§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. McNulty.]
§ 1.1 am
§ Mr. Tony McWalter (Hemel Hempstead)The debate, which is about the treatment of the elderly in residential homes, concerns how we should safeguard the human rights of the elderly. Those of us born in England might well be tempted to think of old age as Shakespeare thought of it. In "As You Like It", Jaques, famously, makes the seven ages speech, which starts with the infant "mewling and puking"—like many Members of the House, perhaps—and ends with the seventh age:
Despite its powerful hold on our cultural consciousness, Shakespeare's seventh age is not true to old age for most elderly people: it is not simply that, in modern times, dentistry has made it possible to keep one's teeth, but that modern medicine extends the prospect of full and joyful old age, with those of advanced years keeping active, sociable and intellectually lively until severe illness or accident takes them to the destination that we all share.
- Last scene of all,
- That ends this strange eventful history,
- Is second childishness, and mere oblivion,
- Sans teeth, sans eyes, sans taste, sans everything.
Although in the past old persons were thought to lose their marbles, we now know that certain illnesses make us lose mental capacity, and the majority of the population do not have the disposition to get those illnesses. Shakespeare may have been right about the seventh age in his day, though even then the speech was directed inappropriately, but in our planning for the care of the elderly we think much more in terms of how to facilitate an active and sociable life, which is what we ought to do.
Today's newspapers feature 93-year-old Jim Dowd, who works for Sainsbury's, helping to collect trolleys and keep them available for customers. While his life style might not be typical, he provides a clear example of how important it is that ageist attitudes do not deny our fellow human beings who have aspirations the possibility of realising them. It might have been less poetic for Shakespeare to say that, for most people, old age brings a capacity actively to continue to enjoy life, albeit at a slower pace, but it would have been more truthful.
I chose the treatment of the elderly in residential homes as my topic because of my disquiet at how elderly persons are being treated at such a home in my constituency. There are in my area manifestations of what I can call the Shakespearean attitude to the elderly and I want to enlist the Government's help to combat them. Gadebury residential home is owned by Hertfordshire county council. Following privatisation by the Conservative council in 1993, the contract for care for 31 such homes was awarded to an organisation called Quantum Care.
Quantum proceeded to refurbish 29 homes, but two, including Gadebury, were left to go downhill for five years. Then, Quantum announced that it would "cost a fortune" to do up the two homes. At the end of January, Hertfordshire county council announced that Gadebury would be closed in July 2000. Since then, there has been an exodus of staff and residents, and the decision is now irreversible.
784 I am aware of the Government's determination to ensure that our elderly population are treated with more respect than they have been hitherto. The case of Gadebury echoes the treatment of council house tenants in what many of us who grew up in such houses regard as the bad old days. Council house tenants used to be strongly reminded that they were merely tenants, and that their hold on their homes was provisional. When their families had grown up, they could be relocated to a smaller dwelling, even though that meant selling the furniture, not being allowed to have a pet, having insufficient space for grandchildren to visit, and losing the garden and facilities that many of them had worked hard all their lives to build up.
We rightly decided that such a system was unjust. Under-occupancy of a council house may make housing managers lose sleep, but the first imperative of housing management is to recognise the right of good citizens who pay their bills to continued enjoyment of their home.
That change in managerial style was welcome, but it has not been extended to the elderly. I did not encounter one person in Gadebury who wanted to be relocated. Furthermore, there was a strong ethos at Gadebury, which conformed to many of the Government's ideas on care for the elderly. The home was primarily residential, but if residents needed nursing care it could be provided without an enforced move. One floor of the home tended to be for those who were frailer than the others, and whose need for nursing care was more pronounced. At Gadebury, those employed by the health service, the care agency and the county's social services team worked closely together. The Berlin wall that was described so ably by the previous Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), had been broken down sufficiently for quarrels about funding and resources to be minimised.
I am happy to commend Hertfordshire county council and the West Hertfordshire health authority for the way in which they have jointly delivered on co-operative programmes of care—in some cases well in advance of governmental initiatives. It is clear that such arrangements are fragile if the threat of closure hangs over a place where such good practice is achieved.
Why was Gadebury served with a notice of closure? The crucial point is that, in the deal that Hertfordshire county council made when it privatised care, there was never any commitment to keep it open, even though it was only built in the late 1960s. Such privatisations often have unacceptable secret clauses and undisclosed understandings. The announcement of closure at Gadebury came as a complete shock to staff and residents at the home, but county council officers had known for more than five years that the plan was to close it. Such secrecy cannot be right. It undermines confidence in any other assurances that council officers may make. The elderly and their relatives and carers were still accepting places at the home in late 1999, even though those responsible for the home knew that it was destined for the chop.
After Gadebury had been neglected for five years, some running repairs that could have been phased over time had built up, and some said that the building needed rewiring and a new heating system. Work on such replacement systems is usually phased, but when there is an 785 undisclosed determination to close a building dating back years, the phased improvement in such systems is not undertaken.
Why did Hertfordshire county council and Quantum Care decide not to invest in Gadebury, especially as it offered a high standard of care that was, in some ways, a model? I am forced to the sad view that it was because the site, which is close to the town centre, is worth a fortune and the county council wanted to asset strip once the initial furore about privatisation of care had quietened down.
The high price of land in Hemel Hempstead brings about many difficulties. As an example, I cite the 65 persons who have used a temporary homelessness provision supplied by local churches over three months around Christmas. That period is now over, and there is now no provision for the homeless in Hemel Hempstead.
With the closure of Gadebury, residents of the home on public land close to the town centre will be cleared and the land asset disposed of. If Hertfordshire county council's first obligation is to ensure that public assets address public needs, its first duty should be to inform itself of the needs that the land asset may be used to address.
I have given what I believe to be the main reason why Hertfordshire county council has connived at a policy that has caused real distress to my constituents. There is, however, a particularly disturbing dimension to the argument. Certain county councillors say that the Gadebury home is to be closed because the Government have produced guidelines, in a paper entitled "Fit for the Future?", that necessitate closure. Gadebury does not afford its residents rooms that measure 10 sq m, and that is what the paper enjoins.
I know that my hon. Friend the Minister will confirm that "Fit for the Future?" is not law, and, indeed, that those who inspect existing homes in future will consider the overall standard of care that such homes provide. If Gadebury did not have rooms measuring 10 sq m per resident, it did have the most precious attribute that any such home can have: it was regarded by those who lived there as a home, and it was organised in such a way that it could be a home for most residents for life, however frail they might become.
The home had a joyful atmosphere, and if the facilities were not the most modern, they were sufficient to produce a quality of life to which, in new legislation, we aspire. I hope that my hon. Friend will confirm that, whatever changes the Government make, when inspectors see good-quality provision of the sort that Gadebury had, their brief will be not to close such homes, but to commend them.
I have four concerns. First, the Government are rightly worried about the standards in care homes; indeed, they are the subject of a Bill being considered in another place. However, the biggest issue for residents in such homes, when they are enjoying their place of abode, is the feeling of security engendered by their belief that they will be able to continue to live there. When a home is well organised and staffed in a friendly way, and when it has the capacity to cope with those who become progressively more frail—that applied to Gadebury—residents believe, very reasonably, that they will probably be able to end their days there. The secretive actions of Hertfordshire county council and Quantum Care violated the reasonable expectations of the Gadebury residents.
786 Summary decisions of that sort, made with no reference to the views of residents, their families and their carers and with no reference to those working in such homes, constitute a violation of the rights of such persons. I ask the Government to ensure that, in future, residents in homes throughout the country will not be subjected to circumstances in which they feel vulnerable to decisions summarily to close such homes.
Secondly, Hertfordshire county council has decided to dispose of an asset that is of considerable value, but could also be used for a variety of socially beneficial purposes, whether for the establishment of new extended care provision for the elderly—in which Hertfordshire is a pioneer—or for other purposes. I am thinking of, for instance, people who are homeless, mentally frail, or both.
I should like the Minister to see such disposal as akin to selling off a school playing field. Such sites are being transmuted from being community resources to being simply private assets. Perhaps the Minister could consider whether he should have the power to call in such asset disposals above a certain value. That is particularly an issue when there is not a unitary local authority. Socially beneficial projects that the borough council might have in mind are not considered by the county council, which has a more focused brief.
Thirdly, Hertfordshire county council's decision was based on the grinding of a political axe. Members were given a figure for the refurbishment of Gadebury which included a large sum relating to compliance with new Government regulations, as articulated in "Fit for the Future?". In doing that, the county council has tried to transfer responsibility for closure to central Government. I ask the Minister to confirm that, as he has said in the past, the remit of the National Care Standards Commission will not be to close homes that work well, even if their rooms are not spacious, and that the commission will have regard to the general level of amenities in and about the environs of a home when it makes a judgment about whether care should continue to be given at such a place.
Fourthly, I ask that consideration be given to the grief caused by the break-up of friendships, the distress caused by unnecessary discontinuities in caring provision, and the bewilderment caused to elderly people when they have to go through an unnecessary uprooting.
As we have yet to act on the Sutherland report, many such elderly people have lost their savings, the family home and their access to friendly neighbours. When government or other agencies consider the closure of a home, they should recognise that they are dealing with persons who have already endured trauma. Although sometimes the closure of a home cannot be avoided—there is such a home not far from Gadebury, but it is not the subject of this debate, as it is falling down and its closure is necessary—I hope that the Government will exercise strongly their powers to prevent unnecessary home closures.
In a recent Adjournment debate, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said that local authorities should act like the Official Receiver in the case of home closures, so that there is a back-stop to prevent unnecessary distress of the type that famously caused eight deaths within a fortnight because of a relocation to Barnet.
787 In the Gadebury case, the local authority, in the shape of Hertfordshire county council, is itself responsible for causing unnecessary distress to residents and erstwhile residents. However, the failures by a local authority to discharge a function are a different order of problem from the current situation, which is that no body is acting to underpin the security of tenancy of those in homes for the elderly.
What knits those concerns together is that the elderly have rights and interests that they, their families and their carers should have the freedom to express. They were denied that freedom in the case of Gadebury, which, prior to the decision to close, treated residents in Shakespearean style as passive recipients of services. Whatever form the seventh age takes, I hope that the Minister will assure the House that he is alive to the need for the human rights of those who are of that age to be taken fully into account.
§ The Minister of State, Department of Health (Mr. John Hutton)I congratulate my hon. Friend the Member for Hemel Hempstead (Mr. Mc Walter) on choosing the subject of residential care for this debate, and also for the way in which he has spoken up for some vulnerable people in his constituency. How we as a society provide for the care needs of older people is a hugely important subject. We live in an ageing society—which is something to be celebrated—and it is therefore right that we look critically at every aspect of our system of providing long-term care for older people, with a view to improving choice in, and the quality and flexibility of, those care services.
My hon. Friend has expressed a number of specific concerns about the provision of residential care services in his constituency and the proposed closure of Gadebury house, in Hemel Hempstead. I shall try to deal with those concerns later in my speech. I think that it would be helpful if I were, first, briefly to spell out the Government's wider policies on residential care, to explain to my hon. Friend the background and context within which residential care services should be planned and delivered.
My hon. Friend may be aware that there are about 30,000 residential and nursing homes in England, providing a range of services for almost 500,000 people. The vast majority of those homes are now being operated by the independent sector. Less than 20 per cent. of residential homes are operated by local authorities. It is the responsibility of local authorities to plan and to commission a suitable range of services to meet the needs of local communities.
The Government's responsibilities are, first, to set the right policy and legal framework to regulate and improve the quality and standards of care being provided in care homes; secondly, in partnership with employers, to develop the appropriate training necessary for the social care work force; and, thirdly, to provide adequate resources to local authorities to allow them properly to fulfil their social services responsibilities.
As my hon. Friend has acknowledged, the Government have started a major programme of reform and modernisation in all of those three key spheres. Many of the reforms were described in the White Paper, 788 "Modernising Social Services". Our main ambitions are to improve the quality of social services and the protection afforded to vulnerable people and better to promote the independence of those who need to use those vital public services.
The Care Standards Bill contains many of those proposals, including the establishment of the new independent regulation and inspection arrangements and the introduction for the first time of a proper framework of national standards for care homes. The new National Care Standards Commission, which my hon. Friend mentioned, will take over from health and local authorities the responsibility for registering and inspecting residential and nursing homes, closing the loopholes that exclude many homes from any effective monitoring. For the first time, all local authority-run homes will be subject to independent quality control and monitoring.
The commission will inspect and register homes against a new set of national minimum standards for the first time. National minimum standards should help to ensure that poor standards and shoddy treatment are rooted out for good and that all residents in care homes, irrespective of which part of the country they are in, will be afforded the same protection and access to decent services.
In September last year, the Department began a consultation exercise on a proposed set of standards developed by the Centre for Policy on Ageing. The consultation ended in January and we are considering our response. The Department received 1,400 responses to the consultation on "Fit for the Future?".
We have made it clear that we want the final set of standards to reflect best practice in ensuring a quality care environment for older people. The standards will be realistic and affordable and will give care providers a sensible time in which to make any necessary improvements in the care home. The national minimum standards will, at the least, depend on the new National Care Standards Commission being fully operational, which will not happen before April 2002. Some of the standards, particularly the more challenging ones relating to the physical environment of a care home, will not be introduced until some time after the commission has started its work.
It should be clear that there can be no substance to the claim that the "Fit for the Future?" proposals by themselves provide any justification for the closure of the care home in my hon. Friend's constituency. We have not yet fixed the final set of national standards, and in any case some of them are several years away from being implemented. The effective planning and commissioning role of local authorities is central to the exercise, because they have the main responsibility for ensuring that the social care needs of their communities are properly met. Many of my hon. Friend's comments addressed that issue.
The previous Government's devotion to the privatisation of care provision put dogma before the care needs of service users and threatened the fragmentation of vital care services. However, it is equally true that the near monopoly of local authority provision that used to be a prominent feature of social care frequently led to a "one size fits all" approach, with users being expected to accommodate themselves to the services provided, regardless of their needs and preferences.
We want to put those bogus distinctions and arguments behind us and move on. We want to move the focus away from who provides the care and place it firmly on the 789 quality of the services experienced by, and the outcomes achieved for, individuals and their carers and families. We do not take a rigid position on whether services should be provided directly by local authorities or by the independent sector. It is the quality of the care provided that counts.
Decisions about the provision of residential care services in Hertfordshire were taken several years ago, as my hon. Friend made clear. That included the decision to transfer the existing residential care homes operated by the county council to Quantum Care, which is a not-for-profit organisation with an excellent reputation for providing quality care to older people.
The role of my Department is to ensure that the local authority has in place proper mechanisms for the effective discharge of its statutory responsibilities and that the people of Hertfordshire receive high-quality social care services.
The social services inspectorate provides a powerful monitoring and inspection role to ensure that both those objectives are met in all parts of the country, including my hon. Friend's constituency, but it is not my Department's role to overrule local decisions made by social services departments or to intervene directly in decisions made by care home providers to continue to operate a particular home.
I understand that Gadebury is closing because it does not meet existing registration standards set by the county council. It is always distressing for residents when a care home closes, so it is enormously important that the upheaval be handled with sensitivity and respect. I understand that every effort is being made to ensure that the residents are found suitable alternative homes that fully meet their choices and care needs.
The new regulatory system will certainly provide stronger powers to monitor the financial viability of homes and will ensure that residents have contracts that clearly spell out their rights—a matter to which my hon. Friend rightly drew attention.
The present situation regarding training is completely unacceptable, as I am sure that my hon. Friend will agree. The social care work force is nearly 1 million strong, but currently 80 per cent. have no formal social care qualifications whatever. The Government have set up a 790 national training organisation for social care, the training organisation for personal social services—TOPSS—which is developing a national training strategy.
We have substantially increased the training support grant, which is now more than £120 million, to support social care training provision. The Care Standards Bill is also setting up a new general social care council. We are taking urgent action to improve training, which will in turn lead to improved care for those in residential care homes.
Hertfordshire's standard spending assessment for social services is increasing by 5.8 per cent. this year, which represents nearly £165 million and is more than twice the rate of inflation, compared with an average increase of 5.1 per cent. nationally. We are providing record resources to the council to allow it to provide effective social services.
In all the three areas to which I referred at the beginning of my remarks, the Government are taking action to improve the quality of social services, and we will continue to do so, because those vital services can be a powerful force for good, performing crucial functions that are fundamental to any decent and compassionate society; but social services are local services, and it is for local councils ultimately to take responsibility for how the resources are used in the front line.
My hon. Friend raised his genuine concern over the decision to close Gadebury house and transfer the residents elsewhere. I fully understand and respect his concerns, and I will be happy to meet him at any time in the future to discuss them in more detail. I will, in particular, draw his remarks about the sale of local authority assets to my right hon. Friend the Minister for Local Government and the Regions.
I hope that, at the very least, I have been able to persuade my hon. Friend that the Government are determined to strengthen the regulation and inspection of care homes, giving more effective rights to residents such as those at Gadebury to have a better standard of care than has sometimes been the case. I hope that he, in turn, will be able to support the measures to which I have referred and to work with us to provide greater security and peace of mind to all those who need long-term residential care.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past One o'clock.