Residential Care Homes and Nursing Homes (Medical Records) (Hansard, 27 March 2000)

§ Mr. Paul Flynn (Newport, West)

I beg to move, That leave be given to bring in a Bill to require persons registered to carry on residential care homes or nursing homes to keep records concerning medicines and their use; to provide for inspection of such records by medical practitioners; and for connected purposes.

The whole House will have been shocked at the level of abuse in homes for young people that have been revealed in the past few years. However, at least a similar level of abuse exists in homes for the elderly, and it remains hidden. The majority of residential homes are run in an exemplary manner by kind, dedicated staff that receives poor wages for their thankless and trying work. However, a recent television programme, secretly filmed in a residential home, revealed a degree of physical and verbal violence against residents that would shock us all.

The purpose of the Bill is to counter another form of abuse—the use of medicinal drugs in such homes. Many families tell a similar story of relatives who, although frail, were active and lively, but, within a short period of entering a home were reduced to inactivity, their behaviour being similar to that of zombies. That is usually explained as being the result of the declining faculties of the residents concerned. However, there is a wealth of evidence to suggest that over-medication is the major factor.

All independent studies have found vast over-prescription of powerful, anti-psychotic drugs. In Glasgow, 28 nursing homes were visited to examine the prescribing of the "chemical cosh" to 217 residents. The study found that 190—88 per cent. —of those residents did not need the drugs. At the end of the day, some nursing homes routinely switch off their patients with the lights. An elderly person living in a nursing home receives four times as many prescription items as elderly people living in their own home. On average, elderly people in nursing homes are given between six and seven medicines—some take as many as 19—many of which are inappropriate and unnecessary.

The use of neuroleptic drugs is of special concern. Such drugs are meant for the deeply psychotic—for the treatment of senility, mania and dementia. The two main drugs are Melleril and Largactil; those drugs and several others reproduce, as a side-effect, the symptoms of dementia. It is often impossible to tell whether the dementia is from natural causes or from the drugs. Another survey found that although 10 per cent. of nursing home residents suffer from serious psychiatric disorders, 50 per cent. rather than 10 per cent. of them receive those powerful drugs.

I am grateful for help in preparing the Bill from several groups, including Action on Elder Abuse and Age Concern, which have given me some recent examples of what is happening. I was told of one nursing home where all the residents are woken up at 6 am and made to go to bed at 6.30 pm. Age Concern said: It has been suggested that the residents are drugged in the evening to go to sleep early, as this would not happen naturally. Elderly people are put to bed at 6.30 pm; when they wake up they are drugged again and hauled out of bed at 6.30 am because that suits the shifts of the staff.

39 The organisation gave another typical example in which groups of elderly people were being sedated without prescription. Age Concern stated: A relative believed the owner was in financial difficulties. Sedated elderly required less attention and less staff. The home went broke. The health of one lady improved when she was removed from the home. That woman went on to a milder drug, although she is addicted for life to the drug that was illegally prescribed to her in that home. Age Concern noted that a prosecution is possible.

Those are not isolated examples. Every independent investigation of such homes undertaken in the United States and in this country reports gross over-use. The most devastating conclusion of such reports is that when the use of those powerful drugs has been reduced or stopped, there has been little, if any, deterioration in the patient's health. The drugs were being needlessly prescribed.

There are possible remedies. Today, I heard about a trial carried out in the Ceredigion area by a local health group. I cannot give the final conclusions because they have yet to be presented to the National Assembly for Wales, which will report on them. However, the trial was a great success. A pharmacist visited 111 individuals; it was found that 194 of the drugs that had been prescribed were unnecessary for a variety of reasons. Many of them were withdrawn. The report stated that the health of those individuals has been improved, and a saving of £15,000 has been made on the drugs bill. That sum can now be given to the homes so that they might provide real help in the form of extra staff and extra care. It is far better for those in residential care to have a helping hand or an attentive ear rather than to be driven into oblivion by a drug.

40 Manchester school of old age psychiatry ran similar pilot schemes, sending groups of pharmacists into residential homes. In every instance that resulted in fewer drugs being used.

I hope that the Bill will be incorporated in the Care Standards Bill. I am grateful to a new group named Action on Elder Abuse centre for ageing, the Alzheimer's Disease Society and Age Concern for the help that they have given me in preparing the Bill. Residential homes are a reality of life for an increasing number of elderly people. In too many cases we are failing to provide the safety, comfort and peace of mind that we all hope to enjoy in our final years.

As politicians, we often agonise over problems for which there are no realistic remedies. The Bill will provide a practical, safe and affordable remedy that can rescue tens of thousands of defenceless, frail and elderly people from the lives of misery and confusion that are now being imposed on them by others out of ignorance, neglect or greed.