects an unnecessary element of uncertainty and anxiety into the situation of the care recipient. As my hon. Friends the Members for Stratford-on-Avon and for Wakefield, and the hon. Member for Mid-Kent (Mr. Rowe), pointed out, we must at all costs avoid the possibility of abuse and exploitation. Regulation would allow local authorities a real sanction with respect to unscrupulous providers.

The great irony is that other care providers are subject to stringent requirements of registration and inspection, but there is still no statutory framework governing the operation of domiciliary care providers—despite the fact that the services they provide are direct, face-to-face services in a person's home. The interface is between the staff member working for the agency and the disabled person, and there is little likelihood of anyone else being around. The clients of domiciliary care agencies are among the most vulnerable in the population, yet the protection that they are currently afforded under the law in their own homes is negligible compared with the protection that is afforded to clients of residential care homes and nursing homes.

My hon. Friend the Member for Wakefield made an extremely important point when he said that that irony was becoming greater by the day. As residential care providers in the independent sector find it more difficult to fill their homes, they are increasingly looking to diversify and are moving into outreach work to use their skills and resources to provide care, not in their residential care homes, but in people's own homes. However, there are two standards: when those providers provide care in the residential care home setting, they have to fulfil fairly stringent inspections and regulation requirements, but when they provide the self-same skills and resources in an individual's home, there is no such standard or quality requirement. We must clearly address that matter.

Those double standards explain why organisations such as the British Medical Association and the Association of Directors of Social Services, in responding to the Bill, have expressed anxiety about the lack of a regulatory framework to govern the provision of domiciliary care. Both organisations have called for precisely the form of regulation that is encompassed in both new clause 5 and new clause 11. Their concern, my concern and, I think, the concern of all hon. Members, would be to ensure that the Bill is not compromised or denigrated because those in receipt of direct payments are subjected to any form of abuse.

New clauses 5 and 11 help to provide safeguards against such abuse. Opposition Members have repeatedly called for such safeguards to be put in place; our call has found a ready echo in the independent domiciliary care sector. The agencies in that sector understand that they provide care for vulnerable people who have few opportunities to raise questions about services and who need protection from unscrupulous operators, however few and far between they are. Such protection is in all our interests and it is certainly in the taxpayer's interest. The last thing that anyone wants to see is public money subsidising exploitation or abuse. Such protection is also in the interest of the overwhelming majority of agencies in the domiciliary care sector which are reputable private sector operators who want to drive the cowboys out of the industry. Most importantly, it is in the interests of disabled people themselves—so that they can feel that they are guaranteed, as far as possible, a proper form of protection.

In the past and in Committee the Minister said that some local authorities had developed good local accreditation schemes that accredit individual domiciliary care agencies. But those accreditation schemes are essentially voluntary and they do not offer nationwide coverage. In the past the Minister has said that it would be appropriate to build into the contracts between local authorities and private providers safeguards that would protect disabled or elderly people in their homes. That is all well and good when the local authority makes a contract on behalf of the individual to provide domiciliary care services, but that does not occur in the Bill.

The Bill rightly empowers the disabled person to contract for himself to buy the care that is most appropriate for his needs. We are talking about a direct, not indirect, form of contract. There is a special need to ensure that proper protection is afforded to buttress that form of contract, which is why we want to see regulation in the Bill.

As my hon. Friend the Member for Stratford-on-Avon has just said, we heard in Committee that the Minister will shortly consider the results of the consultation on the Department of Health's document "Moving Forward". That consultation has now ended, but the Minister felt unable to give the Committee an insight into his thinking about the likely recommendations or the time scale for the decision. Now that we have moved on a month or so, perhaps the Minister will feel more liberated and will be able to tell us more about his thinking and the time scale that we might work to.

It is clear, however, that we cannot wait endless months for the result of the Burgner review to be published, then for the Government's further consultation to begin and then finally for the possibility of legislation being brought forward to the House. Today, the Bill will go through the House and it will become an Act of Parliament. We all rejoice at that, because the Bill has enjoyed cross-party support, but all hon. Members are concerned to ensure that proper protection will be afforded to those who take advantage of the direct payments route.

In case there is any confusion, I must make it clear that the same regulatory standards should apply equally to public and private sector organisations. The issue is not who provides the care, but the quality of care. The quality of care that people experience is important, not who provides it. We all want to see public and private sector organisations provide the highest standards of care possible. That is why my hon. Friend the Member for Wakefield was right to point to the Labour party's policy of ensuring independence. We want regulation to become genuinely independent so that there can be no question of any vested interest obstructing the highest possible standards of care, whether care is provided in the residential sector, the domiciliary sector, the supported housing sector or as respite care and whether it is run by the private sector, the charitable sector, the voluntary sector or the public sector. Independence of regulation will ensure that the highest possible standards are maintained and ratcheted up.

If independence of regulation is to work properly, it must enjoy the support of disabled people and disability organisations. It is important that any consultation on our proposal in new clauses 5 and 11 actively enlists disability organisations so that they feel that they have been fully consulted in the establishment of a better regulatory environment. In that way, regulation will not compromise a sensitive approach to the care of disabled people in their homes.

An important principle is at stake and that is why we have explored it this afternoon and why we explored the issue in Committee a few weeks ago. Under new clauses 5 and 11, if a person took advantage of the direct payments procedure and decided to purchase care, that person, the local authority and the taxpayer could be assured that that person would be afforded proper protection and that the care was of the highest standard possible.

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

The hon. Member for Wakefield is consistent and persistent on this issue. He has already introduced two private Members' Bills on the subject, and another one has been introduced by Lord Ashley of Stoke.

As the hon. Gentleman said, we debated the matter at some length in Committee. I hope that he will accept that I am equally consistent—indeed, persistent—in answering him. We promised that a review of the regulation of domiciliary and day-care services would take place as part of the review of social services inspection. Perhaps the hon. Gentleman looked forward to that review three years ago. However, I think that he now knows that the review has taken place—we have reached the end of the consultation period—and that Mr. Burgner, who is an eminent, distinguished and respected independent reviewer, will shortly bring forward his conclusions. Therefore, I assure the hon. Gentleman that we are doing precisely what he has asked for.

We are looking wider than the new clauses. Our review is examining the question of regulation of domiciliary and day services regardless of whether they are used by direct payment users. The new clauses would limit such regulation to those services used by people in receipt of direct payments. I do not see the logic in that proposal. However, I am sure that the House will agree that it would be premature, if not bizarre, to take any action before we know the results of the review—which are not far away. When we have seen Mr. Burgner's report, we shall be able to examine the issue fully and then consult widely about any proposals that we intend to bring forward.

4.30 pm
Mr. Hinchliffe

The Minister said that the conclusions of the review are due shortly. When will we receive the conclusions of Mr. Burgner's review? What steps will the Government take to legislate and to act upon those conclusions? Can the Minister anticipate what might happen subsequent to the conclusion of the Burgner review?

Mr. Bowis

I do not know exactly when Mr. Burgner will submit his report to me or to my colleagues in Government. The matter is in his hands. However, I genuinely expect to receive it very shortly and I am sure that we will be able to go public about the results before the House rises in the summer.

Mr. Peter Thurnham (Bolton, North-East)

Further to that point, I stress that the review is needed urgently and I hope that we will receive the results before the summer recess. I have drawn the attention of my right hon. Friend the Secretary of State and other Ministers to several issues of concern in the north-west. In fact, there are cases before the courts at the moment regarding the conflict of interest that occurs when local authorities act as both providers and gatekeepers of the standards.

Mr. Bowis

I understand my hon. Friend's concern; he has been diligent in raising those matters with us. I hope that he will find that the review, which goes much wider than the issues that we are discussing today, is helpful in that regard. I have already outlined the timing of the review.

Mr. Archy Kirkwood (Roxburgh and Berwickshire)

The Minister is being very seductive in trying to persuade us to wait for the review's conclusions. He knows that it is not simply a matter of waiting for the review's results and then reaching a conclusion about its results: he will have to find parliamentary time in order to implement those results. We have the opportunity to do that today. Therefore, his seductive arguments will have to persuade hon. Members that, if that opportunity is missed this afternoon, it will be replaced by another opportunity outlined in the Queen's Speech in the next Session of Parliament.

Mr. Bowis

I do not know whether the hon. Gentleman finds my arguments seductive—I am sure that he does not find me seductive. It would be bizarre to set up a review to be conducted by an eminent independent rapporteur and then to say, "To heck with that, we shall push through legislation before we have the results." That would be nonsense.

The hon. Member for Wakefield raised some interesting points—he knows that I respect his views. However, the more I listened to him, the more I thought that he raised as many questions as he answered. I think that he would agree with that. My hon. Friend the Member for Mid-Kent (Mr. Rowe) raised just some of those. Clearly, if we are introducing a measure that is supposed to be user-friendly for people who are in receipt of direct payments, we must be careful about how we impose on top of that a bureaucracy that requires some form of vetting, inspection and regulation of people. After all, in a few moments, Opposition Members will be pressing me to be even more relaxed about members of the family, neighbours, friends and so on. We must, therefore, consider carefully where this might be going.

The other point of which we must be wary is introducing something specifically and only for direct payments which would not be available for people in receipt of domiciliary services as a whole. The whole thrust of our work in Committee has been to ensure that we have a level playing field between direct payments beneficiaries and direct users of service. We would be wise to ensure that, as a result of Burgner, we bring it all together, that the system will be effective across the board and that we do not try to distinguish between the two.

As we know, there are already safeguards for direct payments recipients. No one will be forced to take on any direct payment. When people accept a direct payment, they will not be abandoned by the local authority. Each local authority will need to have in place appropriate monitoring arrangements, so that they are satisfied that recipients are receiving the care that they require. Clause 2 makes it clear that, if the authority is not satisfied that the person is receiving the appropriate care, its responsibilities towards that person are the same as if no payment had been made, so people should not find themselves without care that the authority has said that they should have.

The hon. Member for Stratford-on-Avon (Mr. Howarth) raised again the VAT issue and whether I enjoy my conversations with my Treasury colleagues, which I always do. As I said to him, I think, in Committee, it is a matter not just of conversations, however friendly, with the Treasury, but of European Community law. As, I hope, I explained in Committee, EC law requires member states to exempt the supply of medical services by medical professions and United Kingdom legislation defines that as those on the statutory medical registers, so the UK cannot exempt the supply of services by someone who is not on a statutory medical register, or exempt supply that is not predominantly medical in nature. That is the state of EC law. Perhaps another day we can discuss that, but I hope that that makes it clear where my friendly conversations with the Treasury have got to.

As has been said, some provider organisations have already issued practice documents to their members as a basis for ensuring standards, and some authorities have set up voluntary accreditation or registration schemes in their regions. I expect that any such schemes would at least be brought to the attention of a person in receipt of direct payments, although, of course, it is entirely that person's choice whether to use the person or agency on such a list or someone else.

I am grateful to the hon. Member for Wakefield for keeping this issue in front of us. We need to reconsider it carefully to find out how we should go forward. Today, I have not heard an hon. Member on either side of the House suggest an idea with which I am in conflict and with which I disagree in principle. We agree where we are trying to get to. We are trying to ensure that, whoever is providing services, there are adequate standards and safeguards. As the hon. Member for Stratford-on-Avon said, ensuring that necessary regulation is in place has always been behind our deregulatory drive. When we perceive that it is right to put such regulation in place, we will not hesitate to do so, but come Mr. Burgner's report, we will be in a better position to judge where and how to go forward. I hope that, with that reassurance, the hon. Member for Wakefield will feel able to withdraw his new clause.

Mr. Hinchliffe

This has been a useful debate of more than an hour on what is, all hon. Members would accept, an important issue. May I pick up on one or two points that have been raised? The hon. Member for Mid-Kent (Mr. Rowe) made an important point about the new clause relating not to agencies, as my private Member's Bill does, but to individuals. Clearly, the new clause was tailored to the circumstances that this Bill provides for. As has been pointed out, services may be provided by family members, or by other people known to the recipient. Checks on the suitability of providers should be carried out, however, to ensure that some Joe Bloggs who meets a disabled person in a pub, having just ended a prison sentence for offences against an individual, cannot simply walk into a home and receive payments. The system must be properly regulated and inspected.

My hon. Friend the Member for Stratford-on-Avon (Mr. Howarth) spoke of the need for sensitive provisions. Indeed, we do not want a clumsy mechanism; we want a sensitive means of dealing with the arrangements that will result from the Bill. My hon. Friend also spoke of practical good sense, and I hope that the eventual outcome of the Bill will be a practical system.

My hon. Friend the Member for Darlington (Mr. Milburn) reminded us that the new clause relates not merely to the interests of the person in receipt of services, but to monitoring of the use of public money. After all, a substantial amount of it will be in the hands of those purchasing services. As my hon. Friend said, some form of regulation would allow sanctions against the small number of unscrupulous people who would be attracted to such work. He pointed out that the Bill was a new departure, allowing people to contract on their own behalf. We should consider the implications of that.

Let me repeat my hon. Friend's point. Opposition Members believe that there should be consistency of regulation across the public and private sectors: we believe in an even playing field. That is an important part of Labour party policy, which I hope will be taken into account when we consider the conclusions of the Burgner review.

Having listened carefully to the Minister's speech, I noted that he did not disagree with any of the concerns expressed by hon. Members. He understands that there is a problem—an anomaly. I hope that he appreciates that I am taking his word and assuming that he will ensure that action is taken following the Burgner review, which he says will appear shortly. I agree with him that problems might arise if we dealt with just one element of what is a wide-ranging issue. Although the Chair did not call me to order, my speech ranged beyond the specifics of the Bill, because, as the Minister knows, the issue extends beyond its provisions.

I hope that, in the course of the review, we shall soon see Government action. Having listened to the Minister, however, and given that he seems to understand the seriousness of the problem, I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

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