General

HC Deb 12 July 2000 vol 353 cc998-1005 14. In the House of Commons Disqualification Act 1975, in Part III of Schedule 1 (certain disqualifying offices), the following entries are inserted at the appropriate places— Older Persons' Commissioner. Member of the staff of the Older Persons' Commissioner. 15. In the Northern Ireland Assembly Disqualification Act 1975, the same entries as are set out in paragraph 14 are inserted at the appropriate places in Part III of Schedule 1. l6.—(1) Regulations may provide that the office of Older Persons' Commissioner shall be added to the list of "Offices" in Schedule 1 to the Superannuation Act 1972 (offices etc. to which section 1 of that Act applies). (2) The Secretary of State shall pay to the Minister for the Civil Service, at such times as he may direct, such sums as he may determine in respect of any increase attributable to provision made under sub-paragraph (1) in the sums payable out of money provided by Parliament under the Superannuation Act 1972.'.

Amendment No. 12, in schedule 5, page 107, line 40, at end insert—'Older Persons' Commissioner'— .—(1) The Part of this Act which relates to the Older Persons' Commissioner has effect, in relation to times before the commencement of any other relevant provision of this Act, as if references—

1. (a) to regulated services in England and Wales; and
2. (b) to the provider of such services,

were or included references to services which would be regulated services in England or Wales, or (as the case may be) to the person who would be the provider, if that provision were in force. (2) Sub-paragraph (1) has effect subject to any provision made under sections 117 or 118.'

Mr. Burstow

The new clause introduces the proposition that the Government should establish an independent commissioner for the rights of older people, who would have a number of duties. I want to explain our concerns and why we thought it necessary to table the measure.

A piece of work published earlier this year by Action on Elder Abuse caused me to think that we needed a commissioner to advocate the rights of older people. That body, which is connected with Age Concern and a number of other organisations of and for older people, was established in 1994. In 1995, it set up a pilot helpline to give older people and their carers, friends and relatives the opportunity to report confidentially issues of abuse and other concerns. The service was rolled out nationally in 1998.

The report found that it was necessary to undertake a detailed analysis of two years' worth of calls to the freephone service to see what the trends were. Some 3,919 calls were analysed, of which some 1,564 were about incidents of abuse. As a country and a House, we have acknowledged and taken the necessary steps to start to address child abuse, but there is still too much of a taboo around the subject of the abuse of elders.

Action on Elder Abuse looked at how it would be appropriate to define such a subject. In 1994, a number of definitions were to hand. The definition that it alighted on—in the article "Listening is not enough"—is A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. That definition was signed up to by Action on Elder Abuse in 1995. The analysis bears some reflection. The organisation started by looking at the main types of abuse, of which there are five. The first is physical abuse: hitting, slapping, pushing, restraining and over-medication, the last of which has been a particular concern of Members on both sides of the House for some time.

The second is psychological abuse: shouting, swearing, frightening, ignoring, blaming or humiliating.

The third is financial abuse, whether it be the illegal or unauthorised use of a person's property, money, pension book or other valuables.

The fourth is the sexual abuse of any person forced to take part in sexual activity without their consent.

The fifth is simple neglect; a person is deprived of food, heat, clothing, comfort or medication.

When the definitions are applied, a number of things emerge. It was found that three in four of the callers felt that abuse had occurred. Some 42 per cent. of the calls concerned alleged abuse in sheltered accommodation; 5 per cent. concerned abuse in hospital, 10 per cent., abuse in residential homes; 11 per cent., abuse in nursing homes; and 66 per cent. were concerned with abuse in a person's own home. The survey found that psychological abuse was twice as likely to occur as physical or financial abuse.

The findings of the research are disturbing, showing that abuse is taking place in a range of care settings. The number of people in a formal care setting is small and, given the substantial number of calls expressing concerns about those care settings, it is right to ask the Government to help older people, their relatives and others by providing a mechanism to flag up those concerns.

A director of older person's rights would be able to give a clear focus to the work of the National Care Standards Commission, and beyond it. He would be able to look across all care settings and establish a highly visible position to which people could turn in confidence, in the secure knowledge that their rights would be respected and their needs met.

I hope that such a post will be established in this country—even if it is not established by the Bill—and that a position will be created that has influence over policy makers at a national and local level; that has influence over practitioners; that ensures that there is compliance with minimum standards; and, crucially, that promotes respect for older people and their dignity.

Often when Ministers respond to such amendments, one of the lines of approach is that the amendments are technically defective. In this instance we have relied heavily on parliamentary counsel, because the new clauses and amendments bear a passing resemblance to proposals tabled by the Government to give effect to their commitment to establishing a commissioner dealing with the rights of children in Wales. I hope that Ministers will not deploy the same argument this evening. I hope that they will address the central concern about the need to raise the profile of issues affecting older people, in the context of abuse.

I accept that the Bill already deals with some of the matters to which I refer, but I believe that the new clause is a necessary additional step which would go a long way towards dealing with many of the worries that I—along with other Members and a number of outside organisations—have about the rights of older people and discrimination against them.

Mrs. Spelman

I shall be brief, because the hour is late. [Interruption.] I am keen to ensure that all the remaining groups of amendments are given proper attention, and I am mindful of the fact that other Ministers are involved in those.

I entirely appreciate the needs described by the hon. Member for Sutton and Cheam (Mr. Burstow). They have been well expressed to all Members in publications by recognised voluntary organisations with real expertise, such as Help the Aged and Age Concern. Some of those publications have been excellent, describing in detail the problems experienced by older people. Probably the most moving is Age Concern's document "Turning your back on us", which deals with discrimination in the health service. However, I think the real question asked by the voluntary organisations is, "What is the most effective way of tackling the problem?"

I must tell the hon. Member that I am not persuaded that the best solution is the establishment of an older persons' commissioner. Very professional charities working with the elderly point out that we as politicians must beware any suggestion of tokenism. In a letter to me, Help the Aged expressed its fear that the creation of a Minister for older people—which has happened in Germany—would be a nine-day wonder in practice, and that the existence of one designated person to deal with such matters would make it too easy to compartmentalise. The absence of any real resources or power for that person would make it difficult to get things done.

Established voluntary organisations say that the problems of the elderly should be dealt with in departments where there is power to change the way in which things are done. In particular, they would like the national health service to stamp out all age discrimination in the service.

Mr. Burstow

Will the hon. Lady give way?

Mrs. Spelman

The hon. Gentleman has had his turn. Will he let me develop my argument a little?

In some very good work, the all-party parliamentary group on ageing and older people explicitly calls for NHS powers to be reinforced. The group says that it should be illegal for treatment to be refused to older people simply on the ground that they are older.

Mr. Burstow

I am listening closely to what the hon. Lady is saying. She has prayed in aid a number of the national charities that work for and on behalf of older people. Does she acknowledge that a number of them are, in coalition, campaigning for an entity—a commission, I think—to deal with age discrimination? Indeed, earlier today we considered, and voted on, a ten-minute Bill drafted by that coalition.

12.45 am

Mrs. Spelman

I think that we must be careful not to put words into the mouths of those voluntary organisations. Help the Aged has not specifically lobbied for an older persons' commissioner. That is not the conclusion reached by Age Concern in its document "Turning your back on us." I come back to my basic thesis. The important thing is to look at the powers that the Government have, to look at the way in which perhaps practice is slipping away from those existing powers and to bring it back to the basic principle of eradicating discrimination against older people simply on the ground of their age.

Help the Aged said specifically to me that it is anti the idea of a Minister for older persons because such special Ministers tend not to have the power and resources that are needed to get something done, so that is why I cannot support the specific outcome that the hon. Gentleman wants, although I identify with him on the need to do something about the problems.

I wish to see a vast improvement in the complaints procedure. The hon. Gentleman outlined a large number of complaints by older people about the way in which they are treated, but we need to look at the vehicles that they have to make complaints. Through an age summit that we organised in February, I have learned much about the problem that older people have in making complaints about the care that they receive. They are afraid that they may receive even worse care if they complain about it. Many older people are of a generation that was not encouraged to complain. For them, it is counter-intuitive to complain about the service, which is essentially free to them; they feel that they should not complain.

There is a strong case for advocacy for those older people. We would support that. However, although we agree with the extent of the problem, believe that the Departments have the powers to address some of those problems and want an improved complaints procedure, we cannot support that expression of the solution of the problem—an older persons' commissioner.

The hon. Gentleman sees a need for an older persons' commissioner—an older persons' rights director—and tries to make a parallel; his amendments mirror closely what is envisaged in the Bill for a children's commissioner. There is one important distinction between children and older persons in that respect: older persons have the vote; they have the right to vote. They are one in four of the electorate and the figure is rising. That is an important power, which they can exercise, making the Government of the day accountable for the treatment that older persons have received.

That is a logical argument for making a distinction between the two groups that we are seeking to protect. It is not that we do not believe that older people need protection. We believe that better and more effective tools can be used to address the problems that have been outlined.

Mr. Swayne

The hon. Member for Sutton and Cheam (Mr. Burstow) did well to remind us of the ten-minute Bill that was presented and given leave to be brought in earlier today. I would save the House's time if, instead of repeating them, I asked Members to read the exchanges on that Bill. The hon. Gentleman has drawn attention to a series of problems, which can be summarised as being due to ignorance, carelessness or indifference and wickedness. If a commissioner were created, I am not sure what leverage he would have over those human problems—problems of the human condition.

I believe that it is our responsibility here to defend the rights and interests of elderly people; we should not place our confidence in some commissioner to do it for us. Surely the purpose of the Bill is to lay down the conditions and standards by which elderly people in care should be treated, and not to hand that over following some knee-jerk reaction, saying, "If we had a commissioner, he would do all that for us."

The way in which the hon. Member jumped from the problem to the solution was not very persuasive. I did not detect in his comments any particular logic demonstrating that a commissioner would solve the problems that he described.

Mr. Burns

Does my hon. Friend think that, if we had had an old persons' commissioner 12 months ago, the commissioner could have secured for pensioners more than the measly 75p pension increase that they received in April? Do you think that an older persons' commissioner, if we had one—

Mr. Deputy Speaker

Order. May I tell the hon. Gentleman, who has some experience of the House, that he is now committing several misdemeanours—in the way in which he is addressing his hon. Friend, and in turning his back to the occupant of the Chair, whom he should be addressing?

Mr. Burns

I apologise, Mr. Deputy Speaker.

Does my hon. Friend the Member for New Forest, West (Mr. Swayne) think that, if we had had a commissioner, the commissioner would have been able to persuade the Government to act more swiftly on the conclusions of the royal commission on long-term care about how to help the elderly?

Mr. Swayne

I shall not follow my hon. Friend down that road, as I am sure that you would rule me out of order if I did, Mr. Deputy Speaker. I am convinced that the commissioner would deal not with wider political rights, but with treatment standards for the elderly as defined in the Bill. I suspect that my hon. Friend is right that, in the matters that he mentioned, such a commissioner would have made no difference whatsoever.

Nevertheless, the proposal hits the nail on the head. Some people say, "If only there were a commissioner, he would deal with the problem." Such thinking leads to hon. Members being negligent in assuming our proper responsibility. I believe that we have been negligent in accepting our responsibility. What have we done? In this Bill—rather than simply attending to the problems to which the hon. Member for Sutton and Cheam has drawn our attention and which we all already know exist—we should have formulated solutions to those problems and established the procedures by which they might be remedied. We have not done that at all: the Bill is an empty box.

All that we have done is effectively to give Ministers the power to take action later. The consequent regulations will not even be debated in the House before they are implemented. We are being asked simply to hand over the problem to Ministers, just as the hon. Member is asking us to hand it over to a commissioner. I believe that the new clause demonstrates the House's negligence in its responsibilities.

Ms Stuart

This has been an interesting debate, covering a wide range of issues related to care services for older people. Although the new clauses, amendments and new schedule in this group relate to a proposed commissioner for older people, such a proposal cannot be seen in isolation.

Older people form by far the majority of people receiving the care services that are dealt with by the Bill. There are literally millions of older people—a sizeable proportion of the population aged over 65—who rely on care services of one type or another to help them get the best out of life and to remain independent and active. Good-quality care services can make the crucial difference for older people between active participation in society in later years, and social exclusion and marginalisation. Therefore, the Government need no persuading of the importance of health and social care services for older people.

The hon. Member for Sutton and Cheam (Mr. Burstow) will not be surprised to hear me say that the Government do not intend to accept his new clauses and amendments. However, he and other hon. Members must not infer from that that the Government are not interested in the quality of care provided for older people, because nothing could be further from the truth.

We should not kid ourselves that creating an older persons' commissioner will determine whether the rights and interests of older people are protected. The health and social care services provided to older people throughout this country—their quality, accessibility, suitability, and the enhancement that they make to quality of life—depend on much more than the setting up of a new statutory post. I believe that the Government can claim with justice to be making greater improvements in the care services for older people than have been delivered by any previous Government.

The hon. Gentleman's new clauses talk about safeguards against abuse for older people. The Government have put in place a substantial programme of action to bring about improvements in the procedures for safeguarding older people from abuse, mistreatment and poor care standards.

Part I will set up the National Care Standards Commission as a powerful new watchdog against abuse and poor standards. The commission will work to new national minimum standards. We have already debated extensively the fact that national minimum standards for older people in care homes are being set for the first time, applying equally to all care homes, whether public, private or voluntary.

In future, care home providers will be clear about what standards they have to meet, and older people and their carers will be clear about the standards that they can expect. These will be aimed at promoting better quality care and helping to prevent abuse by grounding practice in the principles of dignity, choice, privacy and respect. The standards will guarantee residents access to an effective complaints procedure and ensure that vulnerable people are cared for by reliable and trustworthy staff who have been carefully recruited and properly trained to do their jobs.

The standards will also ensure that older people in care homes have the right to choose the way in which they live their lives—for example, when they get up or go to bed, what they would like to eat, and so on.

For the first time, older people living in their own homes will also be protected. The Bill introduces as part of the National Care Standards Commission's responsibilities a regulatory framework for personal home care services. In future, all domiciliary care agencies will be registered and inspected annually. That will provide a greater assurance to the hundreds of thousands of older people for whom care in their own home is a lifeline and a means of staying independent.

Elsewhere in the Bill, part VII establishes for the first time a protection of vulnerable adults list that will identify people who have abused vulnerable adults, and ensure they do not have a second chance to harm vulnerable older people; and the establishment of a General Social Care Council will mean that better training and professional standards will apply to the care staff who work daily with older people.

In addition, looking beyond the provisions of the Bill, we have published new guidance, called "No Secrets", on preventing abuse of vulnerable adults. "No Secrets" deals with developing and implementing multi-agency policies and procedures to protect vulnerable adults, including older people, from abuse. Local multi-agency codes of practice will be developed and implemented by 31 October 2001.

Improving the care provided for older people is not just about preventing abuse. It is about making sure that services are up to standard, that the right services are available to meet people's needs, that there is no age discrimination in health or social care services and that health, housing and social care services work together to meet older people's needs rather than letting them fall through the gaps.

We are taking action across all those areas through a range of initiatives, including the long-term care charter; the development of intermediate care services to build a new bridge of care between hospital and home; the extension of direct payments to people aged over 65; the national strategy for carers; and the national service framework for older people.

I could continue in the same vein, but I will not test your patience, Mr. Deputy Speaker. The point that I am making is that the Government are taking real steps to drive up the standards of care services for older people. That is what older people want, and that is what the Government's priority should be. I do not think that it would be the best use either of the Government's energies or of public money to set up a commissioner concerned with older people's care services.

We believe that the new initiatives that we are developing and those already in place are the most effective way of advancing our commitment to better protect older people from harm and abuse, and to improve the quality of the care that they receive. We cannot sensibly consider the addition of an expensive national office before the new arrangements have even had a chance to work.

For those reasons, we believe that available resources should be spent first and foremost on raising the quality of care provided to older people in our society. I very much hope the hon. Gentleman will not press his amendments.

Mr. Burstow

Let me respond briefly to the interesting exchange that we have had on this group of amendments. We have sought to raise a number of concerns. We have concentrated on concerns about elder abuse, but other contributors to the debate have broadened the discussion to include the wider context of age discrimination. If the scope of the Bill had permitted it, we would have wanted a broader remit for the proposed commissioner, so that the concerns of a number of the relevant charities about age discrimination could be addressed.

1 am

The ageist assumptions still prevalent in our society need to be challenged, as does the taboo about abuse of elders. As a society, we have decided to confront discrimination based on sex and gender, and we have decided to tackle racism. The House has decided also that we should do something about disability, and it is time that we decided to do something about age. The commissioner proposed in the new clause would have achieved that.

However, given the hour of the night and the contents of the debate, the best thing to do seems to be to withdraw the new clause, and return to the matter at a later stage.

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.