§ Order for Second Reading read.
§ Mr. Deputy Speaker (Mr. Michael Lord)
Before we begin the debate on the Bill, I advise the House that Madam Speaker has selected the amendment in the name of the Leader of the Opposition. There will be a 15-minute limit on all Back-Bench speeches.
§ The Secretary of State for Health (Mr. Alan Milburn)
I beg to move, That the Bill be now read a Second time.
Nearly 2 million people in our country rely on social services—more than a million older people, 400.000 children and 300,000 disabled people. They—above all other citizens in our society—have a right to expect that care is available for them when they need it and that, wherever that care is provided, it is of the highest possible standard. That is as true for social care services as for health care services. For too long, social care has been the poor relation. It is time to change that; this Bill does just that.
Changes in society, growing public expectations, an ageing population and shifts in family structures make social care ever more central to the Government's ambition of a fair and decent society. Social services enhance the quality of life for some of the most vulnerable people in our society. Our task is to modernise those services so that they can provide our country with the best possible care.
Dedicated and caring staff try to do just that. Thanks to their efforts, standards of care are often good, but sometimes—too often—they are not. Countless reports and inquiries have highlighted the weaknesses and failings of the safeguards that are supposed to protect vulnerable people, especially children. The most recent and devastating example is the Waterhouse report, presented to the House by my right hon. Friend the Secretary of State for Wales a few weeks ago.
At the heart of the Bill lies the concern to drive up standards of care, not only for the almost 2 million people who rely on social services, but for the 900,000 children reliant on early years services and for the 800,000 patients using private hospital services. In this day and age, the public should know that those who provide crucial services are competent and well trained, that clear quality standards will be set and enforced and that those most in need of protection are properly safeguarded. The Bill will enable us to make real progress on each of those matters. It is based on the philosophy that what counts in service provision is the quality of care that the public receive.
The Government have already set up a major programme of reform to raise standards in both health and education. The Bill applies that same approach to those other vital services for the public. The fundamental reforms that it sets in place are long overdue. The regulatory system that we inherited was a mess. It failed to provide adequate protection from abuse; it was characterised by a lack of consistency, independence and coverage.
482 First, there were no national standards and no consistency of approach. The regulatory system was fragmented, with 250 separate local inspection or registration bodies, all operating according to their own rules. That helped to produce a lottery in care. The new system will mean less rather than more bureaucracy.
Secondly, the essential ingredient for successful regulation—independence—was severely compromised under the old arrangements. Local authorities inspected independent care homes at the same time as purchasing most of their services. Worse still, council-run care homes were exempt from statutory regulation and subject to inspection only by their own staff. Such a system could never guarantee residents either the peace of mind or the quality of care that they deserve.
Thirdly, some services—most notably, home care services for elderly and disabled people—were subject to no regulation whatever, with all the potential for abuse that that allowed. Where there was regulation, it was often ineffective, because, more often than not, it was inappropriate, especially in the way that high-tech private hospitals were regulated as though they were low-tech nursing homes.
Fourthly, there was no professional regulatory body dedicated to overseeing standards and practice in the social care sector. There was no organisation, such as those in other fields, to take a lead on driving up training and standards of care throughout the work force. Despite the overwhelming consensus on the need for such a body, the previous Government set their face against it; they refused to listen and refused to act.
In my view and that of many other people, those were shameful failings in the previous system of regulation. The record of the previous Government was one of neglect and complacency. They were so mesmerised by the market that they became careless over standards.
I should have expected the Opposition to have learned their lesson—not least because of the all-too-glaring failings in the regulatory system. Their amendment shows that, sadly, they have not. They remain as blinkered as ever. When asked to choose between safeguarding the public or protecting the providers, they made the wrong choice. They are reinventing their history and not learning from it. Theirs is a record that this Government are determined to put right.
Alongside the other measures that we have already introduced—the new flexibilities for health and social care to work together, the best value programme to drive up standards and the quality protects programme to protect the most vulnerable children in the care system—this Bill will put in place new arrangements for ensuring excellence in vital care services. For no one are these guarantees more needed than for elderly people. Older people are entitled to be treated with dignity and respect wherever they use health or social care services.
I take very seriously the criticisms that have been made of the current system of care. Age discrimination has no part in a modern care system. That is why—alongside the measures that we have already introduced to raise standards in the national health service through the Health Act 1999 and the measures contained in this Bill to raise standards in other care services—later this year, we will publish our national service framework, which will set new tough enforceable standards for the treatment and 483 care of older people wherever it takes place. I expect all parts of the care system to rise to the challenge of meeting these standards of care not just sometimes but always.
These twin pieces of legislation—the Health Act 1999 and this Bill—will revolutionise the standards of care provided for older people and for others who use the care system. Our ambition is this: whatever health or social care service people receive wherever they receive it—and whether it is public or private—they should be assured that the care will be safe, will meet proper quality standards and will be delivered by skilled and competent staff.
§ Mr. Desmond Swayne (New Forest, West)
Will the Secretary of State acknowledge that the draft standards that have been issued for care homes have not been reassuring? They have filled care home providers with horror at the thought of the burden of regulation that may fall on them, and they are the only examples that the providers have seen. Will he acknowledge that it will do little for elderly people if their providers are driven out of business?
§ Mr. Milburn
Good providers have absolutely nothing to fear from the standards that we set out in "Fit for the Future?". As he knows, there has been detailed consultation. We received well over 1,000 responses, and we shall respond to them in due course. As the Minister of State, Department of Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton) has said to the independent care home sector, we shall be sensitive about the way in which we phase in the changes to ensure that the standards can be met. However, the hon. Gentleman would expect, as I would, the highest possible standards of care for our elderly relatives. There should be no compromise on standards of care. However, he and those on the Opposition Front Bench are making the same mistake that they made for 18 years—they are more worried about the providers than the users. It is the users of services who count.
§ Mr. Paul Burstow (Sutton and Cheam)
On the point about demanding higher care standards, will the Secretary of State tell us when the care assistants who work in care homes and in domiciliary services will come under the registration scheme for the General Social Care Council? Until they do, the policing of the standards will not be absolute and will therefore not give confidence to many people.
§ Mr. Milburn
The hon. Gentleman asks a good question. I shall discuss the General Social Care Council shortly, but he knows that there has been no such system of registration in the past. We shall have to phase in the scheme for a very simple reason. Some 80 per cent. of the staff who provide social care services have precisely no qualifications whatever. That is appalling. There is an enormous training deficit and a skills deficit that will have to be tackled if we are to ratchet up the standards of care in the way that we want. We will begin the registration process with those—the social workers—who have recognised qualifications, but we want to move as quickly as we can to register others who are professionals in their own right, but who have not had the training input that they require.
We shall do that as soon as we can, but that depends on our being able to implement our training strategy for social services. We have the right approach, we are 484 making the right investment and we have the means to register staff in a way that they should have long since been registered.
§ Mr. Geraint Davies (Croydon, Central)
Does my right hon. Friend agree that the new initiative offers the private sector new opportunities to provide a range of services for elderly people, particularly for short-term rehabilitative care, as well as to carry out the traditional role that it has now established? There is a growth in demand for such services and in places such as Croydon where there is a lot of provision, the private sector will welcome the opportunity to provide a range of service and the fresh demands and higher standards that that opportunity will bring.
§ Mr. Milburn
My hon. Friend is absolutely right. As he knows, one of the biggest problems in the health care system is that, all too often, the wrong patient is in the wrong place at the wrong time. Twenty per cent. of acute beds in hospitals are often inappropriately occupied by older people who want nothing more than to get out of hospital. Frankly, who can blame them for that? They want to be back on their own two feet and live an independent life, as we all do. However, the lack of active rehabilitation services stands in their way.
We are committed to building up those services. Indeed, when I recently allocated £600 million of additional revenue to the national health service, I said that one of its priorities was to work with NHS providers, and, when it makes sense, with private sector providers to build up intermediate care services. There is a challenge for the private sector, which is to prove that the services that it might offer the NHS and its patients are good value for money, do not create perverse incentives and, most importantly, offer patients the highest standards of care. The Bill covers precisely that and aims to enshrine quality in all parts of the care system.
§ Mr. David Hinchliffe (Wakefield)
On the possibility of using private care homes and private nursing homes, I am concerned that the majority are simply not geared up to the process described by my right hon. Friend. However, whether they will be in future is a different matter.
Will my right hon. Friend reflect on comments made by Dr. Chai Patel of Westminster Health Care on "The World at One" on, I believe, the May day bank holiday? Responding to concern expressed by one or two people, including me, that private care home staff were not trained to do the job, Dr. Patel said that that was wrong and that the majority of those staff were NHS-trained. If my right hon. Friend intends to push people into the private sector, who will staff it? Given what the private sector itself is saying, it appears that the staff will come from the NHS.
§ Mr. Milburn
My hon. Friend makes an important point which relates to what I said about the challenge that the private sector must prove that it can meet. It must offer good value for money and high standards of care, and—if services are going to be located there—must prove that no perverse incentives are created.
I shall attempt to reassure my hon. Friend by saying that he is quite right to state, as he has done before, that all too often nursing homes and residential care homes 485 encourage a form of dependency. Many older people require that, so I cannot say that it is either right or wrong. If people have an acute condition and require active management, it is right and proper that they should be located in such homes. However, there should be choice in the care system. The incentives in the system often result in people being placed in care homes when they could be in their own homes. We must get that right.
The nursing home sector must re-attune its services if it is to provide a range of intermediate care services that encourage independence, not dependency, and enable people to stand on their own two feet. I ask my hon. Friend not to close his mind to that possibility as we must ensure that, whenever care is provided, it is appropriate and of the highest standard. Right now, we do not have the range of rehabilitation services that we need in the NHS.
§ Mr. Andrew Rowe (Faversham and Mid-Kent)
The Secretary of State is in danger of allowing his interest in the private sector to detract from the reality that many local authority homes have not been inspected to the same standards. Indeed, by his own admission, 80 per cent. of staff in those homes are untrained. Will he give us an estimate of what it will cost local authorities to bring their provision up to the standard that he is seeking to impose?
§ Mr. Milburn
Local authorities will have to grapple with that. I do not have such an estimate, and local authorities must prove that they are capable of offering the highest standards of care. What I am not prepared to sanction, whether the care is provided in the private or the public sector, is lower standards of care. Let me state, straightforwardly and with all candour, that if it were an elderly relative of mine, I would want to be assured that the care provided was of the highest possible standard. That must be the right approach. Of course, some care homes in both the private and the public sector will have to grapple with difficult issues, but so be it. If we are to get the right standards of care, that is the right thing to do.
§ Dr. Jenny Tonge (Richmond Park)
Does the right hon. Gentleman think that it would be better to give health authorities more money to prevent the closure of smaller hospitals—I have in mind the old cottage hospitals—and so enable the health authorities to commission low-tech rehabilitation care within their own area, without having to resort to the private sector?
§ Mr. Milburn
Of course—if they can do that, there is no reason why they should not do it. When, in the Budget, we pumped into the NHS an extra £600 million of resources, we told health authorities and primary care groups that one of the stipulations—other than using the money to get waiting lists down and pay for new drugs and treatments—was that they had to build up intermediate care services. They have to decide where such services are best located, although I perceive a potential future for cottage hospitals in that respect.
However, rather like the nursing homes mentioned by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), cottage hospitals have to prove that they are capable of fulfilling the function. No institution has a God-given right to provide any sort of service—that right has to be earned. It must be proved to the public that the 486 right sort of service is being provided to the right standard. Of course there is huge potential for community and cottage hospitals to provide services, but they will probably have to retune the functions they carry out and change the nature of the work force they employ, so as to be able to provide a level of service that is markedly different from anything found in the NHS today.
§ Mr. John Cryer (Hornchurch)
I agree with my right hon. Friend's comments about regulation and I regard the Bill as a welcome measure. However, my local authority is attempting to use the new standards as a reason to close care homes in my constituency and the local borough, and that strikes me as a rather dubious rationale. Will he give some idea of the timetable for the introduction of the new standards, so that local authorities can find investment or other means to adjust to them?
§ Mr. Milburn
I, too, think that my hon. Friend's local authority has adopted a rather disingenuous position—after all, the standards are draft standards. People sometimes think that the Government do not undertake genuine consultation, but this happens to be one of occasions on which it was. We received a huge number of responses and we have to reflect on them, so that, when we introduce the new standards, they are enforceable. In addition, their introduction must be phased in such a way as to enable those who want to change their services to ratchet up standards to do so.
The Minister of State, my hon. Friend the Member for Barrow and Furness, has been dealing with the matter, but I can tell the House that we shall start to introduce the new standards when the National Care Standards Commission comes into being, in approximately two years' time. The process will be phased, so that care homes in the public or private sector that want to change to meet the tougher national standards will be able to do so.
The Bill establishes two new powerful regulatory bodies: first, the General Social Care Council, to regulate individuals providing social services; and, secondly and most important, the National Care Standards Commission, to regulate the organisations providing care services. The commission will be an independent national body overseeing the regulation of private and voluntary hospitals and clinics, care homes for elderly or disabled people, home care agencies and nurses agencies, children's homes, residential family centres, fostering agencies and adoption agencies. It will also carry out welfare inspections of boarding schools and colleges that accommodate children. As recommended by the royal commission on long-term care chaired by Sir Stewart Sutherland, the National Care Standards Commission will also monitor and report on trends in the provision of long-term care and take a national overview of quality in that sector.
It might be for the benefit of the House if I dealt in a little more detail with the three major services that the commission will be responsible for regulating.
§ Mr. John Bercow (Buckingham)
I am grateful to the Secretary of State for giving way so that I may ask a 487 straightforward question: will the regulations flowing from the Bill be subject to the negative or the affirmative procedure?
§ Mr. Milburn
That is a good question. We think that it will be the negative procedure, but perhaps I may return to the matter, because I am sure that I shall receive further and perhaps better advice.
§ Mr. Philip Hammond (Runnymede and Weybridge)
Further to that question, will the Secretary of State confirm that the standards for care homes to be issued by Ministers in the form of a statement will not be subject to any parliamentary scrutiny?
§ Mr. Milburn
That is true. It is the Secretary of State's function. We have had a consultation. We are considering carefully what the care home sector and others—those representing residents in care homes—have had to say, and then we shall make our decisions.
The National Care Standards Commission will be responsible first of all for regulating the full range of social care services. The commission will regulate the 30,000 care homes in this country, accommodating nearly half a million people. That will include, for the first time, care homes run by local authorities, which have until now been exempt. In providing for a national, independent regulation system, as promised in our election manifesto, we will remove the inconsistency and inefficiencies of the current system. Instead of the 250 different authorities responsible for regulating care homes, there will be one national body, providing a much more coherent and consistent service, to the benefit of both care home owners and their residents. For the first time, too, care provided to people in their own homes will be subject to statutory regulation.
Until now there has never been a regulatory system to ensure that as the care home sector grows, it provides proper standards of care and does not put vulnerable people at risk. I believe that this measure will command widespread support.
The Bill also breaks new ground by providing that private and voluntary hospitals will, for the first time ever in this country, be subject to a proper, tough and effective system of regulation. Until now, private hospitals have escaped proper scrutiny of their standards, and patients have had precious little redress when things went wrong. That is wrong, and this Bill will put it right.
People, wherever they receive their health care services, deserve to have the highest standards of care. That is why, following consultation, we will set out new requirements and standards that every private hospital will have to meet. For the first time, there will be a statutory independent complaints system for those using private health facilities. Inspection, and, where necessary, enforcement action will be carried out by expert inspectors dedicated within the commission to regulating health care, including private hospitals and other private health care facilities.
Concerns were expressed in the other place that private health care would not receive its due attention from the National Care Standards Commission because of the commission's broad range of regulatory responsibilities. That is wrong. Private hospitals will be under the spotlight as never before. They will get more than their fair share of 488 attention from the commission. We will therefore be seeking to remove the amendment made in the other place that would hamstring the National Care Standards Commission's powers over private hospitals. Instead, we will table amendments to enable joint working, where that is appropriate, between the National Care Standards Commission and the Commission for Health Improvement.
Such joint working is important. As I said earlier, if it is in the interests of the NHS, and to the benefit of NHS patients, to use private health care facilities to carry out NHS treatment, one thing is absolutely essential: that quality of care, expertise of staff and standards of clinical facilities are up to scratch. The Bill will make sure that they are.
§ Mr. Paul Flynn (Newport, West)
Will the National Care Standards Commission guarantee that the suspected widespread over-prescription in care homes for the elderly of medicinal drugs, particularly neuroleptics, will be placed under proper control, with independent scrutiny from outside homes and from outside those prescribing to the homes?
§ Mr. Milburn
I am aware of my hon. Friend's concern about those issues, which he has raised with me on several occasions. The commission will certainly be able to look at some of these areas. In particular, it will need to look—I am sure that the Committee dealing with the Bill will want to explore this in detail—at processes for administering drugs in care homes. That might partially address some of my hon. Friend's broader concerns about neuroleptics.
I referred earlier to the shocking cases in which children were abused by the very people who were supposed to care for them. The National Care Standards Commission will also have significant responsibilities for safeguarding children. All types of children's homes will be regulated and subjected to rigorous inspections. This, again, will include local authority homes which are currently exempt. It will also include small private children's homes for fewer than four children.
That loophole in the law has long been considered a scandal, and rightly so. We are determined to fix it at the earliest opportunity, so the Bill includes a provision amending the Children Act 1989 to remove the exemption for small children's homes, which we intend to bring into force as soon as possible after Royal Assent. That will mean that even before the other provisions of the Bill are brought into force, and before the National Care Standards Commission is fully up and running, the existing regulatory system will apply to small children's homes for the first time and for as long as local authorities continue to have regulatory responsibilities.
§ Ms Debra Shipley (Stourbridge)
I thank my right hon. Friend for giving way, and welcome his comments about children. He hinted at a time scale, but can he be more specific? The Protection of Children Bill, which I had the honour to take through the House last year, became an Act last July but is still not operable. That is upsetting to me. I was told at the time that it was likely to be operable this summer. I have received a variety of answers to questions put by me and others in the Chamber, which suggest that the date of implementation is late 489 summer, autumn, early winter, or some time next year perhaps. The issue is serious, and I would value urgent action.
§ Mr. Milburn
I pay tribute to my hon. Friend for her work in taking the Protection of Children Bill—now an Act—through the House. I know that it commanded a great deal of support. She will be pleased to know that the Care Standards Bill will establish an equivalent measure applying to people who are unsuitable to work with vulnerable adults.
I know that my hon. Friend remains concerned about the timetable for the implementation of her own Bill, or Act, as it is now. Discussions are taking place between my Department and other Departments, and we intend to enact it as quickly as we can. I do not have a firm date for her, but I shall write to her as soon as possible and let her know the time scale that we have in mind.
In recognition of its role in safeguarding children, the National Care Standards Commission will appoint a children's rights director, whose job it will be to ensure that children's rights and welfare are at the heart of all its responsibilities for regulating children's services. The director will fulfil a crucial function by always being available for people to turn to when they have concerns or suspicions about what may be happening in a children's home or other service.
§ Mr. Hilton Dawson (Lancaster and Wyre)
Over the past three years, under his predecessor and my right hon. Friend, the Department of Health has set high standards for the participation and involvement of young people in care in policy making and in monitoring services. Can my right hon. Friend assure me that that will continue under the new system?
§ Mr. Milburn
Yes, of course. The most important contrast that my hon. Friend could have drawn is the difference between the present regime and the previous one. So many of the scandals that are only now coming to light and being properly scrutinised occurred when the regulatory system in force was inherently and structurally flawed.
The measures that we are introducing are long overdue. By and large, they are not matters of party political contention, so the issue for the Opposition is why, if they had 18 years in government to start taking action, they did not get on and do it. It is easy to sit on the Opposition Benches and say that everything is fine and the Government's proposals are fantastic. It is a damn sight harder to find the legislative time and to commit the resources to make the change, which is what the Government are doing. I pay tribute to my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) for his work to enhance safeguards for children.
As my right hon. Friend the Secretary of State for Wales announced recently, there will be a parallel post in Wales: the children's commissioner. We will amend the Bill to effect that.
I know that there are many in the country and in the House who would call for the commissioner to have a remit for all children, not just those in children's homes or receiving other care services. The provisions in the Bill 490 for a children's rights director in England, and a children's commissioner in Wales, will set up powerful new posts whose holders will champion the interests of children who are most in need of someone to speak up for them. It is those children who most need a voice, and for that reason I believe that, for the purposes of the Bill, those provisions are the right ones.
§ Mr. Davies
I thank my right hon. Friend for graciously giving way. First, can he give an assurance that inspections of children's homes and homes for the elderly will be carried out without warning, so that preparations cannot be made for imminent inspections? Secondly, can assure us that funding to the private, voluntary and public sectors for the implementation of the provisions will be even-handed, and that extra incentives will not be given to local authorities to push everything towards the private sector?
§ Mr. Milburn
I can give my hon. Friend both assurances. There will be at least one unannounced inspection a year. That is right, so that residents of care homes can be assured that the standards of care that they receive have been properly, independently accredited. On the second issue, I can give him the assurance that he seeks.
There is a more general point to make. Sometimes we hear—I suspect that we are about to hear quite a lot in a moment—about the regulatory burdens and the cost of regulation that the measures impose on the care home sector. It is worth reminding the House that the current cost of the fees for regulation amounts to 88p per care home bed. It costs £46 a year. It is also worth reminding the House that the average income stream for one of those beds is £13,500 a year. The cost of regulation amounts to 0.3 per cent. of income. That is a pretty small price to pay to assure vulnerable people that the care that they receive is of the highest quality.
I turn finally to the Government's proposals for the regulation of child care, which are dealt with in part V.
§ Dr. Peter Brand (Isle of Wight)
With reference to the children's commissioner for Wales and the corresponding post for England, is that a difference of terminology only, or will the remit of the commissioner in Wales extend beyond children in residential establishments? There is danger not only for children who are known about in residential establishments, but for those out in the community who need help.
§ Mr. Milburn
In the context of the Bill, the differences are largely differences of job title, rather than of function. There is one slight difference, with which I shall deal in a moment. We propose to give some early years regulatory functions to Ofsted, which in Wales will be the responsibility of the commission. However, I understand that the Welsh Assembly has a broader proposal on which it wishes to legislate at some point. That is a matter for the Welsh Assembly, not for me or the House.
491 On the regulation of child care, our intention is to transfer responsibility for regulation from local authorities to a new, distinct arm of Ofsted—the early years directorate. We will also introduce greater quality into the regulatory system through the introduction of more consistent standards for providers.
Bringing together the regulatory systems for child care and nursery education will not only help create greater coherence and integration, but lead to improvements in the quality of early years services. Establishing national standards for Ofsted to operate will ensure that child safety will no longer be a matter of geography, but consistent across the entire country.
The Bill—it is the first legislation to do this—allows new duties to be placed on those involved in looking after children aged between eight and 14, or 16 in the case of disabled children. Providers will be required to demonstrate that they and their employees are suitable to look after children. Those measures will radically reform the regulation of child care. This is a crucial step towards the creation of a level playing field between public, private and voluntary providers. Parents will have more peace of mind in the knowledge that their children are being cared for properly, wherever they are cared for.
§ Mr. Milburn
I have given way a number of times, and I want to finish my speech.
I want to mention one further aspect of care services that the Bill will include. In Committee, we shall table an amendment allowing the Government to issue statutory guidance under section 7 of the Local Authority Social Services Act 1970, relating to discretionary charges for home care. In future, local authorities will be required to set their charges in accordance with the new guidelines. At present, we do not have powers to issue such guidance.
If home care is to play its full part in helping people to lead independent lives, charging policies that are manifestly unfair and deter people from taking advantage of access to care need to be tackled. Our proposal for a new power should enable us to do just that. We shall consult later on the content of the guidance.
The care services covered by the Bill provide a lifeline for millions of people. They support and strengthen families, give children the start in life that they need, empower disabled people to live, work and enjoy life to the full, and support dignity and independence in old age. The Bill will help to ensure that those services live up to the ambitions that I have identified. It will provide modern, reliable arrangements to protect the welfare of vulnerable people. It will establish rigorous and coherent regulatory arrangements which, as well as safeguarding people against abuse, will promote high standards. It will introduce effective quality checks for private health care—this is the first time that that has happened—and it will revitalise the social care work force, and give it the recognition that it deserves.
The Bill will benefit staff. It will benefit those who run care services. Most important, it will benefit the millions who depend on those services. It is a radical measure, and it will promote radical change. I commend it to the House.
§ Dr. Liam Fox (Woodspring)
I beg to move,That this House, whilst supporting the principles of improved quality of delivery of social care, and in particular greater protection to the most vulnerable, declines to give a Second Reading to the Care Standards Bill [Lords] because its approach is unnecessarily bureaucratic and intrusive, it fails to extend proper regulatory protection to all patients in acute hospitals, it makes insufficient progress towards improving adoption procedures, it will impose substantial additional cost burdens on social care providers at a time when the quality of care provision is being eroded by inadequate funding, without putting in place mechanisms to balance the obligations of higher quality with a guarantee of proper levels of payment, and it depends excessively on regulations which renders proper scrutiny of the Bill impossible.I am in the same position as the Secretary of State in the last debate: owing to prior engagements, I cannot be present for the winding-up speeches. I have already informed the Secretary of State and Madam Speaker of that, and I hope the House will forgive me for any perceived discourtesy.
We support much in the Bill, although we have reservations about some measures, frankly cannot support others, and believe that some need to be taken further. However, it was disappointing that the Secretary of State constantly differentiated between providers and users. We should be concerned with overall provision, and the making of such a sterile differentiation shows how difficult the Government find it to stop being suspicious of any form of independent provision. Without providers, there is no service to regulate.
Let me begin by identifying the parts of the Bill that we support. One important issue is that of high standards in nursing and residential homes. The Secretary of State is right to say that quality should be our watchword in health and social care. I doubt that a single Member would disagree with that. The elderly deserve security, dignity and a quality of care that is appropriate to their clinical needs. That will be an issue when the Government present their programme of intermediate care, as they have said they will do later in the year. Care must be tailored to individual needs; it must not be for the convenience of hospital managers, especially bed managers or those who wish to avoid unpleasant headlines in the run-up to an election.
Although we support the proposal in principle, we shall all have to pay close attention in order to ensure that it applies to the appropriate patients, with appropriate selection. In terms of quality—I hope that the Secretary of State will pay particular attention to this—many of the places where intermediate care will be given are managed largely, in terms of medical care, by general practitioners who do not have full access to the range of medical services that would be available in the hospitals from which patients will be discharged. I hope that we will ensure that patients do not move to areas where they cannot have access to the full range of medical support, and other support that they need.
I welcome measures to protect vulnerable adults from abuse, in the way in which children are protected. Many Members on both sides of the House, including my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) and the Under-Secretary of State for Education and Employment, the hon. Member for Barking (Ms Hodge), argued that such measures should be included in the Protection of Children Act 1999. 493 Perhaps the Minister who will be winding-up the debate, the hon. Member for Barrow and Furness (Mr. Hutton), will have had more time to consider than the Secretary of State had following an intervention, and will be able to give us some idea of when the Bill will be brought into effect. There is no point in putting legislation on the statute book if we do not bring it into effect to protect those whom it is intended to protect.
Anyone who has worked with vulnerable adults will know how important it is for those who, for one reason or another, cannot stand up for themselves to be given adequate protection in law. We therefore welcome the proposals. I shall deal with the concept of a children's commissioner later, but I deal now with the parts of the Bill that we support with reservations.
I welcome a more uniform approach to public and private sector providers in nursing and residential care. We strongly welcome clause 91, which makes new arrangements for the regulation of nursing agencies by removing their exemption from the Employment Agencies Act 1973 and repealing the Nurses Agencies Act 1957. It will bring nursing agencies into line with other employment agencies that supply health care professionals, such as locum doctors, dentists and those in professions allied to medicine in the national health service.
The measure removes an illegal loophole, and we welcome it. However, we have reservations about the logic of the position in relation to acute care; I shall return to that shortly.
The acknowledgement of the need to provide safe and effective delivery of private health care is also a welcome development, but an effective, relevant and resourced body must do that. Their Lordships wanted the Commission for Health Improvement to perform the task. The Government's intention, which the Secretary of State says they will seek to reimpose in Committee, is that the National Care Standards Commission alone should perform it. I think that in Committee the Minister will have to make a better case for reversing the change than the Secretary of State made today. We need to know more about the Government's intentions, and about precisely how the partnership that the Secretary of State mentioned will work. The delivery of the Government's plans will depend on the vehicles that they choose.
There are three other causes for concern. The first relates to Wales and was raised by the hon. Member for Isle of Wight (Dr. Brand). Ministers can give as many assurances as they like about implementation and regulation under the Bill in relation to England, but they cannot possibly give binding assurances on behalf of the Welsh Executive; nor can the House hold them to account, as a result of the devolution legislation. That allows the potential for unevenness, even discrimination, in provision.
Secondly, what does all this tell us about the Government's attitude to local government? Obviously, as the Bill was designed before the Government's poor showing in the local elections, it was designed for the general rather than the specific. The removal of the right of inspection, and the combination of best value and the Bill are likely to remove huge sections of local authority places in residential and nursing care. I wonder whether that was the Government's intention.
494 Thirdly, I was staggered by the Secretary of State's inability to give us even an estimate of how much it would cost local government to bring current provision up to the standards that the Government wanted to obtain throughout the United Kingdom. That does not bode well for the relationship between central and local government. Will the Minister give us a better estimate?
While we are on the issue of money, may I ask who will pay for all this? Will the money come out of the current local authority settlement, or will the Government make more money available? Neither the Bill nor the Secretary of State have much to say about that.
I deal now with the provisions that we find difficult to support. We cannot support the uncertainty over the Government's regulatory intentions or the heavy-handed imposition of minimum standards in a way that does not optimise the quality of the care delivered. The lack of a firm timetable is completely unacceptable; it has blighted the sector and resulted in capital starvation because lenders to the sector are uncertain. I warn Ministers that the result of that ham-fisted approach to the problem could be the closure of many independent care homes and a huge loss of overall capacity in the system. The consequences would be not only a human tragedy, with the care of frail, elderly patients disrupted, but an increased burden on local authorities, which carry the statutory burden of care. They may face simultaneous disruption and loss of their own capacity.
§ Mr. Hinchliffe
The hon. Gentleman paints a bleak picture of the wholesale closure of care homes and private nursing homes. Will he consider the fact that the private sector says that it has 25,000 empty beds? Does he accept that the previous Government used a £10 billion public investment programme and changes in income support and supplementary benefit hugely to expand a sector that most people do not want to use? People want to retain their independence in their own homes, as my right hon. Friend the Secretary of State said.
§ Dr. Fox
Would that things were as simple as the hon. Gentleman suggests. Not only total capacity but its geographical distribution are important. The provisions, if implemented as the Government intend, could result in a loss of private sector capacity and reduced local authority provision in some areas. That would create major problems for the patients involved. We must not deal with that matter lightheartedly or in the hon. Gentleman's typically party political way.
§ Mr. Bercow
Does my hon. Friend accept that I asked the Secretary of State about the regulatory procedure precisely because, whatever the intrinsic merits or demerits of particular regulations, they should not be allowed to go through the House on the nod? Does my hon. Friend agree that the regulations should be fully debated in the House, that the sector should be consulted on them and that it should be granted the courtesy of adequate notice of the requirements for their implementation?
§ Dr. Fox
As my hon. Friend knows, there is scarcely a word that he utters in the House with which I do not fully agree—he will notice that I chose the word "scarcely".
The national minimum standards, which are among the most important matters, will be decided by Ministers. They will not be subject to scrutiny in the House. In other 495 words, the potentially most damaging economic changes for a huge number of care providers will not be debated by those who represent them or those in their care. Our general concern is that the Bill is largely an empty box; it is hugely dependent on regulations that have not even been published in draft.
§ The Minister of State, Department of Health (Mr. John Hutton)
It might help us to make progress if the hon. Gentleman would take another look at the Bill. If he were to read it carefully, he would understand that the national minimum required standards will take effect not on their own but only through the implementation of the regulations. We have made it clear that consultation on the regulations will take place under the procedures normally applied in the House and that the regulations will be developed only after the fullest public consultation.
§ Dr. Fox
No, I will not.
It is bad enough that proceedings on the Bill began in the other place before consultation was finished, but there is now every chance that it will complete all its parliamentary stages before we know how the regulations will be implemented. That is typical—a contempt for Parliament that is dangerous, and that is destabilising for providers and patients.
The Secretary of State referred to child minders. I have reservations about the excessively heavy-handed intrusiveness and the bureaucracy involved in allowing inspectors from the Office for Standards in Education to inspect the private homes of all child minders. Before we can accept the Government's proposals, we need to know whether any evidence exists to show that there is a problem in that sector and, if so, what is its magnitude. We simply seek information. Many decent people will feel threatened by the proposals, so we would need to hear a good justification for them before we could agree to them.
As those proposals are a new distraction for Ofsted, will the Minister tell us what new funds will be made available to it for that function? What staff increases will be required? What discussions has he has had with the Secretary of State for Education and Employment on that matter?
§ Caroline Flint
Is the hon. Gentleman aware that, under the current system of registering child minders, a visit to the home is an important part of the inspection process? The Government have listened and included the best of the current process in the new one.
§ Dr. Fox
If the Government can tell us why Ofsted is a better choice than the local authority, we shall be willing 496 to listen to their arguments. If they can also tell us why it is entirely legitimate to be able to seize computer records and so on, we shall listen. I want to ensure that there is a good justification for such powers and the changes that the Government propose before they are introduced.
I turn now to the proposals that we support but would like to take further. The Secretary of State did not mention adoption; there are too few measures in this connection and the proposals should be extended. We should like several principles to be included in any adoption measures. A national register for those who wish to adopt children should be drawn up according to objective criteria so that those who meet the criteria can adopt children from any part of country. We should not have the petty bureaucratic restrictions that are, sadly, put in place by too many local authorities, with far too much emphasis being placed on their own political bigotry and political correctness and too little on what decent people can offer children in the adoption process.
An adoption plan should be drawn up for all children in care so that the best and most specific type of prospective adoptive or foster parents can be found. All children in care should be allowed by law to have contact with outside groups—whether charities, Churches or families—to give them a full range of cultural experiences, not only those offered by social services.
§ Dr. Fox
I will not give way on that point.
The hon. Member for Isle of Wight anticipated a point that I want to make. We should go further than the Government and consider establishing a children's commissioner for England, if the post is confined to certain criteria. The commissioner must be independent and not answerable to the Secretary of State, although an annual report to Parliament could be made. There should be oversight of the statutory provision of services to children and the effectiveness of legislative safeguards and regulations relating to education, children's services or health services. However, there should be no remit to take up individual cases or to act as the champion for individuals. The commissioner should be mandated to identify weaknesses in policy or delivery. There should be no remit to interfere in the relationship of children with non-statutory providers, especially their parents.
There should be such a commissioner solely for children because children do not have a voice through the ballot box and cannot enact change for themselves. Those in care and those whose parents do not care do not even have a natural adult sponsor. There are differences in the regimes that might be suggested for England and for Wales. I believe that we have to give children in England the same protection as children elsewhere receive.
The Government are committed to providing a children's rights director only for looked-after children. We believe that the provision should go further. Almost all children's charities and professionals support the idea of a children's commissioner. The model that I suggest would allow protection and advocacy without interfering in the rights of parents.
§ Mr. Brazier
All the independent bodies—including, most recently, the Prince's Trust—support allowing 497 mentors to have access to people, yet the Bill provides for one set of professionals to check up on another set of professionals.
§ Dr. Fox
No, I must make progress.
I want to consider equal regulation for all acute health care, in both the national health service and the private sector. We need to move from a managed to a regulated service in our general health care system. It is not possible—and even less desirable—to try to micro-manage a system in the NHS, which employs 1 million people. We need a single regulatory body, which operates in the interests of patients and not providers, for the acute health care sector.
The Government have accepted the logic of unified inspection for care homes. Why do they not accept it for the whole acute sector? Why cannot a single body guarantee the same standards for patients, irrespective of whether they are treated in the private sector or by the NHS? We should legislate for the benefit of patients and our fellow citizens; we should not take account of whether different providers are involved.
The Government have increasingly used the private sector to reduce NHS waiting lists. It is unacceptable to have one regulatory body for one sector and a different regulatory body for another when patients are increasingly interchanged between them. Single uniform regulation is logical. The Bill gives us an opportunity to provide for that. If it receives a Second Reading—I imagine it just might—such regulation can be considered in Committee.
The Bill has much to commend it, but there is also much to be regretted. It provides much more protection for some, but more uncertainty for many. I hope that hon. Members will consider all those points and support the amendment. Good intentions do not make good law; we are in the House of Commons to ensure good law.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I strongly support the Bill. For the first time in 20 years, decisive action is being taken to improve the quality of services for vulnerable people. It is worth bearing in mind that we are considering services for people who are old or ill or infirm or handicapped, or children who have special needs. Our society is supposed to provide care for those groups. We have a special duty of care for vulnerable people because they are least able to look after themselves.
We must ensure that the approach in the new regulatory framework is based on the question: will the service be good enough for me, my children, parents, relatives or the people whom I love or hold dear? If the answer is no, the service is not good enough. We must start from there. The record for the provision of some of the services has been at best patchy and at worst shameful and deplorable. That 498 is to everyone's shame. I do not blame only the staff. In cases of molestation of children that has gone on for years, everyone has been at fault, including hon. Members on both sides of the House, for failing to take the necessary action.
For many services, no standards have been set. That is bad for the people who are being cared for and their relatives because they do not know what they are entitled to expect. Sometimes, when relatives have pressed for higher standards in the private sector, the person in care has been threatened with being thrown out on the grounds that the relatives are troublemakers. That cannot be allowed to happen. It is also bad for staff and managers because they do not know what is expected of them. It is hard for people to do a proper job when they do not know what their job is.
Even when standards have been set, the regulatory and inspection system has clearly been grossly inadequate. Some caring services, such as small children's homes—to which my right hon. Friend the Secretary of State referred—or services for people in their own homes, have been left to inspect themselves. We all know what happens then. Local authorities have been responsible for inspecting themselves.
After a long series of reports and inquiries into scandalous failures, the previous Government did next to nothing. Almost the only change that took place was that child molesters managed to con the media into referring to them as paedophiles. That was the biggest change in the past decade. We must resolve that. The Government inherited a mess and we need decisive action, which is now being taken.
The Bill covers a wide range of services, from meals on wheels and home helps to children in care and old people in residential homes or people in day centres. I pay tribute to large numbers of hard-working staff who do their best in difficult circumstances. However, across the board, services are not good enough. The public are entitled to know that the meals on wheels will be okay, that home helps will not steal from, for example, people who are blind, and that residential homes will be safe and staffed by proper professionals. They need to know that there will be high-quality day care for elderly people, that children in care will not be molested but will be educated and that fostering agencies will be above board.
The proposal for the National Care Standards Commission places regulation of all the services that I have mentioned under one umbrella. That must be right. Standards must be set and the commission must ensure that they are fulfilled. Small children's homes will no longer be left unregulated. Councils will no longer be responsible for inspecting themselves. We shall have an independent, professional watchdog. It has been needed for years. The previous Government, in the face of mounting evidence and reports, did nothing about it. They made no changes. The Bill makes decisive changes, which are likely to lead to substantial improvement in services for vulnerable people.
The Bill covers the public sector, the voluntary sector and the private, profit-seeking sector. Proper complaints machinery will exist for the first time in the history of most of the services, even those in the public sector. We need to ensure that the complaints machinery does not deal simply with individual complaints. We need to analyse the pattern of complaints and ensure that we can 499 identify systematic problems as they are exposed by the pattern of complaints. We must then make use of that. Any sensible business or public sector organisation wants to do that.
I commend the proposal for establishment of a register for people who are unsuitable for working with vulnerable adults. I pay tribute to the enormous amount of hard work by my hon. Friend the Member for Stourbridge (Ms Shipley) on the Protection of Children Act 1999. I urge my right hon. Friend the Secretary of State to go back to the Department, to say, "Stuff the lawyers in all the Departments," and to get on with implementing that Bill because children's safety is more important than a lot of nit-picking by Government Department lawyers—a minor aside.
§ Mr. Hammond
Given the right hon. Gentleman's intimate knowledge of the evolution of the Bill in the Department of Health, can he tell the House what he expects to be the impact on local authority provision of the proposals with regard to unified registration and regulation of care homes?
§ Mr. Dobson
I did not understand the question. I shall sit down again. If the hon. Gentleman asks it in plain English, I will try to answer it.
§ Mr. Hammond
In plain English, what will happen to the local authority care homes? Will there be a massive contraction in the number of local authority care homes after the Bill becomes law?
§ Mr. Dobson
It depends on the quality. I hope that the object is that quality will rise and be uniformly high, whether the home is in the private, voluntary or profit-seeking sector. Frankly, if the local authorities cannot do their job properly, they should not be doing it. That is the test: can they do the job properly? If they cannot, they should get out of the business. That applies to quite a few people in the private sector, too. There will be changes in all directions in different parts of the country.
There is the separate issue of the regulation of private hospitals that were greatly encouraged by the Conservative party during its 18 years in office. During that time, it did absolutely nothing to offer any protection to any people who resorted to the private sector, and was happy to continue to have such places treated as nursing homes.
That was ludicrous because there was a massive change over time. There was a development and extension of the activities of private hospitals. The regulation became increasingly inadequate. That has been recognised even by the people in the private sector itself.
Those people know that there are hospitals that carry out treatment for which they are not properly equipped. They know that operations are carried out in hospitals that do not have decent resuscitation equipment. They know that really difficult operations are carried out in hospitals that do not have the capacity to provide intensive care if anything goes wrong. They know that there are private hospitals where there is no 24-doctor on duty and, in some cases, scarcely a 24-hour nurse on duty. They know, as the public know, that there are private hospitals where doctors who have been suspended by the national health 500 service have been allowed to carry out operations on patients in those hospitals. They know that the regulation—to the extent that there has been any—has been concerned largely with the physical aspects, rather than the state of care and the attention that people have been getting. We have a basic duty to protect the public. The new regulatory body will do that. It will regulate, register and inspect.
There was a plea from the Conservative Benches. After all these years of doing nothing, it appears that Tory policy is still to do very little in case it upsets owners of a few private homes. Decisive action is needed, but the only bit of decisive action that was proposed in that sphere was that, being so successful, the Commission for Health Improvement, which was developed basically as an NHS body and designed to even up and to improve the performance in NHS hospitals—as far as I can recall, unless my memory is playing tricks with me, the Tory Front-Bench team was totally opposed to it and voted against its establishment—should cover the private sector, too.
My view, for what it is worth, is that the National Care Standards Commission is there to provide minimum safety for people who have private treatment, but it is not the job of a public body to help the apparently competing and competitive private sector to raise its standards further. Why cannot such hospitals raise their standards, if they have the merits of the competitive private sector, with all their American connections and such like? They should be able, generally speaking, to raise their standards themselves.
The regulatory body, the National Care Standards Commission, may want to ask CHIMP to provide it with some regulatory or inspection services from time to time, but it should be left like that. Much improvement is needed in the NHS. The commission has its work cut out doing what people want it to do in the NHS. That, surely, must be the first priority, providing we have the minimum standards in place.
I do not want to detain the House any longer. I believe that the Bill is a substantial, major step forward. It will be difficult for the commission to establish itself, to get itself working and to do the job as well as we would like it to do. It is right that the bulk of the circumstances in which it will operate will have to be laid down by regulation. We in Parliament know, if we have any sense, that we are bound to get things wrong at the start. It would be better to recognise that, and not to be vain and proud and to say, "Oh we have got it right. We cannot change it." If it is laid out through regulation, we can change it more promptly and more effectively, and make it work.
I strongly support the main thrust of the Bill. I congratulate my colleagues on the Front Bench on what they have done in bringing it forward. It carries out exactly what we promised to do at the general election. It is another Labour promise being kept.
§ Mr. John MacGregor (South Norfolk)
In the time available to me, I want to concentrate on only one issue: that relating to national required standards for residential and nursing homes for older people, as proposed in "Fit for the Future?".
I want to do so because I have had many reasonable and responsible representations from my constituents on the matter. It seems that we may not be able to debate it 501 in detail in the House, despite what the Minister of State said, because, as I understand it, the measure will be introduced by negative resolution. It would be helpful for him to make a further announcement on that today.
Of course I support high and ever higher standards—as high standards as the community can afford—with higher living standards all round. I take the same test as the Secretary of State. I look for the standards that I would expect for my relatives. Indeed, I have been through that closely recently and so speak with some feeling on the subject.
There is huge concern among the providers of both local authority and private homes about the possible impact of the implementation of the proposals. I thought that it was offensive and unworthy of the Secretary of State—I am sorry that he has gone—to say that we were concerned only about the providers and not the provided—that is totally untrue. I thought that it was offensive to the many highly dedicated people who provide services as providers. It is clear that we should be concerned that the providers are able to provide. It is in that context that I make my remarks.
I want to make three points, which have been put to me by proprietors and representatives of the local authority, in relation to the standards. The first is—I make the point quickly—the fear about the volume of regulation and over-prescription that will flow, if one reads some of the points in "Fit for the Future?" report.
It is not just a question of the fees, which the Secretary of State referred to. The real cost is the administrative burden on the providers. Therefore, I hope that, in drawing up the regulations, the Government will not be unnecessarily prescriptive, will look at the implications for, and impact on, the providers, and will go through what the Lord Haskins committee said, so that we can be sure that the regulations are not overburdensome.
The second point is in relation to staffing. There has already been a big increase in staffing costs for private residential homes, partly because of the impact of the national minimum wage and the working time directives, which in some cases have pushed up staffing costs by 16 per cent. in one year alone. I am told that holiday pay for part-time staff is having a particularly heavy effect on a number of those homes.
The point, which the Secretary of State evaded, is that, at a time when fee increases are not properly reflecting cost increases—as we all know, a large part of the fees must come from local authorities—and margins in those homes are being seriously eroded to dangerously low levels, the issue of cost must be taken into account.
The Secretary of State side-stepped that issue, as did the former Secretary of State—when the first said that local authorities were having to prove their case, and the second said that the test would be whether they do their job properly in local authority homes. That was not really the point. The point was that, if extra burdens and costs are being imposed by the Government on both types of homes, and much of the funding comes from the public sector, we would need to know how the costs will be met and where the funding will come from. The Secretary of State carefully avoided answering that question, but it is important that the Minster of State should do so. It is a great, and legitimate, concern to providers.
502 The third point that I should like particularly to raise is that of physical accommodation standards. I need not go into great detail on the issue, as it was debated in Westminster Hall, on 15 February 2000, in a debate initiated by my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard), in which she explained some of the points that particularly concern those of us in Norfolk. The Minister of State was present at that debate and replied to it.
I visited all types of homes in my constituency—local authority homes; the large new purpose-built homes that have been provided in the private sector, and one in particular; and the small homes that have been developed out of old country houses and that type of building. There are approximately 415 private homes in Norfolk, with an average size of 20 beds. I shall concentrate on the smaller homes, as that is the where the bulk of the provision is currently coming from.
I rather get the impression that "Fit for the Future?" recommendations were designed for, and concentrate on, the large, newly built homes. The problem is that it will be many years before that type of home can replace all the existing ones. The interim period is going to be a worrying one. I understand that, in its current survey, the National Care Homes Association has estimated that 52 per cent. of homes have fewer than 20 beds and do not meet the standards for communal space, and that 10 per cent. of homes do not meet the standards for single and double rooms.
The problem is that if the regulations are implemented as they have been proposed in "Fit for the Future?", many of those homes will be forced to close. Therefore, my main plea to the Minister is that the regulations must be developed and implemented sensitively.
§ Mr. Clarke
I am grateful, and I take the point that the right hon. Gentleman is making—that some of the standards that will be required are not being met. However, does he not look at the other side of the coin—does it not worry him that vulnerable, elderly people are living in such conditions, and that, until the Bill was introduced, that issue was not being addressed?
§ Mr. MacGregor
I shall come to that point in a moment, as I have talked to residents in the types of home that I am talking about, including local authority ones, and I want to say something about that. I shall come back also to the issue of cost. There is not much point in simply saying that standards must be much higher, in over-regulating and in over-prescribing requirements if the result is that the homes on which we depend have to close. That is the point that I am trying to make. I also want to make the point that the homes that I am talking about and have visited do provide a high standard of care that is much appreciated by the residents themselves.
I was speaking about closures. I understand that Caring Times, which undertook a survey recently, came to the conclusion that, if the full "Fit for the Future?" standards were imposed, 54 per cent. of beds in the surveys that it 503 undertook would be lost, and that more than 50 per cent. of the homes would close, because they would be bankrupt. We really do have to address that issue. My particular concern is that the smaller homes, which that same survey highlighted, were the most vulnerable.
The proprietors of those homes have sunk a lot of capital in them to improve standards. They are dedicated, and they have done a good job in recent years. Many of them are approaching retirement age, but they may not be able to sell. Their homes—for a reason that I shall give in a moment—may not be viable, and they will simply close. It would be self-defeating for the vulnerable—for those for whom the Bill is intended—if the outcome were that there were many closures.
"Fit for the Future?" had paragraphs on compliance costs, and seemed to suggest that, because there is over-capacity—which one or two Labour Members have mentioned—in the country as a whole, the effect of closures would not be that great. That suggestion is flawed, for three reasons. The first is a decline in capacity, which the Laing and Buisson Consultancy has already predicted will—in the near future, because of current trends—be up to 10 per cent.
Secondly, as has been graphically brought home to me, if one or two rooms in a small home of 20 or fewer rooms have to close, in current circumstances, in which margins are extremely tight, that home would cease to be viable. If the home has to shut down one or two rooms, it will close. Therefore, "Fit for the Future?" has ignored a big gearing effect.
The third reason has already been dealt with by my hon. Friend the Member for Woodspring (Dr. Fox)—the geographical effect. In my constituency particularly, many small homes are scattered round the constituency, serving local communities. If some of those homes are forced to close, residents will have to go elsewhere, a long way from where their relatives reside. Those residents, and their relatives, say that they want to stay in those homes. They are quite happy to stay in a home which may have one or two rooms that are rather smaller than the proposed regulations would suggest. The benefit to them of being in the home that they have been in and of being close to their relatives is much greater than having a slightly larger room.
On 15 February, the Minister said that the standards must be "realistic and affordable", and that they must give providers a sensible time scale in which to make the necessary changes. I very much welcomed that comment, which suggested that he was taking some of these points on board. I ask him to spell that out rather more. All I am asking for is the application of common sense in examining some of the proposals in "Fit for the Future?"
The National Care Homes Association had a point when it said:Those things which can be measured with a tape measure do not generally impinge on the quality of care afforded.I think that I would have put it slightly differently and said that one does not measure the quality of care by a tape measure alone, as so many other qualities are required.
In the homes that I have seen, some of the rooms would have to be shut under the proposals—they cannot be physically enlarged—but are only a little smaller than would be required in the regulations. They are smaller 504 because the previous local authority specifications were lower, or, sometimes, for the simple reason that they were measured in feet rather than metres. It seems that common sense is very much required.
I ask the Minister to reassure the many proprietors in my constituency and elsewhere, first, that the regulations will not be applied retrospectively to homes in which some rooms may miss the target by only a little and the residents—some of whom I have talked to—are perfectly content with their rooms and do not want to move elsewhere; secondly, that costs will be taken into account, and that, if extra costs are imposed, assistance will be given to both private and local authority homes to help them to meet those costs; and, thirdly, that, for existing homes, especially the small ones, there should be a long transitional period.
Those proprietors are deeply anxious. They have sunk much capital, often after heavy borrowing, into their homes, and their capital is at stake. They are dedicated to providing a service, and it is not enough for the Government to say to them that nothing will happen until April 2002. They need more specific reassurance now, and I hope that the Minister will be able to give it today.
§ 3.8 pm
§ Mr. David Hinchliffe (Wakefield)
It is perhaps worth making one point in reply to the speech by the right hon. Member for South Norfolk (Mr. MacGregor), who mentioned private owners' capital. I remind him that much public-sector capital—£10 billion, at least—was provided.
§ Mr. Hinchliffe
I think that the right hon. Gentleman accepts that point.
I welcome the Bill, which has been a long time coming. What is particularly exciting is that, today, in a debate on community care, we have a time-limit on speeches—usually, I am able to speak in these debates for half an hour and no one grumbles. We now have interest in the subject that we have not had before, and I commend the Government for generating that interest. They tackled an issue that has long needed to be tackled.
Many hon. Members in the Chamber deserve commendation for their contribution to the Bill, not least the ministerial team. However, many hon. Members—Back Benchers and former Ministers—have contributed quite remarkably to bringing the Bill together, and I commend them. It is a great honour to follow my very good and right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), who is still held in the greatest affection in God's own county. To me, London has always been a strange place, full of—with apologies to my hon. Friends from London—odd people.
§ Mr. John Austin (Erith and Thamesmead)
My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) is also held in high regard in London. This may be the first time in 20 years that the issue has been addressed, but Bills do not come out of nowhere. My right hon. Friend's period in office is coming to fruition in the Bill. Nobody has done more than him to drive up standards in health and social services.
§ Mr. Hinchliffe
I entirely agree. My right hon. Friend deserves the greatest credit.
505 Some of my comments on the Bill will be critical of it. I hope that my hon. Friend the Minister understands that they are intended to be constructive, and that I make them in the hope that in Committee the Government will look at some of the detailed points that need further examination. My comments are made in the context of my delight at the overall thrust and principles behind the Bill, which is long overdue.
I welcome the National Care Standards Commission. I think that I wrote the policy document that first proposed removing the function of regulation from local authorities. I was shot at by some of my local authority colleagues at the time for that suggestion. I felt that it was important that regulation was independent from provision. I welcome the establishment of that principle.
However, I have a slight proviso. One of the strengths of the previous system was local knowledge and accountability. I hope that we build local knowledge into the National Care Standards Commission, because it is fundamental to pick up intelligence about where things may be going wrong.
I welcome the mechanisms for independent health care and, in particular, the proposals for domiciliary care. I introduced two Bills on the issue in the previous Parliament, which were opposed by the then Government. It is wrong that we have not regulated the domiciliary care that is given to some vulnerable people.
I also welcome the General Social Care Council. The social work profession has long campaigned for such a body. I pay tribute to the parliamentary panel on personal social services and its secretary, Mr. Dick Clough. The hon. Member for Faversham and Mid-Kent (Mr. Rowe) has done a lot of hard work on that panel over many years. It is a cross-party issue on which there has been consensus.
It would be wrong not to pay tribute to the successful campaigning of my hon. Friend the Member for Stockport (Ms Coffey) on small children's homes. Those provisions will be called the Coffey section. I also welcome the attention that has been given to fostering and adoption services. I would welcome clarification on whether the Bill will impinge on the accountability of guardians ad litem. I have some concerns about the lack of accountability of those professionals, who have a key role.
I listened carefully to the hon. Member for Woodspring (Dr. Fox), who made the astonishing comment that the Conservatives wanted an adoption plan for every child in care. He obviously does not know that the majority of children who come into care are there only temporarily. It might be for only a couple of days. They are fostered while there are problems at home and then they go straight back. The Tories want adoption for every child who comes into care. The hon. Gentleman has clearly not thought that through, because he would not give way on it and left in a hurry. It is a bizarre idea, but we are used to that from the Conservatives.
My concerns must be seen in the context of my strong overall welcome for the Bill. My first concern relates to children's rights directors. My right hon. Friend the Secretary of State has left the Chamber, but he inherited from his predecessor a policy document—which I know well—containing a commitment to appoint a children's 506 rights commissioner. There is a distinction between what the Government are proposing and what most people involved with child care want, including the Health Committee and other Committees and all-party groups that have pushed strongly for a rights commissioner.
The role envisaged is too limited. Let me give an example of where a rights commissioner is desperately needed. Nobody has considered the fundamental principle of the welfare of the individual child in relation to the Child Support Agency. Like most hon. Members, I deal with any number of cases of disputes between parents when things have gone badly wrong—they are not talking to each other and access is wrongly being denied to parents as a result of CSA policies. A rights commissioner could penetrate an area that needs to be examined in the interests of vast numbers of children in this country who are suffering. I hope that the Committee will look at that.
I find it embarrassing to agree with the hon. Member for Woodspring on one issue, but I do not fully understand why the Government are moving the inspection of child minding and day care to Ofsted. I used to be involved in registering child minders and day care when I worked in local government. I hope that further thought will be given to the proposal, because they are essentially care services and should be dealt with by people who understand the care issues involved. Ofsted is unsuitable for the role. Given its reputation, we could end up with league tables, performance-related pay or targets for tots. I have a serious worry that we are turning our young children into robots. They are under pressure to achieve academically and league tables also put teachers under pressure. I do not want those inappropriate pressures brought into child minding for the under-fives.
§ Mr. Austin
I have some concerns on that. I am sure that my hon. Friend also agrees with the comments of Lord Laming in another place, to the effect that child minding is about social care and good child care practice rather than education. The Minister in another place responded by saying that he hoped that those involved in the inspection procedures in social services would move over to Ofsted, bringing their skills and knowledge. From his experience of social services and child care in local government, does my hon. Friend share my concern that many of those involved in child minding registration do not work exclusively in that area? If they moved to Ofsted, they would be divorced from their other child care functions and from their professional colleagues involved in social care. Would my hon. Friend care to comment on that?
§ Mr. Hinchliffe
My hon. Friend makes an important point, which reinforces the need to look at the issue again. I hope that the Minister will take his comments in the spirit in which they were intended and that we can look at the issue in Committee.
I should also like to query the regulation of adult day care. Having read the Bill and the guidance, I am not clear about that. If it is not to be regulated by the commission, it is a huge worry. I can envisage private care or nursing homes being closed on the grounds of poor standards and reopened the following day for day care, giving the same personal care with no regulation. Can we look at that again? We need to consider the way in which the commission can deal with proposals to close care and nursing homes. I had a debate about a home called Garden 507 House in Wakefield, which closed suddenly—its standards were rather poor—and was transformed, under the same ownership, into a day nursery. We need to understand how the separation of the regulatory system would deal with such a situation. The commission would deal with the care side and Ofsted would deal with the day nursery. We need to address the practicalities.
My most serious concern is that the Bill looks at where we are now. I do not want to use the word "reactive", but it is not aspirational, as I should like it to be. We have heard the expected defence of private care home owners from the Tories. They did pretty well under the Tories and made a lot of money. We now have a huge empire full of empty places that nobody wants, funded largely by our taxpayers' money.
The key question is how we would want to be cared for. Some of us are older than others—some are even older than me. I do not want to be in geriatrica, wall to wall, facing other people with similar problems. I want to remain in my own home in my own community. That is what we should aspire to. The Bill reacts to the current situation rather than looking forward 10, 15 or 20 years, when people will want something fundamentally different to what is deemed the norm now—the "oh, stick them in a care home" attitude. We can do better than that. In 1988, Denmark passed legislation prohibiting the institutional care of old people. If it is illegal in Denmark, a country not dissimilar to ours, why are we anxious to prop up an declining private care sector? Why are the Government considering filling some of the 25,000 empty places with people who ought to be cared for in some form of intermediate care setting within the NHS?
We must consider life in non-institutional settings and home-based care, and we must look at what communications technology can offer in sustaining independence. We must anticipate where we will be in 10 or 20 years' time, because there will be a fundamentally different picture. This is an excellent measure which, with a bit of work, could become a landmark reform. I want to see that happen, and I think it will.
§ Mr. Paul Burstow (Sutton and Cheam)
The Bill comes to us from the Lords much improved from its First Reading incarnation. The establishment of a comprehensive system of inspection and regulation of social and health care providers is long overdue. It is essential if we are to build public confidence in services for children and vulnerable adults that this Bill secures Second Reading and Royal Assent, and that the tools that are given to regulators are put in their hands as soon as possible.
Their lordships have done much to strengthen the Bill and to ensure that the protection afforded to vulnerable people covers the widest possible range of care settings. However, there is still a question of timing to be considered. How soon will the National Care Standards Commission begin to exercise its registration and inspection powers? When will home-based care be covered by national minimum standards—2003, 2004 or later?
Day care—a late addition to the Bill—is another area on which we must establish clarity of timing. The Minister has offered a guarantee that, within one year of the 508 National Care Standards Commission being established, the Government will carry out a review as to how and when the regulatory regime for day care will come into force. It was not clear from the debates in the Lords what that meant in practice. When will the review be concluded? When will the regulations be in place to give comfort to those receiving domiciliary care that those providing it are doing so appropriately?
When will that take place; 2002, 2003 or, as seems more likely, a much longer time scale? We have only to look at the process for producing the standard for "Fit for the Future?" for care homes to see how long that process has taken. It is something like two and a half years since the initial commission of that work, and we now await the results of the consultation exercises. If the same pattern holds true today for day care, we will lack national standards until 2004 at the earliest. I hope that the Minister can give reassurance on this point.
The commission will be registering and inspecting against national minimum standards. Care home standards have been set out in "Fit for the Future?" and we have heard concerns about that. The Minister will know of the concerns felt by many in the independent homes sector about the burden that these standards represent. Lord Hunt stated that the Minister of State hadindicated that the staffing ratios set out in "Fit for the Future?" will not be adopted. He has also given assurances that reasonable time scales will be set for homes to meet the final standards that will be required through the new regulatory pattern.—[Official Report, House of Lords, 28 March 2000; Vol. 611, c. 714.]
§ Mr. Hammond
Does the hon. Gentleman agree that expressions such as "reasonable time scales" do not help bankers and home owners who are trying to deal with the blight that has descended on the industry? Does the hon. Gentleman have any idea of what a reasonable time scale is for compliance with the new physical standards for accommodation?
§ Mr. Burstow
I look forward to exploring in some detail in Committee what the time scales will be. That is undoubtedly a legitimate cause for concern. It can be overstated, but it is nevertheless a legitimate concern about which we should be seeking clarification.
Much emphasis has been placed on physical standards such as room size. I am not convinced that room sizes or the number of power points in a room are a satisfactory proxy for quality care. I hope that the commission will be able to focus its work on quality, and not just on things that it can easily measure, such as room sizes. By quality, I do not just mean the quality of care provided but, more important, the quality of life of the residents. That means that service users and care home residents must be treated not as passive recipients of care, but as active participants in promoting and regulating quality.
However, I do not believe that the National Care Standards Commission can be an independent voice for elders because most older people never come within the ambit of formal social care. For that reason, I believe that there is a case for establishing a commissioner for the rights of older people. Such a commissioner would lend an independent ear and a powerful voice to promoting the rights and interests of older people. Such a commissioner would work closely with many aspects of central and local government, looking at the impact of those services on the lives of older people. The work would include the 509 Commission for Health Improvement and the National Care Standards Commission. The commissioner would report to Parliament.
Such a focus is needed, as I believe that there is in our society a lack of recognition of elder abuse. It is still a taboo topic. We have broken the taboo when it comes to child abuse. There is still much to be done in the area of child protection, but the framework is in place. I pay tribute to the Government for what they have done, and we are beginning to see a real step change in the provision of services for children. I do not believe that the same can be said of elder abuse. Cases such as those highlighted in The Express's "Respect" campaign show why action is needed to stamp out elder abuse and age discrimination. The Express found evidence that residents in one care home wereput to bed against their will and woken as early as 4.30 am to get ready for breakfast; not properly cleaned even though they regularly soiled themselves; left to sit for hours without activities and woken at two hour intervals during the night to be taken to the toilet because they are not given incontinence pads.The Minister will say that that case can be dealt with by the commission, but work by organisations such as Action on Elder Abuse has found that abuse extends beyond formal care settings. In their report "Listening is not Enough", Action on Elder Abuse highlights serious cause for concern about financial abuse by family members, physical abuse and neglect in care settings and psychological abuse wherever the older person lives.
An independent commissioner for older people would send a powerful signal that the dignity and rights of older people matter and will be upheld. There is still a serious question mark over the role of the commission and its relationship with the Commission for Health Improvement. Where does clinical governance end and the national care standards begin?
Given the talk of using nursing homes to provide step-down or convalescence beds and rehabilitation paid for by the NHS, surely the clinical responsibility—and hence the inspection responsibility—will rest with the Commission for Health Improvement. However, nursing homes will be registered and inspected by the National Care Standards Commission. Who leads? Who follows? Who decides what needs to be inspected? This is not clear in the Bill, and those providing the care will need that spelled out. I hope that the Minister will say more about that in Committee.
My noble Friend Lord Clement-Jones successfully amended the Bill in respect of the commission's powers to contract with the CHI, and that was an important step in the right direction. We were disappointed, if not surprised, to hear today that the Government intend to reverse that amendment.
While the commission will be doing this work in terms of inspecting and regulating private hospitals, it remains our view—as we stated during the passage of the Health Act 1999—that these matters should be regulated across the health service and not parcelled up into pieces. That principle has been accepted in respect of the registration and inspection of care homes, whether they are public or private, and we believe that the CHI should be charged with the responsibility to inspect public and private health care providers without fear or favour. It was a mistake by the 510 Government not to have embraced that, and we will continue to press the point as the Bill goes through the House.
While the commission will regulate places and institutions, the General Social Care Council will regulate employers and employees alike. The council is very welcome. But how rapidly will it be allowed to cover the work force? Ministers have decided that those registered with the council in England must be qualified. But only one in five of the 1.25 million social care work force hold a relevant qualification. The largest part of the work force is made up of residential and domiciliary care staff where the level of qualification is very low indeed. Yet it is those people who have the greatest access to vulnerable people. Those staff are the very people who should be covered by the council to restore public confidence in our care system.
The Training Organisation for the Personal Social Services training strategy sets out targets for boosting the number of qualified residential staff to between 40 and 50 per cent. over the next five years, but that is dependent on substantial increases in training resources and a much improved staff retention record. TOPSS is still to set targets for the training of domiciliary care staff. Where will the money come from to enable that to be realised? The Minister will no doubt tell us that the Government already provide funds to local authorities to train their staff, but what about private and voluntary sector providers?
The Bill is intended to improve protection for the public, but by restricting registration to the minority of staff in the work force who hold formal qualifications the Government are leaving the door open to neglect and abuse. Studies in the US have found that there is a much higher incidence of abuse by care workers who have received no training. The level of untrained and unqualified staff in social care is unacceptably high. The Government must ensure that the front-line staff, whom we trust with the most intimate care of vulnerable people, are registered with the council as soon as possible. When stacking shelves at Safeways pays better than caring for frail elderly people, how does the Minister expect to attract the right people to join and stay in the care work force?
The danger is that the fine words that the Bill contains will be realised not in five years' but in 10 years' time, and that cannot be right. Wales has decided to go for a big-bang approach and will register all social care staff, qualified or unqualified, from the outset. It has a smaller work force so that will be easier to manage. What is the Government's timetable for registering all staff in social care in England? The Secretary of State, in answer to my earlier question, said that it would be done as soon as possible, but some clarity on the timetable would be welcome.
It had been widely trailed by Ministers that the Government planned to bring forward amendments to establish a children's commissioner for Wales who would be a champion for all children in Wales, whether in care or not. That is not quite what we heard today, and that will prove a disappointment to many on both sides of the House and to people outside.
§ Ms Julie Morgan (Cardiff, North)
I can assure the hon. Gentleman that the National Assembly for Wales is well aware of the scope of the Bill and intends to extend its scope as soon as it is passed.
§ Mr. Burstow
I am delighted that the scope will be expanded, but why wait until the Bill is passed? Why not establish the commissioner in the Bill?
§ Dr. Brand
It is possible for the National Assembly for Wales to expand the role of the newly named commissioner which, according to the Bill, will be exactly the same as the English equivalent. However, I can think of no legal ways in which this House will be able to expand the role of the English commissioner without further legislation.
§ Mr. Burstow
That is right. The Welsh Assembly does not have its own legislative powers so it will rely on this House to give it the additional powers needed to widen the scope. The Bill provides an opportunity now to put in place the necessary powers to enable the Assembly in due course to widen the scope, and that matter needs to be considered further. The hon. Member for Lancaster and Wyre (Mr. Dawson) recently introduced a ten-minute Bill which would have provided for a children's rights commissioner for England, and I understood that the same provisions would be made for Wales in this Bill. It now appears that that is not what is intended, and I hope that the Minister will explain what the differences will be in practice. It now appears that one will be called a commissioner and the other will be called a director, but they will exercise the same jurisdiction, functions and responsibilities.
§ Ms Julie Morgan
The National Assembly for Wales will add on advisory powers to the role of the commissioner, in addition to the powers given by the Bill, but will await additional legislation from this House to create the full commissioner role. The National Assembly sees the Bill as the first step in creating a full-blown children's commissioner in Wales.
§ Mr. Burstow
I am encouraging the Government to take several more steps to achieve the full intentions of the ten-minute Bill, which hon. Members on both sides supported. I hope that we can achieve that end, because many right hon. and hon. Members have campaigned for it for many years and felt that we were much closer to achieving it than we in fact appear to be.
When it comes to "Fit for the Future?" and the other national standards that will follow, I know that many care home owners and providers feel that the Government have failed to recognise that higher standards, better regulation and more training come with a price tag. Unless fee income can be increased, the numbers of providers leaving domiciliary care and residential care will continue to rise. Reducing choice and competition will result in lower standards. Providers will seek to pass on the costs of the extra obligations that are rightly being placed upon them in the form of higher fees and, in turn, social services departments will pass them on in higher charges or tighter eligibility criteria. Our aim has to be to protect vulnerable people from neglect and abuse and it cannot be right that we then present those very people with the bill for that service.
Only last week the Audit Commission published a damning report on unacceptable variations in the level of charges for non-residential services. The range is staggering. Nine out of 10 councils now charge, but it cannot be fair that two people with the same assessed 512 need for care and the same financial means can pay widely differing amounts for their care package—anything from no charge to £120 per week. What the Audit Commission found is yet another postcode lottery. I am not opposed to charging, but it must be based on ability to pay. It must also be fair and consistent, and personal care should be free on the basis of assessed need. The Audit Commission found that one in three councils are operating charging policies that leave pensioners with less to live on than income support. Far too many councils fail to take account of the costs of disability in their charging policies and, as a result, the most disabled service users face the highest charges.
I have already asked my own council to benchmark its charging policies against the Audit Commission's report, pending the guidance from the Government that the Secretary of State said was imminent, but many local authorities feel that they have been left to stew when it comes to developing charging policies. Since publishing a White Paper in 1998, the Government have maintained a Trappist silence on the subject of charging policy. Local authorities have had to develop their charging arrangements in a policy vacuum. We were expecting an announcement in July, so I was heartened to hear the Secretary of State say that the Government will take the necessary powers in the Bill to give the necessary instructions to local authorities to stamp out the practices that the Audit Commission criticised. I am delighted that the dialogue that a delegation and I had with the Minister seems to have encouraged that change. We will work hard to support any such amendment as best we can, because it is wrong that pensioners can be driven into poverty by local authority charging policies.
§ Mr. Hammond
As the hon. Gentleman seems to have such a close understanding of the Government's intentions, does he understand that the Secretary of State intends to cap fees chargeable at a maximum or to introduce some standardisation? The latter would mean an increase in fees in those areas in which they are at present low or non-existent.
§ Mr. Burstow
At a delegation organised by the all-party disablement group last week, I raised with the Minister the need for the power to be included in the Bill. As the hon. Member for Woodspring (Dr. Fox) recognised in his speech, we now have a framework for progress, but it is mostly an empty box and we have to wait to see the regulations. Will we have to wait until July, or beyond that? Will we see change before the general election or will change have to await the outcome of that election?
As there has been a vacuum in non-residential charging policies, so has there been a vacuum in long-term care charges. The British Medical Association, in its briefing on the Bill, said:The organisation and funding of long term care needs to be established before confident regulation of care homes can be developed.That must be right. The royal commission majority offers a humane and practical formula for addressing the funding of long-term care and, indeed, its conceptual framework was adopted by the Audit Commission in its examination of charging policies.
It is a disgrace that, in this country, debt collectors should still be chasing after dementia sufferers for money to pay for their care. Liberal Democrats support the royal 513 commission's main recommendation. Personal care should be free on the basis of assessed need. Location should not matter when people need intimate care such as bathing, dressing or feeding: that care should be free.
The Bill deserves a Second Reading. It has been improved in the Lords, but serious questions remain. I hope that the spirit of co-operation that characterised deliberations in the other place will inform our examination of the Bill in Committee.
§ Mr. Hutton
I am grateful to the hon. Gentleman for giving way, and for sharing with the House that information about his party's policy on care issues.
The hon. Gentleman said that he supports the principle of free personal care for people receiving residential care, but he has confirmed his party's view that it is acceptable to charge for domiciliary care. He also said that he understood that there was a justification for charging in that respect.
§ Mr. Burstow
When the Minister reads Hansard, he will see that I also made it clear that the personal care element of non-residential care should be free. As the Minister is interested in our policy, I will ensure that a copy of the policy statement from our last conference is sent to him so that he can inform himself more about the matter. It is appropriate for Liberal Democrats to set out where we stand on this issue. Too often, we are criticised—unfairly—for not stating what our policies are.
As I said, the Bill deserves a Second Reading. The public require a system that promotes dignity and independence by providing the support and help that people need, when they need it and in the way that suits them best.
§ Mr. Tom Clarke (Coatbridge and Chryston)
I have listened to the debate with mixed feelings. I am truly delighted that the Government have introduced this Bill. It demands our support, and it enjoys the overwhelming support of the organisations working in the sector. However, I must admit that until my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) and my hon. Friend the Member for Wakefield (Mr. Hinchliffe) made their contributions, I had a feeling of deja vu. We know that there are problems, but the House seemed determined to stick at the detail of the proposals.
I have been a Member of Parliament since 1982. I must tell the right hon. Member for South Norfolk (Mr. MacGregor), with great respect, that he did not ask a single question that has not been answered in report after report. The reports compiled by Sir Roy Griffiths and Lady Wagner are especially relevant in that respect. Given the problems that remain, and the fact that demography is making them worse, it is intolerable that we are not prepared to make progress until every detail of cost has been spelled out. It is as if the House were filled with accountants who are unaware of the vision needed to make progress and meet the day-to-day challenge of improving the lives of the vulnerable people whom this Bill seeks to help.
514 My right hon. Friend the Member for Holborn and St. Pancras was right to say that many people give the impression that we should do nothing, despite the evidence to the contrary. More than a decade ago, Sir Roy Griffiths said that the status quo was simply not an option with issues such as this. If that was true then, it is even more so today.
I realise that cost is important and, if I have time, I hope to deal with the question of resources, but there is a danger that those who know the price of everything and the value of nothing will prevail. I welcome the Bill because it will allow progress to be made in such sectors as community care and child care, and in the provision of protection for vulnerable adults. That progress will not come a minute too soon.
It is said that the public despair of Parliament, but they do not do so because of our power, influence and democratic role in society. People despair at the way in which we go on and on, nitpicking and debating questions to which they know the answers. For example, Mencap gave a wonderful briefing today, at which it described the problems faced by young people with learning difficulties, and set out the need for proper regulation and inspection of their institutional care. However, many of the points that it made are ones that it has made for years.
We must move on and implement the proposals contained in the Bill. I welcome the proposals for long-term nursing and social care for older people and for disabled people. I welcome the Bill's approach to services for children in special care. I welcome the proposals regarding care provided for people in their homes, as a result of which an extremely important component of modern community care will be subject to statutory regulations.
The proposed National Care Standards Commission is profoundly welcome, and long overdue. It will ensure that local circumstances are seen as part of a bigger picture. It is absolutely right and perfectly reasonable for the Bill to encourage the commission in the establishment of minimum standards. I am more and more convinced that what matters is our response to the needs of individuals, especially the most vulnerable. In all candour, I can tell the House that, if asked to choose between the views of service providers and those who need the services, I am on the side of the latter.
It is entirely unacceptable that four in 10 councils do not carry out their inspection duties with regard to adult care. That is an argument for minimum standards in itself, and there are other examples of where improvements must be made. Do needs vary that much? I respect the rights of every individual, and acknowledge that every individual is unique, but what does the Bill seek to achieve?
The aim behind the Bill is to provide a clean and healthy environment for people, to offer comfort, acceptable standards of hygiene, a sensitive response to the problems caused by double incontinence, and a social environment in which people can feel wanted, and loved. That is not too much to ask. If the House can support those aims through legislation and regulation, that is what it should do.
It is absolutely right for hon. Members to criticise the work that is going on, but the House must remember that examples of best practice in all the matters that I have set out can be found in many parts of Britain. I am sure that all hon. Members want that best practice to become the norm.
515 I unreservedly welcome the Bill's proposals on training for care workers and social workers, and the proposal for general social care councils. The point has been made more than once in this debate—as it was in another place—that 80 per cent. of care workers have no recognised qualifications. That is an important point, but I invite the House to consider the other side of the coin: this country has depended for many years on people such as auxiliaries, cleaners and home care workers to deliver those vital services. In many cases, they make a sterling contribution to the life style and quality of life of the people with whom they work.
I hope that we can put right problems to do with training, but also that we can do so with a sense of appreciation of those people who are so committed to helping others in so many ways, often without much in the way of financial reward. Moreover, what I have just said about that 80 per cent. of people and their dedication applies to many social workers as well. I hope that that does not make me sound too much of a populist.
Let me turn to the provisions on the very important issue of child care. I had the privilege of leading for the Opposition during the passage of the Children Act 1989. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) made an outstanding contribution. The Minister at the time was David Mellor who, in my opinion, was excellent, not least because he was prepared to listen. I know that Ministers will listen to the points made by the hon. Member for Sutton and Cheam (Mr. Burstow) and others who support the principles of what we are seeking to achieve but who, quite rightly, will question the detail and put forward better ideas if the opportunity is there. I hope that we will continue in a spirit of optimism and progress.
My overwhelming recollection of the passage of the 1989 Act was the dreadful evidence of the inquiries into Cleveland, the Orkneys and elsewhere. I listened to the social workers and took the view that for many it was a case of "damned if you don't and damned if you do". That does not excuse the House from its responsibilities, which are addressed in the Bill.
I welcome the proposals for introducing a children's rights director, for protecting vulnerable children, for introducing the National Care Standards Commission and for the regulation and inspection of children's homes. Such proposals are extremely welcome and long overdue. The same is true of plans for fostering agencies, voluntary adoption agencies and, above all, for removing the exemptions on children's homes. My hon. Friend the Member for Wakefield sought to do that, and was in some measure successful, when the 1989 Act was before the House.
I could not welcome more warmly the new duties to be placed on those involved in looking after children aged between eight and 14, or 16 in the case of disabled children and, as Mencap points out, children with learning difficulties. Providers should be obliged to demonstrate that they and their employees are suitable to deal with such serious responsibilities in child care. Few occupations could be more important. I am glad that the issue is being addressed in the Bill. I have no doubt that, as it goes through its various stages, the provisions, acceptable as they are in principle, can be improved still further. That can do Parliament nothing but good.
516 I recall my days in local government and my work on a social work committee for children. I end this part of my speech by reflecting on a conference on children that I attended many years ago. It was addressed by a lady who, happily, lived a long life and was active in another place, Lady Elliot, who gave so much to the National Society for the Prevention of Cruelty to Children. What she said then is just as profound and relevant today. She said:without affection, life has little meaning for most people, and none at all for children.If the Bill takes a step forward in that respect, we will all welcome that.
Finally, I turn to the provisions on home care. Because care in the community is so dependent, and rightly so, given that so many people continue to exercise their right to stay at home, we must ensure that services are available, that they are properly scrutinised, and that the people who benefit from home care have a say in service delivery.
In the past few days, I visited Mr. Muldoon in my constituency. Until Christmas, he was a perfectly able man. He became disabled within a matter of weeks. He is now trapped in his bedroom; he is not able to use a chair lift—there are none—and there is no ramp at the door. He wants to get out and meet the bowlers and the people with whom he shares his life. I accept that when it comes to resources, even in my constituency, my local council has difficulty in delivering.
We are talking about carers and about some people who will not understand what we are seeking to do in the Bill unless it really impacts on their quality of life. Mrs. Walker, who runs a carers' organisation in my constituency, drew to my attention the case of a person who suffers from schizophrenia who, because the nurse was on holiday, did not receive medication for five days. I hope that if these policies are pursued by the Scottish Parliament—because I realise the Bill's limitations—such problems will no longer occur.
I end my speech by welcoming the Bill.
§ Mr. Simon Burns (West Chelmsford)
I, too, broadly welcome much of what is in the Bill. However, a number of areas cause me concern. I believe that the Government could have improved the drafting, but that can be considered in Committee.
I also welcomed a great deal of what the Secretary of State said. One could not disagree with much of it. That also applies to the remarks of the right hon. Member for Holborn and St. Pancras (Mr. Dobson) and others. Clearly, any sane individual wants the very best care for their parents or the elderly.
I thought that the Secretary of State slightly spoiled an otherwise balanced and reasonable speech by claiming that nothing had been done in this area between 1979 and 1997. I believe that the Bill is yet another stage in a rolling programme of community care, and it is to the community care aspects of the Bill that I wish to devote my comments.
In the late 1970s and early 1980s, there was a fundamental shift in the way in which we sought to look after our elderly population, and rightly so. The old philosophy for the frail and the elderly, as opposed to the 517 elderly who needed medical nursing care, was to shut them away in hospitals—much as happened to those suffering from mental illness—where their quality of life was negligible. All they had was a dormitory-style bedroom with a bedside table and a lamp. That is not dignified for anyone. We were absolutely right to adopt a more enlightened policy on caring for these people.
The main emphasis was to provide all the support possible where it was feasible for the elderly to remain within the security of their own homes, with support through social services and other agencies. Where elderly people were not ill but were too frail realistically to be supported or support themselves at home, they lived in residential homes.
As my right hon. Friend the Member for South Norfolk (Mr. MacGregor) said, we saw the development of many independent, privately owned residential homes as well as a local authority sector providing this form of care and help for the elderly. Many of these homes are of the highest quality. In many instances, the children of elderly people are looking in their localities to find a home that fits the requirements and needs of their parents or their elderly relatives. Like us all, they want the best quality care and home for their parents. They are not prepared to take second best.
However, it would be naive to say that every home in the private and local authority sectors is of the highest quality. Clearly that is not so. That is why it is probably right that we have a legislative framework to raise quality of care standards. However, that must be done sensitively and realistically.
To suggest that nothing has been done since 2 May 1997 is patent nonsense. With the change in philosophy of the community care programme, we saw a great deal done. The moneys given to local authorities to assist the policy have frequently been mentioned. Since then, as part of the developing programme, we have seen changes introduced where they have been needed. The Registered Homes Act 1984 was an important piece of legislation. Contrary to what the Secretary of State said, there was the important Burgner report of 1995. There was also the landmark speech of my right hon. Friend the Member for Charnwood (Mr. Dorrell) in October 1996, in response to the Burgner report, which set out what the previous Government proposed to do. That was followed by the publication of White Papers early in 1997.
If we had won the 1997 general election, we intended to introduce what was known to us as the great social security reform Bill. Fundamental changes were to be made. Many of them foreshadowed the contents of the Bill. In some instances they have been slightly changed and arguably improved upon with time and more consultation.
For example, we were going to remove local authority responsibility for inspecting private homes, when their homes were not subjected to the same regime. The Bill will rightly stop that practice because it is patently nonsense. All homes for the elderly should be inspected on a consistent basis. Similarly, we intended to introduce a national benchmark system. The Government have moved slightly further with their commission. Perhaps that is an improvement with hindsight, but it represents the same principle of seeking to raise standards.
518 We intended to enshrine in legislation the regulating of domiciliary care. That important issue must be addressed, and the Bill does that. That is why I broadly welcome many of the provisions set out in it. However, I am slightly concerned with some of the details. The issue uppermost in my mind concerns minimum standards and requirements for homes. The approach must be sensitive, responsive and flexible. Having read "Fit for the Future?", I have grave concerns about some of the suggested benchmarks, especially those relating to room requirements.
The Government could jeopardise a good intention and lose a good policy overall by becoming too bogged down in stipulating minutiae, which will place a significant burden on many homes without necessarily improving standards. I would argue that some of the requirements are patently ridiculous and that it would be absurd to introduce them.
As my right hon. Friend the Member for South Norfolk said, it would be ludicrous if, by being over-prescriptive, we were to put out of business many excellent residential homes because they could not afford to fulfil the requirements, or because they did not have necessary space to enable them to do so. That would cause an even greater problem than that raised by requiring them to raise standards. If they were put out of business, there would be no homes available for many people.
A suggested basic room requirement is that there should beat least 4.1 sq m for each resident (communal space must include a social room and a dining room).Depending on the number of residents, is that feasible? Is it necessary to use cast-iron terms? Another requirement states:Single rooms, in current use, must have at least 10 sq m of usable floor space (12 for wheelchair users).Do we need to have that detail?
I assume that "single rooms" means bedrooms, and 10 or 12 sq m would be quite a lot of space in those rooms. Is it absolutely necessary?
I am concerned that, as has been mentioned by several hon. Members, these minimum standards will emerge as a result of the Government's consultations. Then, as the Secretary of State said, ministerial decisions will be made. However, as I understand it, they will not be enshrined in regulations that come before the House. Unless the Minister can correct or reassure me—
§ Mr. Hutton
The hon. Gentleman is wrong. Standards will be reflected in regulations, so the House will have the opportunity to debate them in the normal way.
§ Mr. Hutton
I do not want to take the hon. Gentleman's time. However, we shall have to await the detail of the regulations. To reassure him and the House, let me say that minimum standards cannot take effect unless they are reflected in the regulations. Standards will not have any independent, free-standing effect. They will 519 take effect only through regulations. If there is to be a 10 sq m requirement, that will have to be reflected in the regulations.
§ Mr. Burns
I am grateful to the Minister but I am still unhappy. Even if the regulations were to include minimum room space standards, they would almost certainly be subject to the negative resolution of the House. That means that they would not be amendable. If the House debates regulations and raises problems with them, a Minister will not say from the Dispatch Box or in Committee, "We accept what you say. We shall withdraw the regulations and bring in new ones." From my experience in the House, I know that Governments do not do that. I am surprised that the Minister is relatively laid back on this issue. Governments do not withdraw regulations and reintroduce them. They believe that when they publish regulations, they are the best on offer and should be implemented. I am worried because I think that grave hardship will be caused to many extremely good residential homes, which we do not want to put out of business.
There are problems with local authority homes. Local authorities have said over the years that they have not had the financial resources to improve and enhance their residential stock. If they have to upgrade their properties to meet minimum standards—in reality, probably for the first time—either they will have to close them because they do not have the necessary resources, or their budgets will be strained even more unless the Government are content to provide additional funding.
Much of the Bill is broadly welcome in principle. I have raised some issues on which the Government must listen carefully. They must listen to the responses to their consultations; they must listen at the Committee stage and take account of further comments—notwithstanding the fact that the measure will have already gone through that process in another place. We all want to make sure that the measure is right; we do not want to score political points. We are united in our belief that standards for the care of the elderly are of paramount importance.
Parallel to that, and of more immediate concern to many elderly people, is the Government's response, later this summer, to the problem of long-term care. Many elderly people and their families confront that problem not in relation to the home in which they live—where many will be content—but in relation to paying for it. They want to know what the Government will do to improve the present situation, because, over a period of time, it has become a mishmash.
§ Ms Ann Coffey (Stockport)
I very much welcome the setting up of the National Care Standards Commission for the regulation and inspection of adult and children's services in the independent and public sectors. My brief remarks are on standards.
The current standards for the registration and inspection of children's homes cover several important matters, such as the physical environment, staffing, staff training and health and safety. I hope that during future consideration of standards for children's homes, careful thought will be given to establishing standards for the care and control of young people placed in such homes.
520 I do not underestimate the challenging and difficult behaviour presented by some of those young people, nor the problems experienced by staff in maintaining control and providing care. Children's homes take some of the most difficult and disturbed young people, some of whom went into care for the first time because their problems were unmanageable in their own homes. Local authorities choose placements with those problems in mind.
The progress of those young people is subject to regular review by social workers. Too many children leave the care system with poor skills; they have low educational achievements and are often extremely angry. The care system should not be merely a holding operation; it should give added value to children's lives. Sadly, that does not happen for a majority of children. In essence, that is the problem we face.
The commission should examine the care and control that is provided by those homes. It could consider how the homes deal with such matters as absconding, incidents involving the police, exclusions from school, truanting or problems with neighbours—all of which are problems of control. It could also examine the activities and structures in the homes, as they not only cope with problems but give added value to young people by providing a high standard of care and support.
Standards for the physical environment and for staffing are designed to provide care and control. However, unfortunately, that objective has often been lost. To ask the commission to consider care standards in relation to outcomes for the young people in those homes would firmly re-establish that relationship.
I welcome the requirement for children's homes of fewer than four children to register. I thank my hon. Friend the Member for Wakefield (Mr. Hinchliffe) for his kind remarks. At worst, the loophole was open to unscrupulous providers; at best, it failed to provide proper safeguards for children and young people, who were often placed many miles away from their local authority. It is good news that, after the Bill receives Royal Assent, the Children Acts will be amended to require such homes to register immediately with a local authority. That shows the Government's determination to improve care standards in children's homes.
The requirement for the regulation of independent fostering and adoption agencies is welcome. For a long time, their position has been unclear; they have operated in a legal grey area, because fostering regulations allowed local authorities to delegate some of their responsibilities to such agencies. The relationship between local authorities and agencies has varied. Some agencies have suffered because of local authorities with attitude.
The recognition of such agencies will give foster parents a choice of agencies. I hope that will encourage all agencies to improve their support to foster parents, who have a difficult and challenging occupation.
I welcome the fact that local authority fostering and adoption services will be subject to inspection. There has been widespread concern about children waiting in the system for a decision on their future and about the length of time it takes to find permanent families, including adoptive families. Figures show wide variation between local authorities in the percentage of children placed for adoption; in the length of time that children wait in care; and in the number of breakdowns in the care system experienced by children.
521 The organisation of services varies widely. In some local authorities, dedicated, specialist teams deal with adoption, while in others, social workers provide such services among their other responsibilities. I do not know whether those different forms of organisation affect the figures—it would be interesting to find out.
As well as the introduction of standards for fostering and adoption agencies, I hope that other factors will be considered—for example, the length of time that children have been in foster homes waiting for a decision on their future; the length of time that children wait before adoption; the number of multiple placements; the number of breakdowns; and the number of complaints from foster parents. Such matters reflect the service that is provided. An improvement in fostering and adoption services, as part of better overall planning for children, is fundamental to the provision of permanent homes for children.
It is important that the system gives the best possible care to the young person or child who enters it. Children should feel cared for. To feel that nobody cares is a lonely experience for an adult; for a child, it is devastating. In setting standards, the Bill will ensure that care is a positive experience for children. That is long overdue. The Bill is much to be welcomed.
§ Mr. Andrew Rowe (Faversham and Mid-Kent)
The Bill brings together many of the interests that I have pursued during my time as a Member of this place. The hon. Member for Wakefield (Mr. Hinchliffe) was kind enough to recall my campaign for a variety of improvements in personal social care, including a campaign for a general social work council. When we were in government, I had many an argument with Ministers about the importance of such a council.
It is a pity that for so long proposals excluded workers in that field. I always argued that a social work council should be something like the Michelin guide, so that people's skills could be noted as they acquired them, rather than waiting for some unspecified period when people would be deemed to have sufficient qualifications to be allowed to register. That was a shame.
The Bill demonstrates that the quality of care is absolutely vital. One of the distressing features of public care—whether for the elderly or, more important, for children—is the fact that the care providers change so fast. The vulnerable people who most need stability are frequently confronted by a change of carer. Most young people in care are subjected to more changes in the person who is supposed to look after them than I would have been able to cope with at that age.
In parenthesis, I suggest that it would be a better investment of public money sometimes to provide security and affection to the young people who are in long-term care than to provide the same sum later for the police, prisons and young offenders institutions. I feel strongly that we sometimes consider the problem the wrong way round. We should invest in the relatively small number of young people in long-term care so that we can compensate them for the instabilities and miseries that they have endured. Community Service Volunteers, of which I am 522 a trustee, and the Prince's Trust, which commented yesterday, both have evidence to suggest that such investment brings stability to those young people and enables them to play a full role in society.
I am very pleased by the proposal for a children's rights director even though I would have preferred a children's rights commissioner. I have always believed that a commissioner was the right way forward, as does the NSPCC of which I am a trustee.
I hope that as the United Kingdom Youth Parliament—I have the honour to be the chairman of its steering committee—emerges from its birth pangs, it will grow into a serious representative voice for young people. If we can make it as inclusive as we are desperately trying to do, it will become a sounding board on which Ministers and Government organisations will be able to test their ideas. We should make the Youth Parliament as information technology sensitive as we can, so that Government proposals can be put into a language that young people are able to understand. We will then be able to float our ideas by them. At present, most of our provision for young people is made in complete ignorance of what they themselves would choose.
It is vital that we improve the training and recruitment of care staff. One of the paradoxes of public provision—especially low-paid public provision—is that as the employment figures improve and unemployment falls, the difficulty of recruiting and retaining good-quality staff in the caring professions becomes much more acute. The Bill provides a remarkable opportunity for the Government flamboyantly to turn their back on age discrimination.
Many people—mostly, but by no means exclusively, women—have long experience of caring for a relative. When that relative dies or is taken into long-term permanent care, those people often want to use their caring skills in return for a part-time or full-time wage. Many of them will have an instinctive sympathy, as well as age parity, with the people for whom they care. Many of the problems of respect that the Secretary of State mentioned in his speech will solve themselves because such carers will deal with their near contemporaries. We do not do nearly enough to make caring attractive to those of our older citizens who would like to do it.
Another element of training has been extraordinarily mishandled. I used to get extremely angry with Conservative Ministers—I am happy to get equally angry with Labour Ministers—about the way in which we have mishandled the national vocational qualification. The whole point of the NVQ, as I saw it, was to authenticate skills that people had acquired in practice. For example, if they had learned to turn someone so that he would not get bed sores, to feed someone who could not feed himself or to wash someone with a disability, those skills could be accredited through the NVQ.
However, in the traditional British way that has lasted for at least 100 years, academics have tried to get hold of the system and turn the qualification into the equivalent of an O-level or something similar. They have tried to make the qualification more academic, which is nonsense. In an occupation in which 80 per cent of people have no recognised qualification, we need to recognise the practical skills that they have and on which they can build in part-time, day-release or other studies. We would then have more people with qualifications.
523 I am also interested in the costs that will result from the Bill. It will be expensive if it is to work, and all of us want it to work well. However, the idea that changing names and changing structures will enable us to find the money to make it work well is pie in the sky. If 60 per cent. of agencies already do not carry out their inspection responsibilities because they do not have the resources to do so, can we be certain that the new agency will carry out all its inspections and that it will have the money to do so?
If we are to have much better and more effective training for a higher percentage of caring staff, they will expect an enhancement in their pay. If they receive that, it will increase costs enormously. Therefore, it is essential that the purchasers of residential care and domiciliary services pitch what they are prepared to pay at a rate that will bring providers into the market. Whether they are local authority providers or private providers, purchasers of domiciliary and residential care increasingly squeeze the sums of money that they are willing to offer. That is a dangerous game.
I was sorry to hear in some exchanges a continued suspicion of the private sector. That is a shame, because in this area, above all others, the record of the public authorities has not been very good. The many scandals in children's homes, in particular, and in many local authority and publicly provided residential homes for elderly people clearly demonstrate that the nature of the provider is by no means a guarantee of good service.
In the private sector, many small homes have typically been set up by couples who felt stultified by the constraints of the public sector. They worked for public authorities or for the national health service and felt that they were not able to do many of the things that they would have liked to do for their patients or clients. Therefore, they left and set up a home with the firm intention of providing better care than they would have been allowed to provide in the public sector. To belittle what they do or to imply that they are in it only for the money is a shame.
The Bill should provide a real breadth of vision. I wish to provide an example that is continually forgotten but that arises from one of the campaigns with which I have been associated. Many problems would be greatly reduced by a serious programme of building lifetime homes. A great new welter of houses is to be spread across the south-east, built by private developers. They must not be allowed to claim exemption from new building regulations that have, at last, been passed and state that there must level entry at front doors, that one must be able to turn in the hall and so on.
If one allows houses to be built with steps up to the front door, narrow doors and windows too high to see out of when one is in bed, the demand for residential care will again be exaggerated. When estates are being modernised, lifetime houses should be built. There is a lamentable lack of imagination and drive when it comes to making sure that homes meet minimal requirements and are accessible for people with disabilities and those with growing frailties.
The new system suggests that we could make much more use of volunteers. I remember Peter Smallridge, a former director of social services in Kent, saying that one need only put up a notice outside a home saying 524 "KCC residential home" for the entire community to walk past and, indeed, never go near it. We need a much better programme to involve volunteers in homes. They go in and out unexpectedly, so can notice whether there is a smell of urine in passageways and whether people are frightened of the staff. They are as good at observing such things as anyone.
However, we want more than that. We want better links with the education service, whether formal education, such as further education and adult education, or informal education, such as the university of the third age. One of the worst things that happens to people when they go into residential homes is that they switch off. It suits the stretched staff for them to watch "Neighbours"—not taking it in, but just sitting there—rather than being stimulated by new interests. I hope that the new dispensation will lead to such stimulation.
I have some minor queries. Who will be responsible for the accuracy and timetabling of checks on staff? At the moment, checking to find out whether a member of staff is fit to look after children, boy scouts and so on takes so many weeks that an employer loses that person in the process. That is terribly important, as is the fact that nursing agencies that are to be regulated should take care to ensure that nurses are working for an appropriate period. At the moment, nurses with a mortgage to pay sign up with a nursing agency; they become exhausted on NHS wards and exhaust themselves even more until they provide an inadequate service to patients and staff.
I conclude with the point made by my right hon. Friend the Member for South Norfolk (Mr. MacGregor). It is important that the inspections relate to the quality of care, not the size of the bedside table.
§ Ms Julie Morgan (Cardiff, North)
I am delighted to speak in our debate. I strongly welcome the Bill, and believe that the Government are showing their commitment to children, young people and adults in vulnerable positions. We all hope that the Bill will help to prevent scandals, such as those in children's homes in Wales, which have shamed this country.
The Bill covers England and Wales. My right hon. Friend the Secretary of State did not have time to cover in his introduction those provisions that are specific to Wales. The principles are the same in both countries, but there is a specific difference relating to the children's commissioner. In Wales, we are all waiting eagerly for the Secretary of State for Wales to table an amendment that will pave the way for establishing the post of a children's commissioner for Wales.
I want to concentrate on the children's commissioner, as there has been some interest this afternoon in Wales going a different way from England and introducing a children's commissioner, not a children's rights director. We must accept that that is a consequence of devolution. In Wales, we are doing what the National Assembly for Wales wants to do, although legislation on the matter is still to be passed in Westminster. We must consider how the two are to be tied together.
I shall talk about how the concept of a children's commissioner has developed in Wales. Welsh voluntary bodies have led the way in lobbying for a children's commissioner. Children in Wales, the umbrella body, has been in the forefront, along with Barnados, the NSPCC 525 and other voluntary agencies. Before I came to the House, I was a social worker with Barnados and was involved in the campaign to establish a children's commissioner for Wales. In the National Assembly election campaign, Labour's manifesto stated that we would establish such a commissioner to look after the rights of all children in the community including those in care and those who are looked after. I believe that that now has all-party support in the Assembly.
The Welsh aspect of the Bill also gives rise to an interesting and historic occasion. Introducing the post of children's commissioner will be one of the first pieces of primary legislation to be passed in Westminster in response to a direct request from the National Assembly. It will not be easy for the Assembly to get exactly what it wants and it will not get it all at once in the Bill. The amendment to the Bill that I mentioned must be as wide-ranging as possible to cover as many children in different situations as possible. I wonder whether there are situations to which the Bill could apply—for example, adolescent units in hospitals, such as that in my constituency which admits adolescents for five days a week. I do not believe that that will be covered by the Bill in its present form, but it would be useful for such settings to be covered in regulations.
The Assembly seeks to establish a role for the commissioner that will cover all children in all settings, along with every aspect of their lives. It seeks a commissioner who would speak for children's rights and who would have the role of implementing the United Nations convention on the rights of the child in Wales. The commissioner would be a champion of children's rights and would raise the profile of children's issues in Wales. The commissioner would play a leading role in ensuring that the 70,000 children and young people in Wales would have some say in planning services. We in Wales envisage that that will be a key aspect of what he does.
Throughout the world, there are commissioners who perform a role similar to that which we want in Wales. In Sweden, children and young people under the age of 18 have an ombudsman of their own, established by parliamentary legislation in 1993. In principle, the ombudsman covers all issues relating to children and young people. Children in Sweden are consulted on current issues by questionnaires, letters and telephone. They communicate their views via the internet and there is an information line. The commissioner goes out of her way to try to get young people's views on legislation or other measures going through the Swedish Parliament.
In Norway, the ombudsman succeeded in increasing the period of paid maternity leave and worked to introduce legislation prohibiting physical punishment. Commissioners and ombudsmen act as advocates for children's rights.
In the UK and Wales, children do not have a voice. They are especially vulnerable because their position is weak and there is no explicit recognition of children's civil and political rights. In Wales, responsibility for children is split between the Assembly and Westminster bodies such as the Home Office. There is often no consideration of children's needs in areas that do not directly affect them, such as transport, housing and health. The Assembly intends to extend the commissioner's remit 526 in relation to his advisory capacity after the Bill has been passed to cover all devolved matters. The commissioner will not deal with Home Office matters, as they are not devolved, but will cover all devolved matters. In that respect, the commissioner would operate in an advisory capacity until further primary legislation is introduced in Westminster to establish what the National Assembly wants,
The Welsh commissioner can be a voice for all children and the Bill enables a start to be made. Although the commissioner should protect the rights of all children, emphasis must be placed on the rights of children in difficult circumstances, some of whom do not live in settings covered by the Bill: I have in mind disabled children, refugee children, traveller children, homeless children, children living in acute poverty and children living with domestic violence. We want the commissioner to be able to speak up for all such children.
Through the amendment, we in Wales have a unique opportunity to lead the way in the United Kingdom. The post of the children's commissioner must be established as a matter of urgency, especially in the light of the Waterhouse report on the terrible scandals in care homes in north Wales, and of the current investigation into care homes in south Wales. We urgently need the post. The north Wales and south Wales inquiries demonstrate the need for a voice for children in care, and the amendment will be a first step toward establishing a more complete role at a later stage.
The Assembly has available the money needed to establish the post of commissioner during this financial year, and the commissioner should have the statutory power to support all children in Wales, many of whom experience social exclusion outside the settings encompassed by the Bill. After the Bill is passed, there will be a need for further legislation to broaden the remit of the commissioner.
We welcome the Bill and the amendment that is to be tabled. Let me end by saying that it is most important that children are involved as the legislation proceeds, that the regulations are drafted, and that the Act eventually operates.
§ Mr. Simon Thomas (Ceredigion)
It is a pleasure to follow the hon. Member for Cardiff, North (Ms Morgan), whose advocacy of children's rights in Wales is well known. Judging by the thunder that we heard, her forceful and passionate speech in favour of the children's commissioner moved even the heavens. As her voice appeared to be failing toward the end of her speech, I am glad to be able to save it from further stress; I hope that mine will also last the course.
I, too, shall concentrate on role of the children's commissioner in Wales and the way in which the Bill can be strengthened in Committee to develop that role. I start by paying tribute to the many right hon. and hon. Members—some of whom might well be present today, unbeknownst to me, as I do not yet know all their faces—who have, over the years, advocated that such a post be created. I pay special tribute to my hon. Friend the Member for Meirionnydd Nant Conwy (Mr. Llwyd), whose face I do know, who in 1993 introduced a private Member's Bill that would have established a children's commissioner in Wales.
527 The creation of the post was a Plaid Cymru manifesto commitment that was mirrored in some shape or form in all of the parties' manifestos for the National Assembly elections. That is why I was disappointed by the speech of the hon. Member for Woodspring (Dr. Fox), whose approach to Welsh matters showed no understanding of events in Wales. Considering that he was once the Conservative spokesman on constitutional matters, including Wales, it would appear that we have been spared. However, other hon. Members seated on what I still think of as "the Benches opposite", even though they are, in fact, situated to my right, made far more cogent speeches.
§ Mrs. Caroline Spelman (Meriden)
My hon. Friend the Member for Woodspring (Dr. Fox) has apologised for no longer being here. I suspect that the hon. Member for Ceredigion (Mr. Thomas) did not hear my hon. Friend say that he understood the importance of the initiative in Wales, but regretted the disparity that will now arise out of devolution. Perhaps the hon. Gentleman should not put words in the mouth of my hon. Friend.
§ Mr. Thomas
A measure that delivers in Wales what Welsh people want must be counted one of the successes of devolution.
§ Mr. Thomas
Then it is for English Members of Parliament to make that case for England.
In his worst mistake, the hon. Member for Woodspring revealed his confusion about the new commission. The standards commission in Wales is to be the National Assembly—there will be no separate body. Therefore, his arguments about the lack of democratic control do not apply, at least in Wales, because there the commission and the Assembly will be one.
A children's commissioner has been a long time coming, although no particular blame attaches to the current Government or even to the previous Government. The fact is that society as a whole has taken a long time to catch up with the concept of children's rights and the need to enshrine children's rights in legislation. No doubt, before long, similar arguments will be heard in debates on corporal punishment; we shall see how that issue develops. The House will be aware that the establishment of a children's commissioner for Wales was a key recommendation of the Waterhouse inquiry into abuse in north Wales children's homes and foster care.
I welcome the central tenet of the Bill and the way in which it sets out national standards—Welsh national standards in Wales and English national standards in England. Events in north Wales were not only about the deliberate abuse of children; they involved poor management, poor standards and a lack of listening to children. The lessons of north Wales are now being felt in my constituency. The current director of social services in Ceredigion was named in the Waterhouse report as an individual who had let children down in his previous post in the old county of Gwynnedd. He is now on sick leave while his management role in Ceredigion is externally appraised.
When the events became public, I was still a member of Ceredigion county council. We noticed straight away that we could not immediately check out county staff and 528 learn what qualifications they had and what standards they had reached. Therefore, I welcome the Bill's provisions relating to standards. I raise that case to highlight the crucial importance of clear management roles and national minimum standards to the protection of vulnerable children and adults in care.
I also welcome the proposed role of the National Assembly to oversee and monitor national care standards in Wales, and the establishment of Cyngor Gofal Cymru—the Welsh name of the Care Council for Wales, which is responsible for training. I hope that one of the council's priorities will be to deliver training in both languages—I understand that it is to replace the Council for Education and Training in Social Work, which was a pioneer of Welsh-language social work training—especially at local level. Those in my constituency who want to pursue social care training have to go outside my rural constituency and travel 40 or 50 miles to get the NVQ training that will bring them up to the right standard.
National Assembly Members have made it clear that they want the commissioner to have a strong and powerful role that will allow his or her office to take a view of the quality of life of, and the range of services delivered to, children in Wales. It is true that the Bill, even with the amendment, does not achieve all that we want. The hon. Member for Cardiff, North made the reasonable suggestion that the Assembly should add an advisory role to the work of the commissioner, then seek other legislative opportunities to develop the commissioner's role further. Jane Hutt, the Assembly Secretary for Health said on 1 July 1999:we are absolutely committed to establishing an independence Children's Commissioner for Wales who can advise the Assembly on the delivery of services for children.That much is within the remit of the Bill. However, she added that the commission, in the role that she envisaged,would be able to promote the rights and interests of all children.The Bill needs to be strengthened before those aims can be achieved. I would like to think that Ministers will heed the concerns expressed by several hon. Members and look for ways to insert new provisions in the Bill, so that the Assembly can exploit to the full the role of the children's commissioner in Wales. If Wales is pioneering in this regard, I very much hope that other areas of the United Kingdom will see what we can do and follow us in time.
There is real concern in the National Assembly that the Bill may not be the complete vehicle for the independent commissioner—one who will have the interests of all children in Wales at heart—that so many people want to see. As I understand the Government's intentions, those services covered by the Bill will come under the commissioner's remit, but the wider remit is a matter for debate. We are in danger of having a care standards commissioner, and not a fully fledged children's commissioner. That is one of the matters that we need to address.
We need to move towards a more obvious ombudsman role for the commissioner, a sort of Ofchild or Offspring, able to take up individual cases if necessary, as test cases, to see how Government policies within Wales affect the whole remit of children's care. I should like to mention one aspect of particular concern to me: the provision of play, which has slipped back over the years from the time in the early 1990s when things seemed to be moving forward very well. We have now slipped back on play facilities for children, an essential part of their natural upbringing.
529 There is also a danger of the commissioner's becoming too bureaucratic. We need flexibility. We need a commissioner who does not just report annually to the National Assembly, where the report is debated for a week or so and then forgotten, but a commissioner who is actively involved in children's issues and reports to the Assembly fairly regularly.
I should like to take an example from elsewhere, one that I saw last week in Canada—the commissioner of the environment in the province of Ontario, who was looking at the environmental bill of rights and the response of Government Departments to it. It struck me that it had taken five years for that commissioner to grow out of the bureaucratic restrictions on him and start to look at the overarching issues that link together all environmental questions. In other words, he had been concentrating on individual environmental issues, and only after five years or so had grown enough wings to look at the overarching issues, which in that case happened to concern land use planning. I should not like to see that happen in Wales; I should like the commissioner to be looking at those overarching issues from the start.
There may be some concern that that means that the commissioner will start interfering in many Government Departments, but that is the whole point. If children are to be better served than they have been in the past, a truly independent commissioner must have that ability to go into various Government Departments and see what they are doing for children and how everything links together.
That is why my party, Plaid Cymru—the party of Wales, has been advocating in the Assembly, particularly in the debate there yesterday, a similar power to that of the Commissioner for Racial Equality and the Equal Opportunities Commission to issue a non-discrimination notice and go in and try to move towards change within Government offices.
We need to combine the natural influence, which will grow, of the office of a commissioner in Wales with sufficient statutory powers to ensure that children's rights move on in Wales and that the sort of disastrous behaviour to which the hon. Member for Cardiff, North (Ms Morgan) referred is put firmly in the past.
An additional and important power is enforcement, where there are questions in relation to cross-boundary issues. This can best be illustrated by talking briefly about the Welsh language. Many hon. Members will know that it is one of the two official languages in Wales, and there is an obligation on all Government Departments to deliver services in the Welsh language, which by implication, with the Children Act 1989 and the need to take into account children's cultural background, means delivery of services in Welsh to Welsh-speaking children. There are young people who leave Wales for care. Young offenders are an obvious example. I am concerned about how their needs may be met within the context of the Bill.
This raises a question about the children's commissioner's remit for non-devolved and cross-border matters. These are no doubt matters for debate and discussion in Committee. The Welsh Language Act 1993 is a useful model.
I should like briefly to mention private sector care homes. I agree with many of the points made during the debate by Labour Members. However, I would point out 530 that in rural areas private sector care homes play a very real role where the local authority cannot deliver the small-scale homes that allow people to stay in their villages. We have many small homes in Ceredigion of just four or five units, which allow people to stay in their own community, where their family live. I should not like to see standards introduced in such a way as to force those homes out of business.
My final point concerns the role and participation of children and young people themselves. The National Assembly has a unique partnership with the voluntary sector, a scheme that is unique within the framework of the United Kingdom. This could be a very useful base for expanding the advocacy role of children. The National Assembly can use its burgeoning relationship with the voluntary sector and advocacy and children's organisations, such as Children in Wales, to listen to the views of children and involve them in the appointment and progress of the office within Wales. I hope that on this and other matters the Government will listen not only to what the National Assembly says, but to what its Committees are saying. There are some interesting debates going on there. I hope that we can deliver to Wales the sort of children's commissioner that the children and young people of Wales deserve.
§ Mrs. Joan Humble (Blackpool, North and Fleetwood)
I should like first to say how pleased I am at the interest that so many hon. Members have shown in this debate, many of them drawing on their own experience to take part in it in a constructive manner. The interest shown in the debate perhaps also reflects the fact that now is the time for a new legislative framework.
The hon. Member for West Chelmsford (Mr. Burns) referred to the Registered Homes Act. That legislation was passed in 1984, and much has changed since then. It is now time to look at a new framework, and especially a new national framework, with national standards, so that individuals do not suffer from a lottery of care depending on where they live.
Perhaps that is why the Bill has been so warmly welcomed by so many bodies—local authorities, the independent sector, the voluntary sector; indeed, all agencies concerned with caring for vulnerable people. It is the culmination of a great deal of pressure from many people over a long period of time. It is important that we get it right, because we are talking about the most vulnerable members of our communities. We need to ensure that we are setting the right standards for them and supervising the care that they receive.
In setting those standards, we must first look at the 1 million-plus people who are employed in the care sector and ensure that they are trained, regulated and supported. Therefore, I shall begin with a few comments about the proposed General Social Care Council. The council will at last give social workers the status as a profession that they deserve.
§ Mrs. Humble
I thank my hon. Friend for that intervention. He is also a constituency neighbour, and yes, he would say that because from past knowledge of him as 531 a social worker, I know that he cared deeply for the young people for whom he cared. There are many more such social workers, often working in difficult circumstances.
It has always been especially difficult for social workers to project a positive image of themselves and their work, because examples of poor practice when things go wrong are what hit the headlines. The public rarely hear of the hard work, the long hours and the commitment of social workers dealing with difficult people, often in difficult circumstances.
We must also remember that sometimes the wrong decision is made, and worse, sometimes social care staff are involved in abuse and misconduct. Many people are dependent on the care and support given by social workers and other social care staff, who make vital decisions about their welfare. By setting up the General Social Care Council, we will be able to reassure clients that standards have been set, training specified and codes of conduct put in place, as well as giving status to the profession.
I look forward to the council gradually including more groups of care workers in its remit as the educational standards are set and met. It is often care assistants in residential establishments, day centres or domiciliary agencies who deal with vulnerable people, so they need to be drawn into the scope of the regulatory system.
The National Care Standards Commission will allow users, staff and the public to get a much clearer idea of what standards of service and conduct to expect. Many people who approach social services for various sorts of service have little idea what is on offer, what to expect and how to judge the quality of the service. At last, we are to give them information that will enable them to judge the quality of the services offered; to know what they are entitled to; and if it is not offered, to ask why. As members of the public, they will be able to get involved in the debates in which we are engaged in determining care standards. I hope that the commission will actively engage in the process of empowering service users, listening to what they want, and discussing their priorities for social and nursing care.
We have heard much about the need to listen to children. I entirely agree that it is important for the voice of the child to be heard. Equally, it is important that adults with disabilities have a say in the sort of provision that they receive, and that elderly people are listened to, not just for the purpose of setting up the services, but when they have complaints and concerns. I am particularly conscious of the fact that many elderly people do not complain about the services that they receive. They are extremely vulnerable, so we need to encourage them to be directly involved.
I shall comment on the "Fit for the Future?" document, with no apologies to my right hon. and hon. Friends who have spoken about it with passion. I want to pick up on concerns expressed by Opposition Members. It is not just in rural areas, as the hon. Member for Ceredigion (Mr. Thomas) said, that care homes are a vital part of the community.
Many elderly people have come to Blackpool to retire. They come to the Fylde coast to enjoy the sunshine and all that it has to offer, but the time comes when they look for residential care. We have many residential care homes, which I visit. I speak to the staff who work in them and to the residents who are looked after there.
532 "Fit for the Future?" is an important document and should inform much of our debate. Many of its proposals will improve the quality of life and the quality of care for older people, so we must not dismiss it out of hand. Many of its recommendations for good practice are already being implemented in care homes, but those who run homes in the private sector in my constituency are concerned about the physical standards that homes will have to meet.
Some of those standards will be difficult, if not impossible, to meet. The document acknowledges the need for a realistic timetable for implementation of national standards, and recognises that they will need to be applied with a "certain degree" of local flexibility. That flexibility will be crucial.
In the Lancashire county council area, 71 per cent. of homes will not meet the standard for 10 sq m bedrooms. In the Blackpool unitary authority area, that figure rises to 91 per cent. Fifty per cent. of Lancashire's residential homes and 34 per cent. of Blackpool's will not meet the requirement for 80 per cent. single rooms. That includes a large number of homes offering care to my constituents.
§ Mr. Michael Jabez Foster (Hastings and Rye)
Does my hon. Friend agree that the seaside towns especially will have a problem? Victorian and Edwardian buildings, many of which are listed, will have particular difficulties in complying with the standards, not just in terms of cost, but physically. Does my hon. Friend agree that a light touch will be important with respect to those areas?
§ Mrs. Humble
I strongly agree with my hon. Friend. Many of the homes that I visit are exactly the sort of establishment that he describes. They are small homes offering fewer than 25 beds and are converted from former domestic residences. Indeed, many elderly people choose them precisely because of the homely environment that they offer. I hope that the Government's final proposals will be sufficiently flexible to recognise the particular local difficulties that areas such as mine and other coastal towns may have.
§ Mr. Hammond
I know about the star rating system that operates in care homes in the hon. Lady's constituency. Does she agree that it might be better to think in terms of establishing an overall star rating system measuring the overall care experience in a home than to think in terms of mechanistic measures of input, as the Bill seeks to do?
§ Mrs. Humble
The hon. Gentleman has anticipated what I was going to say. I will elaborate on the star system shortly.
Implementing "Fit for the Future?" as a standard will cause widespread home closures. It will seriously destabilise the care market, and will also reduce the amount of choice for potential clients. All that, however, must be seen in the context of the full commitment of my local care providers—and certainly that of the Lancashire Care Association—to the provision of high-quality care. I see that when I visit homes in the area.
In Blackpool, the commitment to standards and quality has led to a partnership between the local authority and the independent and voluntary sector in the development of an independently run star rating system. Residential 533 Domiciliary Benchmarking has developed a detailed set of criteria against which both independent and local authority homes are measured. Interestingly, that anticipates the Bill's provision for all homes to be treated equally.
The star rating scheme offers a mechanism for external validation, but it is also a useful management tool for home managers. It offers annual assessment of residential care establishments that highlights both their strengths and their weaknesses, enabling managers to deal with the weaknesses and enhance the strengths. In the first year of the scheme, about half Blackpool's homes have participated and have been awarded stars. A brochure has been produced, which means that members of the public have a much clearer idea of what services are on offer before placing their elderly relatives in homes.
Blackpool council has decided to reward higher standards of care by paying homes more if they have higher star ratings. It recognises that investing in quality sometimes has cost implications, and it is rewarding those who are investing in training and in improving quality. There has been a 3 per cent. increase for two-star establishments, a 4 per cent. increase for three-star establishments, and a 5 per cent. increase for four and five-star establishments in the fees that the local authority will pay. That often leads to substantial additional income for homes, so it is clearly an incentive for investment.
I am sure the Minister will expect me to say this. Yes, sometimes quality does cost—although many aspects of the Bill demonstrate that we can raise standards simply by changing work practices and improving management. I know that substantial additional resources have already gone into social services, and I have seen the results in my constituency. Lancashire county council has invested an additional £750,000 in community care services, and that is now showing on the ground in terms of the assessments that people receive. There is much to be welcomed in the Bill. As I have said, we see examples of good practice locally—certainly in my constituency.
I should like to discuss many parts of the Bill, but I have run out of time and others wish to speak. I look forward to their speeches, and to the speedy passage of the Bill.
§ 5.9 pm
§ Mr. Julian Brazier (Canterbury)
I have mixed feelings about the Bill. I am torn between welcoming any measure that would tackle abuse in homes for children, the elderly and vulnerable adults with learning difficulties, and considerable disappointment that this huge, complicated and lengthy Bill is mostly about establishing regulatory structures but does not contain much of a clue about the content of those regulations.
I am co-chairman of the all-party adoption group and a vice-chairman of Voice, which looks after the interests of adults with learning difficulties.
I shall make three relatively brief points before focusing principally on children in care and adoption. First, I echo the points that have been made thoroughly and extremely articulately by several of my hon. Friends and, most recently, by the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble). A balance must be struck on regulating residential and nursing homes for the 534 elderly. As my hon. Friends have said, that balance must focus on the quality of care, not meeting the length of a tape measure.
Another good residential home has closed recently in my constituency because of financial overstretch. Its owners said, bluntly, that reading "Fit for the Future?"—the Government's consultation document—finally persuaded them that their home had no future. [Interruption.] The Minister may shake his head, but they said that publicly.
Secondly, it is also extremely important to strike a balance when legislating for pre-school child care, and considerable emphasis must be placed on weeding out potential abusers. The industry is expanding quickly under the working families tax credit and other Government policies and, irrespective of whether one approves of those policies, it is sadly inevitable that paedophiles will try to get into the market as it expands. The industry is vulnerable because 126,000 people have been convicted of serious sexual or violent offences against children. However, the need for checks—such as those carried out by the police, as well as the measures hinted at in the Bill and the rigorous pursuit of references—should not be confused with petty over-regulation.
We should learn from our dreadful experience of the ham-fisted attempts of social workers in Kent to close several excellent playgroups after the introduction of the Children Act 1989. An especially good playgroup in Whitstable came within an ace of being closed down on the basis that there was insufficient provision of lavatories, even though the Government circular issued in the wake of the Act made it clear that the scale guidelines on lavatories were not to be interpreted mechanistically. The inspectorate was forced to back off and we saved a good playgroup at the last minute.
Thirdly, I want to make a particular point on adults with learning difficulties. The Government's ideas, if fleshed out, should be good news, but I remind the Minister of a matter that has been on his desk for some time. In a joint letter, the hon. Member for Slough (Fiona Mactaggart) and I raised the matter of access to the files of people with learning difficulties. A legal anomaly seems to have existed for a long time. Whereas adults are entitled to access to their files and can obtain files on behalf of children, there is no mechanism for getting hold of files on behalf of people with learning difficulties, who, unfortunately, are prevented from obtaining their own. I hope that the Minister will address that.
The Minister will not be surprised to hear that adoption and children in care constitute the principal burden of my speech. Hon. Members from all parties have raised the issue of adoption. We all welcomed the news that Downing street was setting up a unit to consider the lamentable figures: fewer than 4 per cent. of children in care have been adopted in the past five or six years. That is only 2,000 out of nearly 53,000 children who are languishing in care. The majority of them are in foster care, but a proportion are in children's homes. Twelve thousand have been in care for more than four years. Some of those are now too old realistically to be adopted, but they could have been candidates for adoption when they were first placed in care.
I was tremendously disappointed when I read the Bill and found that, while plenty of clauses relate to regulating fostering agencies, it provides no specific ammunition on 535 adoption. The Secretary of State made only a passing reference to adoption in his opening speech. [Interruption.] I am sorry, but I did not hear that sedentary intervention.
§ Mr. McCabe
I simply said that the Secretary of State made a more lucid statement than the hon. Member for Woodspring (Dr. Fox), who said that all children who came into care for any amount of time should be considered for adoption.
§ Mr. Brazier
The Secretary of State made no statement on adoption. He mentioned it in only half a sentence, whereas my hon. Friend the Member for Woodspring (Dr. Fox) made sensible recommendations. I believe that, after a transitional period, when it has been established that children are most unlikely to return to their birth families, in principle, every child should be considered for adoption. There are examples in my constituency of much older, severely abused children, who have been successfully adopted with remarkably little support, even though, like many other hon. Members, I would argue for more support.
§ Mr. Brazier
I am sorry, but we are up against the clock and many other hon. Members wish to speak.
I want to mention two subjects in this area that the Bill could have covered but does not. There have been strong statements from Downing street about the way in which we will coerce—that is the only appropriate word—the many local authorities with appalling records on adoption from care into providing for more adoption, and especially into considering more favourably parents who want to adopt.
Let me deal with one canard. Time and again when I have debated the point with senior social workers, they have said, "Ah, Mr. Brazier, you'd be the first to castigate us if we placed for adoption children who were subsequently abused." Yet the local authorities that have the worst records of not undertaking proper police checks and thus of placing children in foster care, where they have been abused, and which have repeated incidences of abuse in their children's homes, also have a lamentably low record on placing children for adoption. That can be checked in the Library.
For example, three London authorities are involved in one case in my constituency. For many years, they placed children with a single man who was sent to prison two years ago. He was known to Kent social services as a potential abuser, yet for 10 years three London local authorities placed children with him for fostering because they could not be bothered to check with the local social services. Last year, one of them, Lambeth placed fewer than 1 per cent. of the children in its care for adoption.
I should like to propose concrete measures for coercing those authorities into giving parents who want to adopt a fair chance, after carrying out the sensible police and reference checks. They should not discard them simply for the familiar, politically correct reasons that we have heard so often.
There are several ways of doing that. One is a national register, which was suggested by my hon. Friend the Member for Woodspring. I would support that. If the 536 Government are not willing to go that far, another approach would be to put some welly at least into the existing legislation on value for money. Arguably, more than half of local authorities are performing really badly, but we could take the duty away at least from the really bad ones at the extreme end—the Lambeths, the Islingtons, the Hackneys and one or two leafy rural authorities, too; why does Dorset have such a poor record when Bournemouth next door has a good record, for example?—and hand the duty over either to voluntary agencies, or to a national agency.
A second proposal within the issue of adoption and children in care could be in the Bill and is not. I have said that the Bill is all about setting up frameworks for regulation. I think that there is much to be said for having a national framework, but there is little hint of what the regulations will be.
I know that the Minister is a fair-minded man. He kindly received a delegation of the all-party group on adoption before it had even formalised its all-party statement. We had a good exchange with him. Last year, his Department commissioned some excellent research, with which I know the Minister is familiar, from Cardiff university. It was published by BAAF—British Agencies for Adoption and Fostering. It caused considerable ripples because it took the lid off the poor practice in many local authorities. Above all, it ended with a mass of detailed and sensible proposals in that area.
Many of us hoped that those proposals would form a basis for Government regulations and that they would then be put out to consultation, so there was dismay when we heard that, instead, the Government had given the whole package back to BAAF and asked it to spend a long period bringing out its own regulations, which would then go out to consultation.
I do not want to get involved in any personal attacks. I look forward to the director of BAAF, Felicity Collier, addressing our all-party group on the subject in a fortnight's time, but two facts are indisputable. First, BAAF has consistently supported the practice in most local authorities and attacked organisations such as the Institute of Economic Affairs, which first took the lid off what was going on. Secondly, BAAF is principally funded by adoption agencies, including many of the local authorities where the problems exist, so it is disappointing to hear that it, rather than the independent report, will be given the role of providing the core of the regulations. Ironically, BAAF published that report. I hope that, in answering that point, the Minister will identify what pressure he has put on BAAF to ensure that some strong voices from outside the immediate BAAF club are involved in drafting those regulations.
Within the limited time available to me, I should like to make two further points. First, the Minister is setting up a children's commissioner with the power to look at the interests of children in care, a proposal that is warmly welcomed by hon. Members on both sides of the House, although there have been various criticisms, and questions as to whether it goes far enough. I think that, on balance, it is a good thing, but I strongly suggest that we need something else—it was hinted at by my hon. Friend the Member for Woodspring and my hon. Friend and neighbour the Member for Faversham and Mid-Kent (Mr. Rowe)—a clear statutory role for volunteers in the system.
537 By chance, I heard testimony only a month apart; first at a Voice meeting from someone involved in whistleblowing in the learning difficulties area; and then from a lady who had much to do with taking the lid off child abuse in Wales. It struck me how difficult it was for professionals to blow the whistle, so I make an appeal—I see that my time has come to an end, Mr. Deputy Speaker—for a much bigger statutory role for voluntary mentors in the system.
§ Mr. Jonathan Shaw (Chatham and Aylesford)
I am grateful for the opportunity to speak in this debate. As someone who worked as a care assistant on first leaving college, and, more recently, as a social worker, I warmly welcome the Bill. I have had personal experience of the difficulties caused because we did not have the type of provisions made in the Bill. It addresses issues that have caused the profession and the public many concerns.
I am pleased to see that my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) is back in the Chamber, as I should like to join in the accolades paid to him by my hon. Friends. His passion, drive and determination are responsible for much of this legislation. Those of us who were in the Chamber when he presented White Papers and the Utting report could not fail to detect that passion, much of which we heard in his speech today.
We look forward to the passage of the Care Standards Bill—and to Second Reading of the Children (Leaving Care) Bill. Both Bills will do much to assist and improve safeguards for some of our most vulnerable citizens. As any of us, or our friends or relatives, might one day need care, we could all be directly affected by this Bill, so we all have a self-interest in its passage.
There have been various reports and inquiries on care standards: on how we can care for those of us who are frail or disabled and protect those of us who have been abused. The names of the inquiries and their chairmen have changed over the years, but, every time that there is another inquiry, we politicians shake our heads, wring our hands and say, "This must never happen again." Sadly, it does happen again. I hope that this legislation will change that, so that we never again have reports such as that on the appalling events in north Wales. However, we do not know what will happen in the future, and such events may occur again. We can only do our very best in legislating, but we should be prepared to revisit the issue. Nevertheless, I hope that we never again see such cases.
When I was undertaking my social work training, the Kimberly Carlisle and Jasmine Beckford tragedies—I am sure that many hon. Members remember them—caused us consternation. It was difficult to believe that young children could slip through the net and lose their lives. More recently, we have had the Utting report, and the harrowing Waterhouse report, which told of children living in a climate of fear, violence and abuse, with people inflicting deep emotional scars on them. Those reports have showed us the system's deficiencies.
Lack of training is one of the recurring themes in those huge reports. However, training and proper qualifications in providing good-quality child care and good-quality domiciliary care for the elderly and disabled require 538 investment. As long ago as 1948, the Curtis report examined the situation in children's homes and told of the need for better-qualified residential staff. More that half a century later, we are saying the very same thing.
Many hon. Members have mentioned the 1 million people in the social care work force, 80 per cent. of whom have no qualifications. I welcome the 50,000 qualified social workers who will be added to the register of the General Social Care Council, and I think that there is a commitment that heads of homes also will be registered as soon as possible. However, as hon. Members have already said, the many other social care workers should be registered.
It will take a long time to do that. Work in social care is often poorly paid, and those who do it may not continue long enough to obtain qualifications to enable registration. I hope that, in his reply, my hon. Friend the Minister will say whether he has an aspiration, or a timetable on qualifications, for those people, and whether he can report back to Parliament on any progress. We do not want to find that in 20 years, the figure for those without qualifications is still 70 per cent.
§ Mr. Shaw
I would rather not give way, because I want to try to keep my speech short so that my hon. Friends have a chance to speak.
I hope that my hon. Friend the Minister will be able to refer to qualifications.
The General Social Care Council is a welcome development that will do much to raise the profession's standing. It has been called for for a long time. There is a shortage of qualified social workers and many local authorities find it difficult to fill all their posts. That increases the case loads of existing social workers, because they want to ensure that all the children on the at-risk register are visited and the standards of the day centres are checked. There are only so many hours in the day. If the council raises the profile and standing of the profession, new applicants may be attracted.
Social workers do not receive many accolades. They are often damned if they do and damned if they do not. We do not see headlines saying "Mrs. Jones is on the road to a full recovery thanks to the care package put together by her social worker", but that is what normally happens: the boring, day-to-day reality of social services departments. The scandals are few and far between.
One of the golden lessons from the many reports that we have received is that we have to listen to children better. Warner, Waterhouse and Utting all said that. Children need to have confidence that the structure is real, not a black hole where complaints are lost. Complaints should not be dealt with by the individual concerned. I have seen complaints go up and down the line, with the social worker involved sending it up to the director. We need a more serious system in which young people are listened to.
I salute and applaud the quality protects programme, which is making a real difference. It is not just warm words, but real money that the Department has put in. It is having a good effect in my two local authorities of Kent and Medway. I hope that the Government keep the issue of putting advocacy on a statutory footing under review.
539 The children's rights officer is another welcome development, although, together with many hon. Members on both sides, I would rather have a children's rights commissioner, who would cut across all Government Departments and could be a champion who impacted on all legislation.
Putting independent fostering agencies on a level playing field with the public services is welcome. I worked in a fostering team in north Kent for a while. The Utting report made specific mention of the growing number of private fostering agencies in that part of the country, principally to serve the London boroughs, which had great difficulty in recruiting. We did not know anything about those agencies and had no relationship with them. That shroud of mystery led to suspicion. We understandably felt some animosity when they poached our foster carers, as we saw it. We do not want stand-offs. I am sure that the agencies had an important contribution to make. Let us get them working together. A level playing field of inspection will do a lot to bring the agencies together.
Another important issue is private fostering. Amendments were tabled in the other place by my noble Friend Lady David to regulate private fostering. The Government resisted them because they felt that private fostering concerned arrangements within families. That certainly was not the case when Utting reported, as he was concerned about private fostering. In paragraph 3.74, Utting quoted a social services inspectorate report of 1993 which said:Private fostering covered a wide range of situations in which potentially vulnerable children were being placed in the care of strangers, without any checks being undertaken as to their suitability to the care for children.The way in which some of the placements were being made raised some very real concerns about the welfare of these children.Time and again we have heard in the Chamber today, "Is it good enough for my relatives?" Given that background, would I be happy to place my child with a private fosterer? No, I would not. I would want that fosterer to be regulated. The matter should not stand as it is in the Bill at the moment, with an inspection and a visit every six months for the child. We know that, with a shortage of social workers, that will not happen. We need private fosterers to approach the National Care Standards Commission to be regulated and registered. Otherwise, we will see similar situations. I hope that the Government will reconsider that matter, given the contradictory information given in Committee in the other place and in the Utting report.
On many fundamentals, the Bill is uncompromising, because we have compromised too much in the past. It will be welcomed by high-quality service providers in the public and private sectors. It will be welcomed by children in care, elderly people in residential care, people with disabilities and the country.
§ Mr. Desmond Swayne (New Forest, West)
I believe profoundly that we get what we pay for. As a people, we have always wanted things on the cheap. We have been unprepared in many instances to pay the premium required for quality. If people do not get what they pay for, they are largely responsible themselves for not insisting on quality. As a nation, we are poor at getting 540 quality. We are good at complaining, but we complain to one another; we rarely confront the restaurateur and send back the bottle.
If we insist on quality, and we realise that we have to pay a premium for quality, we ought to be prepared to pay that premium for quality when it comes to quality of care. The state, through at least one of its agencies, is the largest purchaser of care services. We have a profound impact on the market by the standards that we demand and for which we are prepared to pay.
The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) was perceptive. If the Government think that room sizes and doorway widths are important priorities and if they are prepared to pay the premium for them, that will send a powerful signal to the market, and the market would respond to that. My fear is that the Government are not prepared to pay for the standards and quality that they want. They want to achieve those standards without paying for them; to achieve them by regulation.
When the Secretary of State was asked what estimate he had made of the costs to local authorities of providing the standards in the draft standards guideline that he had issued, he said that he had made no such estimate. That is irresponsible. Is the intention behind the Bill to privatise that form of residential care? If the impact of the measures is to drive the public sector out of the market, that will be the result.
Another reservation that I have about the Bill is that it is something of an empty page on which regulations can and will be written. I do not favour such enabling legislation, because it leads to much bad law. When constituents ask us how on earth this or that legislation came into existence and how could we have voted for it, the answer often is that we never voted for it at all. It was subject to the negative resolution procedure, sat in the Library for 20 days and no one raised a prayer against it. Nobody actually read it, so it became law. I favour a return to the system whereby every regulation was included in Bills and every Committee stage was taken on the Floor. Of course, we would have much less legislation, because it would take so long, but I reckon that we would be much better governed as a result.
The Government cannot resile from the draft standards that they have issued, including those on room size and door widths, and I draw the Minister's attention to the perceptive comments on those standards by the hon. Member for Blackpool, North and Fleetwood. A representation that I have regularly received from my local care providers is that the owners of residential care homes perceive that they will be subjected to the same standards as nursing care homes, and the two are very different.
There has been some talk about how sensitively the regulations might be introduced—perhaps over two, five or even seven years. However, if care home owners have borrowed money over 25 years to address the standards in their residential care provision, and then fall foul of the new regulations, a seven-year introduction period will be of no benefit. The mere issuing of the standards has blighted the industry. I have had many care home owners tell me that they are now unable to sell their properties as a result of the proposed regulations, and the banks and finance providers have noticed that and are not prepared to lend.
541 I find it strange that I agree in many respects with the hon. Member for Wakefield (Mr. Hinchliffe) on the provision that Ofsted should be required to scrutinise the activities of pre-schools, especially when the main competitor of pre-schools—the reception classes in primary schools—will not be subject to the same level of regulation. The Bill may be a disaster for pre-schools, which are part of a delightful movement. All my three children have been through pre-school education and my youngest is still there. I really enjoy visiting the pre-schools in my constituency, but they all take place in dusty, perhaps inadequate, church, school and village halls. I wonder what blow will be dealt to that movement by a host of unwelcome and unnecessary regulations. I thought that parliamentarians might have learned from the disaster that regulation has been for so many other activities, not least the livestock and meat industry.
In conclusion, I draw the House's attention to the contribution from the right hon. Member for Coatbridge and Chryston (Mr. Clarke). He said that it was important that we provide for our elderly people a loving and caring environment. How true that is, but regulations measure only the easy, unimportant things. Room sizes and door widths make little difference to a loving and caring environment. That is reason enough for voting for the amendment this evening.
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. Before I call the next Back Bencher, I point out to the House that five remain to be called. The winding-up speeches will begin at 6.30 pm, so hon. Members can draw their own conclusions. I have no power to restrict any contribution, but all five Back Benchers can be called to speak if speeches are curtailed.
§ Mr. Steve McCabe (Birmingham, Hall Green)
I begin by congratulating my right hon. Friend the Secretary of State on bringing forward the Bill. Regulation in this area is long overdue, and the clear aim is to raise standards and protect vulnerable people.
My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) spoke about day care and domiciliary care. I understand that a Government amendment in another place means that establishments providing day care for elderly people will now be included in the National Care Standards Council. As the elderly population expands, and as we encourage the policy that people should be maintained in their homes for as long as that is practicable, the matter of day care provision and domiciliary care is likely to arouse as much concern as residential care. Will my hon. Friend the Minister say when he hopes that day care provision for elderly people will be subject to regulation and inspection?
It is worth noting that about a third of all psychiatric care in this country is conducted in private psychiatric hospitals and clinics. That is a vital sector, but it is also open to all sorts of potential abuse. It is right that we should seek to regulate it.
542 We should also be concerned about the fairly substantial numbers of people who are transferred to national health service hospitals following failed treatments or procedures originally carried out in the private sector. Many of the operations are quite substantial. If they were carried out in the NHS, the consultant would be supported by three or four assistants, but in private hospitals he often performs operations without that help. It is probably no great surprise therefore that so many errors and mistakes arise. It seems to me that that is another area ripe for some regulation.
Clause 6 establishes the National Care Standards Council and is to be welcomed. However, what will be the relationship between the council and the social services inspectorate? At present, the inspectorate plays a significant role in promoting standards of good practice.
Ministers have given assurance that regulators appointed by the commission will be experienced people, with special expertise in health or social care. Will my hon. Friend the Minister say a little more about their recruitment?
I especially welcome the provision that a complaints procedure will be a condition of registration. Will my hon. Friend confirm that that requirement will apply too to private nurseries and child day care provision?
I recently had personal experience of a private nursery in my constituency. No complaints procedure was in place there, and the nursery had many other shortcomings. I understand that social services departments have limited powers with which to deal with such establishments. What makes it all the more alarming is that the proprietor of the nursery is an inspector for Ofsted—the very body that will be responsible for inspecting child day care provision. It cannot be right to employ as regulators people whose own standards of practice leave a lot to be desired.
There has also been criticism from the private residential sector of inspection work carried out by the local authority. There remains suspicion in some quarters—with reason, I think—that some individuals are unduly hostile towards the private sector. We need to have confidence that inspection or regulation will be truly independent. We should be careful about employing those who have ideological objections to a particular sector, allowing those with direct business interests to inspect their competitors, or employing those whose own standards of practice are flawed. I would be grateful if the Minister could reflect on that when considering the best way to recruit appropriate staff.
I welcome the establishment of the National Care Standards Commission, which seems to be a response to the Sutherland commission. I appreciate that I have nothing like the influence with the Minister that the hon. Member for Sutton and Cheam (Mr. Burstow) has. However, now that the Government have brought forward this Bill, which deals with one aspect of the problem, may I ask my hon. Friend the Minister whether it is not time to bring forward complementary proposals to deal with the question of payment for residential care? I welcomed today's announcement on guidance for domiciliary care charges, but we need to sort out who pays, what level of means-testing—if any—will be applied, and what charges should be applied across the country. The hon. Member for Sutton and Cheam pointed out that the recent Audit 543 Commission report shows a remarkable variation in charges, but there is no correlation between the level of charge and the standard of care or service.
Quite a lot of time has been spent today on the private residential sector and the draft standards suggested in the consultation document, "Fit for the Future?" Significant costs could be imposed on the sector, leading to a significant reduction in capacity, if those draft standards are implemented too quickly or if there is too much rigidity when considering the physical features of homes.
A care home owner said to me recently that if he were to comply with the room size requirements, he would have to rip out all the en suite facilities that he has just installed at considerable cost. That makes no sense. I welcome recent ministerial comments that it is planned to phase in those requirements and that the emphasis will be as much on standards of care as on any physical feature.
The hon. Member for Woodspring (Dr. Fox) made the point that if Ministers are considering giving private care homes a new role in providing care for those leaving hospital and needing recuperation, we have a right to expect significantly higher standards in those establishments if they are to provide adequate intermediate care. In such cases, it is reasonable to demand increased numbers of properly trained and qualified staff and resources such as physiotherapy. The prospect of a new and quite lucrative market for care home owners surely means that they should wish to upgrade their establishments significantly. We should make a distinction between establishments that might seek that sort of business and other homes to which right hon. and hon. Members have referred.
I welcome the proposed General Social Care Council, but how will it be funded? Will it receive part of the budget now held by the Central Council for Education and Training in Social Work, which is about £600 million a year? What will the relationship be between the council and the register that it will establish at some time after April 2002, and the new nursing regulatory body, which I believe will cover health care assistance. which is likely to come into force in September 2001? We need to know whether there will be a point of contact or connection between these agencies.
§ Dr. Peter Brand (Isle of Wight)
I welcome the thrust of the Bill. It will allow us to catch up with changing practice over the past 20 years. There were fit people in part III homes 20 years ago, and we now have residential and nursing homes in which there are much greater levels of dependency. We have heard that the private sector does much work that used to be the natural work of the national health service.
The Bill does not address sufficiently the anticipated changes that I hope that its enactment will encourage. The contribution of the hon. Member for Wakefield (Mr. Hinchliffe) clearly made that point. If we are to use the private sector imaginatively, we should stop the current practice of using it as a sort of oubliette for difficult people with whom we do not want to bother the NHS. It is not a challenge for the private sector provider only to give us a modern service. The NHS must ensure that there is suitable outreach from the secondary care sector and other such areas. For that reason, I am extremely disappointed that we do not have a common final route of 544 complaints—for example, using the health ombudsman for all patients irrespective of whether they are in the private sector or in the NHS, or funded through the private sector or the NHS.
The two inspection regimes will be extremely confusing. No doubt that issue will be explored when the Bill is considered in Committee. I welcome the inspection registration that will be set up for residential homes. However, I hope that there will be a reasonable amount of local discretion. Inspection and registration should not mean hitting people over the head and removing their ability to provide a service.
We have had an extremely good joint inspection and registration unit on the Isle of Wight. It did not merely inspect and regulate because it advised, supported and guided on better forms of practice. I hope that the local element of a national system will not be lost.
Flexibility of interpretation should be allowed when dealing with the draft standards that have been published. There is no need to say anything about that after the excellent speech by the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble). However, I shall use the example of an acute nursing home that is used by patients for only a short period, occupying their own room. Must such a place have enormous dining rooms, common rooms and smoking rooms if they are never to be used? There should be a degree of local discretion.
I shall engage briefly in the children's commissioner-children's director debate. I appreciated the contributions made by the hon. Members for Cardiff, North (Ms Morgan) and for Ceredigion (Mr. Thomas). I hope that we can benefit from the Welsh Assembly's more enlightened view. I think that the hon. Lady and the hon. Gentleman are being too modest in not pushing for what they clearly want to see in their home country to be set out in the Bill. We would support them because that is what we want to see in our home country. I hope that in Committee they will support amendments that may well take the form of a ten-minute Bill that was introduced not so long ago.
There is also the matter of child care, child minding and pre-school playgroups. I have some fear of Ofsted in that regard. Unlike our local inspection and registration unit, which is an enabling organisation, most schools in my local authority have not found being Ofsteded a positive experience; they tend to be relieved when it is over because they do not enjoy the process.
When dealing with small, flexible organisations such as pre-school playgroups, it is important that there is knowledge as well as structure—sympathy as well as regulation. That would be better achieved through the inspection and registration set-up that will be created, which would have a social care background, than through an assessment of how well children are doing on their tables or of the standard of their reading and writing.
I hope that the new regulations will resolve the anomaly over child minding under the child care tax credit system, whereby people can receive the credit only if they use a registered child minder, who must have a qualification for under-fives. Under the regulations, children with special needs or learning difficulties can qualify for those credits, but older children rarely benefit from the care of people who are trained specifically to look after the under-fives. At present, the system is far too rigid. It should be 545 possible to assess individual carers as to their suitability to look after a particular child. If they are appropriate, the tax credit should not be denied.
In response to an intervention by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), the Secretary of State referred to domiciliary services. The royal commission was clear as to the difference between the provision of home helps, who traditionally give social support such as housework and shopping, and the domiciliary help that people need because they are physically or mentally frail. Our policy is to means-test charges—we would welcome a unified set of regulations—for social support in people's homes, but to work towards the provision of free personal care, whether delivered in a residential setting, such as a nursing home, or in people's own homes. That would eliminate the perverse incentive to shunt people off to homes, because, as has often been pointed out this evening, people want to stay in their own home for as long as possible.
§ 6.3 pm
§ Ms Jenny Jones (Wolverhampton, South-West)
As someone who worked in child protection and on child abuse cases some years ago, I support much of the Bill. Many of the new provisions are long overdue.
I congratulate my right hon. Friend the Secretary of State for Health on presenting the Bill, and join my colleagues in praising my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) for his work on such matters—I am pleased that we can acknowledge his input.
I seek clarification on the transfer of regulation of child minding and day care from local authorities to a new arm of Ofsted. My hon. Friend the Minister will be reassured to hear that I am not making a pitch to serve on the Standing Committee; I merely want to know how that transfer of responsibility will work.
Although I realise that we need consistent national standards for the regulation of child minding and day care, we should note that some local authorities have maintained good standards for a considerable time and have offered an excellent service. One of them is Wolverhampton borough council. In correspondence with me last year, the Department of Health acknowledged the excellent work done by Wolverhampton. Councils that already offer an excellent service are concerned about the effects of such a transfer of responsibility. Therefore, I want to take the opportunity to try to clarify some issues.
In Wolverhampton, we found that the registration and monitoring unit of social services works very closely with the Wolverhampton Childcare Agency, which develops child care for the under-fives. It was set up more than a decade ago and is acknowledged nationally for the good work that it does. The agency and the unit deliberately work closely together to build up the local intelligence network that is needed if their work is to be effective. If the regulation arm of such work is to be moved from the local authority to Ofsted, will my hon. Friend the Minister tell us how that link will be preserved? On the face of it, the link will be broken and that has implications for the quality of the local service.
I agree with my hon. Friend the Member for Wakefield (Mr. Hinchliffe) about Ofsted. I have grave reservations about whether a new arm of Ofsted will be the suitable 546 national body to take on the regulation of child minding and day care. Ofsted has a certain style and, frankly, that style will be inappropriate for the regulation of child minding and day care. It is as simple as that.
At the moment, Ofsted deals with formal education. As far as I am aware, it does not have any expertise in the regulation of child minding and day care, so where will it acquire such expertise from? The obvious solution seems to be that staff working in local authorities will be transferred to Ofsted, particularly if it works on a regional or sub-regional basis. Will my hon. Friend the Minister clarify whether that is the case? If it is, what arrangements will be made, especially bearing in mind that they will probably have to take account of the Transfer of Undertakings (Protection of Employment) Regulations 1981.
Whenever one moves something from locally elected councils to a more centralised quango, it is legitimate to raise the issue of political accountability. If people do not like what their local council does, they can go to it and complain. However, if they do not like what this new branch of Ofsted does, to whom will they complain? Where will the local accountability go?
My constituents very much value the highly accessible local service that they have. If it is moved from Wolverhampton to a London-based quango, they might lose out. Some councils already offer a good service and achieve high standards, so it would be ironic if attempts to raise all standards nationally and to achieve consistency meant that those local authorities that probably provided the model for the Bill found that their local services were downgraded. That would be unfortunate. I hope that my hon. Friend will bear those points in mind and give me reassurances and clarification.
§ 6.8 pm
§ Mr. Hilton Dawson (Lancaster and Wyre)
It is a privilege to take part in the debate to support this excellent Bill.
In this country there has been much justified criticism of social workers, the organisations that employ them and social work in general. However, some of the very best people whom I am privileged to know are social workers. They are utterly dedicated, resilient, occasionally eccentric—I admit that—and they do good work, and sometimes great work, with unlikely people in sometimes extraordinary circumstances. No other profession would require someone to build a relationship with a reclusive elderly lady, with long periods spent standing on the doorstep and negotiating by means of slips of paper, to bury a long-dead cat or to return years' supplies of empty milk bottles surreptitiously to the dairy.
The General Social Care Council is vital because social work is a distinct profession. Social work employs people in many different ways and many different circumstances, but it has defined skills, a knowledge base and superb values. Social workers listen to people and are non-judgmental, and social work is imbued with unconditional positive regard. It enables vulnerable people to make their own choices and to make what they will of their lives.
There have been many scandals in social work, but it has also been a scandal that an excellent profession has been underpaid, undervalued, undermined and maligned for so long. The General Social Care Council is a big step. 547 It will have a huge job and it will need continuing massive support from the Department of Health to develop professional practice. Social work is a mighty job, which involves itself in the biggest issues of all and decisions that utterly change lives. It is hugely stressful; it involves major statutory powers and a duty to protect vulnerable people. Every hon. Member should place more value on social workers.
There is a chance that this will be a great Government for children in care. The Government need to be great in that regard. There are decent people on both sides of the House, but, quite honestly, I loathed and despised the previous Conservative Government for their wilful neglect of the children in care with whom I worked for 15 years before I came to the House.
§ Mr. Dawson
They were certainly not your policies, Mr. Deputy Speaker; they were those of the Conservatives. They would never have done what this Government are doing, such as introducing "Quality Protects", establishing a new national organisation for young people in care, imposing new statutory duties towards care leavers and introducing this Bill.
§ Mr. Dawson
No. We have heard a lot of nonsense about the children's commissioner from Conservative Members this afternoon. They immediately undermined their arguments by creating a spurious split between parents' rights and children's rights. Conservative Front-Bench Members are trying, once again, to leap on a popular and populist issue that they do not understand. Their attitude towards it is absurd.
After the introduction of the Children Act 1989, the previous Government had eight years in which to bring in a new adoption Act. This Government are taking sensible action on adoption and putting children's needs and best interests at the forefront of their policy. The Conservatives are treating adoption as a political ideology, and that is totally unacceptable.
The National Care Standards Commission will shine an independent light on all those places where children live away from home. There will be a children's rights director. Let us savour the words "children's rights". They are a fine Government who explicitly commit themselves to children's rights. I eagerly anticipate the work of the commission, which will be informed by the people who know about services—the children who live in children's homes. The commission will take a child-centred approach to raising standards in homes, in fostering and in adoption.
I would prefer the Bill to range a little more widely, because as well as introducing a children's rights director, which is essential, we should be following the excellent example of the Welsh Assembly in establishing a commissioner for all children. That is an argument for 548 another day, but I am confident that the logic of the Government's commitment to children, to joined-up policies and to human rights will lead to children also winning that day.
I support everything that has been said about private fostering. We should establish a right to independent advocacy for all children in care. I am aware that that is a developing field and that the Government have a host of good intentions, but I should like to see in the Bill a real commitment to a statutory right to advocacy for children in care.
I shall not go on as we have only a short time available. The Bill is important and the Government deserve great credit for having brought it this far. I strongly support it.
§ Caroline Flint (Don Valley)
I thank my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) for his brevity. I join my colleagues in honouring our right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) for his contribution, not only during today's debate but throughout his political life, especially when he was the Secretary of State for Health.
I shall address two matters, one of which has been raised by my hon. Friends the Members for Wakefield (Mr. Hinchliffe) and for Birmingham, Hall Green (Mr. McCabe)—the protection and inspection of day care facilities for vulnerable adults. One year ago today, I wrote to the then Minister for Public Health, my right hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), after being approached by a constituent, Mrs. Sawdon. She expressed concern about her son, who attends a local day care establishment called a social education centre which, for five days a week, provides care and educational activities for vulnerable adults. Her point was that such establishments are not open to any form of external inspection. The Minister replied that the situation was under review but that, as yet, the Government did not consider it necessary to legislate.
In November last year, I put a question to the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), which was followed up by a question from my hon. Friend the Member for Wakefield, because we believe that we have to pay attention to the important issue of day care facilities. In my area, and in many others, parents are asked to pay a fee for such services. Many do not object to that charge, but they like to know precisely what they are paying for and what safety procedures and precautions are being observed, so that they can be sure that the service reaches the highest standard.
I hope that my hon. Friend the Minister will clarify the position. According to the Official Report of the debate in the other place, the powers in this Bill will be usedto introduce regulation by the national care standards commission of day care centres which provide nursing or personal care.I hope that that extends to facilities that provide educational activities, such as the centre in my constituency. Also promised wasa review within one year of the commission being established to decide the details of exactly how and when the regulatory regime will come into force.—[Official Report, House of Lords, 28 March 2000; Vol. 611, c. 650.]549 Will my hon. Friend put confirmation of that on the record of this House and elaborate on it?
I chair the all-party child care group. I should like some clarification in respect of the regulation of day care services. I understand from the explanatory notes that nannies do not come under the definition of such provision in the Bill, except if they look after the children of more than two families in the home of one family. Therefore, if the care is provided by a nanny in the home of one set of parents and the children of another set of parents come to that home, it appears that the Bill will apply. I hope my hon. Friend the Minister will look carefully at those provisions.
Child care is changing enormously and, as several Opposition Members have said today, it has huge potential for growth. To an increasing extent, nannies are not employed only by the extremely well-off, and shared arrangements are often made. Parents are concerned about the right setting for their child, so they choose the familiar setting of the home, into which care provision is brought.
I should also like clarification of how the provisions apply to disabled children. In connection with domiciliary arrangements, the Bill states that the provisions will apply if someone comes into the home to care for a person who has an illness or disability. Will they apply if a family employs a nanny to come into the home to care for a child who has special needs and who cannot be left to fend for itself in the same way as they will to adults who receive domiciliary care in their home?
Those were the two matters that I wanted to raise. I look forward to making a speech on Monday at a conference organised by the NSPCC on protecting babies from harm, and to elaborating on the many things that the Government are doing to make sure that children come first—giving support to parents and families and making sure that we have the highest standards expected in this important sphere.
§ Mr. Philip Hammond (Runnymede and Weybridge)
This has been a worthwhile, largely measured and well-informed debate, showing a good deal of consensus on both sides of the House on many of the objectives of the Bill.
I have been whiling away the moments by looking up in "Dod's Parliamentary Companion" the background of some of the hon. Members who have spoken. No fewer than six on the Government side have a background in social work, which gives them experience on which to draw but means that they will come at the problems that we are discussing from a certain point of view.
I was disappointed that the Secretary of State chose to strike the pose that he did, seeking to undermine the spirit of shared objectives by claiming that all good things in social care began on 2 May 1997. I am extremely grateful to my hon. Friend the Member for West Chelmsford (Mr. Burns) for putting the Bill in its correct historical context.
I do not know whether the right hon. Member for Holborn and St. Pancras (Mr. Dobson) was making a bid to get his job back. If so, the Secretary of State can sleep soundly, because obviously no one has told the right hon.
550 Gentleman that overt hostility to the independent sector is now off-message. I was going to describe what the right hon. Gentleman said as intemperate until I heard the hon. Member for Lancaster and Wyre (Mr. Dawson), whose comments I found most intemperate. He made outrageous allegations against the last Administration. If he would care to tell us to whom in particular his accusation of wilful neglect was directed, I am sure that those people would like the opportunity to respond. His comments are the grossest insult to people such as my hon. Friend the Member for Faversham and Mid-Kent (Mr. Rowe), who has a long and honourable history in the House of engagement with issues around adoption, fostering and the protection of children which even the Secretary of State was happy to acknowledge.
§ Mr. Dawson
I made it very clear that there are decent people on both sides of the House, and I would certainly include the hon. Member for Faversham and Mid-Kent (Mr. Rowe). But the experience of those working in the field that I worked in was of a Government who, over many years, with many opportunities, did not care and did nothing. In fact, they undermined efforts that were being made to help children in care.
§ Mr. Hammond
The hon. Gentleman's intemperate language does nothing to advance his cause.
By and large, the debate has been constructive and well informed. I should like to mention particularly the contribution of the hon. Member for Birmingham, Hall Green (Mr. McCabe), who once again has saved me quite a lot of time by making several of the points that I wanted to make and asking the Minister several of the questions that I would have posed to him.
I wish to make it clear at the outset that we did not take lightly the decision to table a reasoned amendment. On large parts of the Bill we share the Government's aspirations, although we do not always agree with them about the route that they have chosen to reach our shared objectives. There are others where we believe that an opportunity has been missed to strengthen protection of the vulnerable, to extend the principle of the level playing field and to put in place all the elements needed to ensure that the future provision of social care, primarily commissioned by local authorities but supplied by independent providers, is placed on a stable and sustainable basis.
We welcome the recognition of the need for a unified system of regulation covering both public and private sector providers of social care, but we regret that the Government have not demonstrated their commitment to this unified approach by extending the proposals on registration of independent hospitals, as my hon. Friend the Member for Woodspring (Dr. Fox) suggested, to cover all hospitals, so that all patients, wherever they are treated, can benefit. We shall press for the Government to follow the logic of their own argument.
We welcome the commitment to quality in residential care, but we are dismayed that the Government appear to have been lured into a bureaucratic "check the box" approach, measuring inputs rather than outcomes, and focusing on easily measurable physical features such as room sizes and numbers of power points or chairs in a room, rather than on what really counts—the quality of the care experienced. That point was eloquently made by 551 my right hon. Friend the Member for South Norfolk (Mr. MacGregor) and also by the hon. Member for Sutton and Cheam (Mr. Burstow).
We applaud the establishment of external control, albeit not fully independent, over local authorities' functions in relation to adoption and fostering, but we deeply regret that the Bill does not take the opportunity to give the Care Standards Commission a duty of maintaining a national register of potential adoptive parents, approved according to standardised, objective and relevant criteria. I welcome the knowledgeable contribution of my hon. Friend the Member for Canterbury (Mr. Brazier) to the debate.
We support the good intentions behind the proposed inspection and registration of child care facilities, but we share with some Government Members the gravest reservations about the practical and ethical consequences of imposing a welter of regulation and creating draconian powers for a new army of bureaucrats to enter people's homes and to inspect and seize documents and possessions.
We shall need further clarification on the role of the children's rights director and on the differences proposed between the regimes in England and Wales. We see no logic in accepting different levels of protection for the interests of children in one country compared with the other. A children's rights director is not the same as a commissioner, as the hon. Member for Wakefield (Mr. Hinchliffe) and my hon. Friend the Member for Faversham and Mid-Kent pointed out, underlining the bipartisan nature of views on the issue.
We shall seek clarification of the scope of powers under the Bill to regulate alternative practitioners on the fringes of medicine, and to extend to the often vulnerable people who turn to those unregulated practitioners the protection that the Bill provides to other groups.
We shall want to know what message the Government want local authorities to take from the Bill, removing as it does many of their functions, curtailing others and, taken together with the Local Government Bill, effectively squeezing them out of residential care provision.
Towering above and beyond those concerns are two overarching flaws in the Bill—the excessive use of regulations and ministerial statements of standards, which renders the Bill a virtually empty box, not amenable to proper scrutiny or analysis; and the total absence of any acknowledgement of the huge resource implications of the Bill or of the crisis in funding of social care provision, which in many areas of the country makes the Bill's worthy objectives look like distant aspirations.
I shall deal first with the use of secondary legislation to make regulations, and worse, the powers for Ministers to set the minimum standards, which will literally spell life or death to care homes, without any parliamentary scrutiny. In key areas of the Bill, it is impossible for us to assess the impact or significance of what is proposed until the standards and regulations are finalised.
If the Minister does not mind my saying so, I think that his intervention on a couple of occasions muddied the waters. It is my clear understanding—I am sure that if he were listening, he would correct me if I am wrong—that, although the regulations will be presented to the House in the form of statutory instruments subject to the negative procedure, the standards will be set by a ministerial statement and will at no time be subject to scrutiny in the 552 House. Probably the most important part of the Bill in terms of its impact on people providing social care will thus come into effect without any proper scrutiny.
The Government-commissioned paper by the Centre for Policy on Ageing, "Fit for the Future?", has set the cat well and truly among the pigeons, with hundreds of proposed standards for care homes, many of dubious value and some ruinously costly to implement. We now know that the Government will not implement all of those proposals, but we do not know which ones they will implement, at what level and over what time scale.
In the meantime, the proposals relating to accommodation in particular have blighted the sector. Care home owners and lenders alike are unable to assess whether particular homes will be compliant, or will have to invest heavily in order to avoid closure. Many properties are, in effect, unsaleable, and many capital providers have simply withdrawn from the market. A clear statement from the Minister, and a timetable, are now imperative—not just to protect the owners and operators of care homes, but to ensure that the provision that exists in the marketplace remains there.
§ Mr. Hammond
My hon. Friend is entirely right. I shall say more about this in a moment. However, it goes further than that. Ultimately, the burden of cost that falls on the private sector will be borne by the taxpayer in one way or another. The presence of 75 per cent. of people in residential and nursing homes is financed by local authorities and, ultimately, by the taxpayer.
Elsewhere—for example, in relation to independent acute hospitals—the Bill's registration regime is subject to compliance with standards and regulations that are as yet unknown. These are not minor housekeeping details; they are fundamental to a proper assessment of the impact of the Bill. The use of regulation-making and standard-setting powers—sometimes beyond the scope of parliamentary scrutiny—and the failure to present draft regulations for consideration in parallel with the Bill mean that the Government are asking the House to write them a blank cheque.
Meaningful scrutiny is impossible. The regulatory impact assessment published with the Bill—the Government are obliged to publish such information for the benefit of Members—is itself a meaningless exercise. It acknowledges that costs will be imposed, both in the form of fees and in the form of the costs of compliance with standards—but with no estimate whatever of the potentially enormous total of the latter.
§ Mr. Dawson
My colleagues have been scrutinising the Register of Members' Interests. We note that the hon. Gentleman has a shareholding in Castlemead Ltd., a company involved in housebuilding and development, including the development of premises for lease to general medical practitioners. Did the hon. Gentleman declare that interest before the debate?
§ Mr. Hammond
My interest is declared in the register. It has nothing whatever to do with the subject of today's 553 debate. As far as I know, general practice premises have nothing to do with the subject of the Bill. What I find most amazing is that the hon. Gentleman's right hon. and hon. Friends on the Front Bench have been scrabbling through the Register of Members' Interests. Given the army of civil servants and special advisers that they have behind them, one would think that my registerable interests, and those of my colleagues on the Front Bench, would be firmly fixed in their minds.
I trust, Mr. Deputy Speaker, that I have not transgressed the rules in any way. I do not believe that I have. That was a rather pathetic attempt by the hon. Member for Lancaster and Wyre (Mr. Dawson), if he does not mind my saying so. Perhaps, on reflection, he will wonder whether it was wise to allow himself to be used as the stooge of the Front Bench as the register was passed backwards through the Chamber.
As I was saying before I gave way to the hon. Gentleman, perhaps too generously, the regulatory impact assessment gives no estimate of the potentially enormous cost of compliance with the standards that are to be imposed by ministerial statement under the Bill. In the one area in which progress on draft standards has been made—standards for residential care homes—the publication of the document has blighted the sector with uncertainty, as the Government have had to distance themselves from the majority of the recommendations and from the excessive burdens recommended by the authors of that document.
Who will pay? Especially in the residential and domiciliary care sector, a raft of new burdens will be laid on top of the compliance cost of the huge burdens that the Government have imposed on businesses through higher taxes, the working time directive, the minimum wage, the parental leave directive and the other paraphernalia of the social chapter.
§ Mr. Hammond
I simply make the point that the Government have already imposed a huge additional financial burden on businesses in general and especially on the independent care home sector. They have done so against a background of below-inflation increases in the fees paid by most local authorities during the past three years.
A large firm of chartered accountants, acting as receivers, is already one of the biggest operators of residential care beds in the country. The Minister knows that a crisis point has been reached, especially in high-cost areas, with squeezed local authorities simply unable to pay the fees that will ensure an adequate supply of beds. Not only have the fees risen more slowly than inflation, but the needs of those placed in care homes has increased dramatically as local authorities have been forced to ration. People are now routinely being placed in care at the residential care fee level, although their needs are equivalent to those of people who only a few years ago were placed in nursing care.
The Bill completely misses the opportunity to link fees, ideally with incremental bands, to needs as well as geographical cost criteria—and, in turn, to relate staffing 554 ratios and other standards to those levels—and to ensure that that is done fairly and transparently by introducing a standardised assessment mechanism that can be accepted by providers and commissioners across the country. We shall table amendments in Committee to achieve those objectives and to end the lottery by which different local authorities use different assessment criteria and vary the eligibility thresholds to reflect their changing budgetary circumstances.
We must know whether the Government will openly acknowledge that their proposals will be paid for from the public purse. If local authorities are not fully reimbursed for the additional costs, the number of placements that they can support will decrease and people with ever greater needs will be left to fend for themselves. If the Government are prepared to acknowledge that they will pay the bill, why do they have to legislate to achieve those important improvements?
As my hon. Friend the Member for New Forest, West (Mr. Swayne) has said, the Government could have achieved many of their objectives through the contracting process by arranging for premium fees to be paid where certain standards were met in the way that the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) described in respect of her local authority.
I re-emphasise our support for many of the aspirations behind the Bill. My noble Friends in the other place have sought—in some cases, successfully—to address some of its shortcomings. If, as I expect that they might, the Government defeat the Opposition amendment and the Bill receives its Second Reading, we shall continue that work in Committee in a constructive and positive way. We shall try to convince the Government of the need to extend the Bill's scope in some areas, to change its focus in others and to narrow its ambitions where it risks straying beyond what is practical and creating excessively intrusive and bureaucratic mechanisms, to create workable, fair and consistent legislation.
The members of the Standing Committee that will consider the Bill will be hampered by its architecture and the "cart before the horse" approach that the Government have adopted. We will not know the Bill's full cost implications perhaps for years to come—not until long after parliamentary scrutiny has been completed and certainly not until we see the detailed standards and regulations. We do not know the cost impact on service providers because no meaningful regulatory impact assessment is available. That cannot happen until the detailed standards and regulations are in place.
We do not know how or whether the Government intend to meet the huge cost burdens that the proposed changes will impose on local authorities, independent providers and others, nor consequently the impact of this well- intentioned but potentially damaging Bill on the availability of, and access to, social care and the other services that it covers.
I urge my hon. Friends to support the amendment and send the Government back to the drawing board with a clear message that the House supports the Bill's underlying aspirations to improve quality, strengthen protection of the vulnerable and level the playing field, but cannot approve what is in essence a blank cheque without the remotest guidance on the costs that will be imposed, or any clue about how they will be met.
§ The Minister of State, Department of Health (Mr. John Hutton)
During the debate, we have heard nearly 20 speeches from the Back Benches. Many of those speeches were excellent, including that of the right hon. Member for South Norfolk (Mr. MacGregor). The hon. Member for Ceredigion (Mr. Thomas) also made a good speech. It was the first time that I had heard him speak. He took exactly the right approach to the Bill and made a positive contribution to the debate. That also applies to the speeches of my hon. Friends the Members for Stockport (Ms Coffey), and for Cardiff, North (Ms Morgan), my very good hon. Friend the Member for Wakefield (Mr. Hinchliffe); my hon. Friends the Members for Blackpool, North and Fleetwood (Mrs. Humble), for Chatham and Aylesford (Mr. Shaw), for Birmingham, Hall Green (Mr. McCabe), for Wolverhampton, South-West (Ms Jones), for Don Valley (Caroline Flint) and my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson), who introduced a welcome note of consensus to our proceedings.
No speech was better than that of my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). My right hon. Friend the Secretary of State and I had the privilege of serving under my right hon. Friend the Member for Holborn and St. Pancras when he was Secretary of State for Health. Many hon. Members who spoke pointed out that the Bill owes a great deal to my right hon. Friend's commitment, vision and concern for children and frail and vulnerable people. He deserves a round of applause for the measure. [Interruption.] I did not mean that literally.
Twenty substantial contributions to our proceedings were made this afternoon. I hope that hon. Members will not think me discourteous if I do not try to respond to every detailed point. A welter of comments have been made. It is apparent from the volume of material that I have at the Dispatch Box that I am inundated with technical information, which I shall try to plough through.
Let me begin with the points that the right hon. Member for South Norfolk made because he and others, including my hon. Friend the Member for Blackpool, North and Fleetwood, expressed some anxiety about "Fit for the Future?". The right hon. Gentleman asked for three assurances: that the regulations would not be too prescriptive; that they would not be too burdensome; and that the better regulation taskforce would be properly consulted on their implementation. I can give him an assurance on all three points. We have tried repeatedly to send a clear message from the Department of Health to the care home sector and others that we shall proceed sensibly and carefully with the proposals.
Few hon. Members who spoke in the debate, apart from the hon. Member for New Forest, West (Mr. Swayne), on whose speech I shall not dwell, argued against higher standards. The hon. Gentleman is the authentic voice of 19th-century laissez-faire politics, and we expect nothing less of him. I tried to reassure the right hon. Member for South Norfolk in a debate in Westminster Hall that we shall take a common-sense approach to the Bill. It would be stupid to do otherwise, and we are not stupid. We need and rely on good-quality care home providers. As we move towards a new set of minimum requirement standards, we shall ensure that they are sensible, affordable and practical.
556 The right hon. Gentleman and many other Conservative Members referred repeatedly to the potential use of a 10 sq m standard. A bit of historical accuracy might be helpful. The right hon. Gentleman and other Conservative Members might be interested to know that their party is responsible for the 10 sq m standard, which it set nearly 30 years ago. Having had a standard for 30 years, people have been—[Interruption.] The hon. Member for West Chelmsford (Mr. Burns) says that I am wrong.
§ Mr. Hutton
Sorry. I stand corrected, but the standard is nearly 30 years old. It was introduced by the hon. Gentleman's party. It was never properly seen through, so there is an issue that we need to address.
I am not saying that that will be the final standard that we set, as that would be inappropriate, but it is wrong of Conservative Members to give the impression that the reference to a 10 sq m standard has been pulled magically out of thin air; that it will come as a complete surprise to everyone in the care home sector; and that everyone is putting their hand in the air and saying, "What on earth is going on?"
§ Mr. Hutton
That is true, but if the hon. Gentleman is arguing that the 10 sq m standard is too high, that will be an interesting argument. I have not heard any Conservative Member say that 10 sq m is too high a standard.
§ Mr. Hutton
I agree. That is exactly the issue that we are trying to address with the Bill. As the Secretary of State said, at the moment, in relation to residential care homes, there are 150 different regulatory units. That is a recipe for chaos, as he rightly said. The guidelines to which he referred have come not from us but from local authorities. It is the care home sector itself—the point has totally escaped Opposition Members—which has asked us to introduce greater consistency and to have a proper level playing field that will ensure for the first time that good care home providers are not undercut by poor providers. That is precisely what we are trying to do with the Bill. That will become clearer to Opposition Members as they find out a little more about what we intend to do.
My hon. Friend the Member for Wakefield made an important speech and asked a number of specific questions. He started with a specific concern about the inspection process that the National Care Standards Commission will oversee. Others have raised similar concerns. The commission will deliver its services through a network of locally based teams involving lay 557 inspectors drawn from local communities, so it is absolutely our intention that, as the commission takes on that responsibility, it will keep a local focus and draw on local expertise.
Several hon. Members, including my hon. Friend, referred specifically to Ofsted's role in the new arrangements to be introduced under the Bill. I know that, in the Standing Committee, where those issues will be looked at in more detail, the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Barking (Ms Hodge), will be more than happy to respond to some of those technical and detailed points, but I make it clear that the Government's proposals have been generally welcomed by the sector. Ofsted's duties in relation to the Children Act 1989 are clear. The focus on care, welfare and development of the child cannot and will not be played down by the new statutory responsibilities that we want to give Ofsted.
My hon. Friend the Member for Wolverhampton, South-West referred specifically to the transfer of staff. It is our intention that local authority staff who do that work will transfer to Ofsted. My hon. Friend might be interested to know that, if those staff do transfer to Ofsted, it will more than double in size, so I do not believe that she should seriously entertain any concern that an education culture will dominate that part of its work. She can be reassured about that.
My hon. Friend might also be reassured by some good news. I am informed that the National Childminding Association asked its 40,000 members to tell it of their concerns about the Government's proposals. The good news is that the members of the association unanimously supported the Government's proposals. The only slightly bad news is that only two replies were received. Therefore, we probably need to think carefully about what the response means. However, as I said, my hon. Friend the Under-Secretary of State for Education and Employment will certainly be prepared to entertain a further, more detailed discussion about all those proposals.
One other matter that arose repeatedly in the debate—in all the speeches by Labour Members, and in some of those by Opposition Members—was a request to me to clarify in a little more detail the Government's intentions on future regulation of daycare services. In another place, my noble friend Lord Hunt made it clear that we intend to use clause 39 to extend the regulatory framework to include daycare centres. There is therefore absolutely no question about that—it will happen. My noble Friend said that, one year after the National Care Standards Commission is up and running, we want it to be able give us advice on how to extend the framework.
I think that that is an entirely sensible way of going about the matter. We have to take advice from the commission on its ability to take on that new and important additional responsibility, which has never been attempted before. We have to ensure that we get that particular part of the process right.
§ Mr. David Drew (Stroud)
Will my hon. Friend also investigate the implications for sheltered units, and 558 particularly very sheltered units, some of which have contacted me to say that they are unsure how developments on registration will affect them?
§ Mr. Hutton
My hon. Friend has made a very good point, and we shall certainly most carefully consider those matters as we develop our proposals.
The hon. Member for Canterbury (Mr. Brazier) expressed his long-standing concern about adoption. He knows—he and I have spoken at length about adoption issues—that the Government take those issues very seriously indeed. The hon. Gentleman and his hon. Friends can be reassured and quite confident that we intend to produce our new proposals in the very near future.
The hon. Member for New Forest, West made a characteristic contribution to our proceedings. Although I do not want to dwell on his speech—it would probably be better if we drew a veil over most of it—he made two points that were absolutely extraordinary for someone of his views, which he is obviously very careful about articulating. Effectively, he was arguing for a substantial increase in the amount of social care expenditure provided to local authorities, which was quite bizarre. Perhaps he and Opposition Front Benchers will tell us how much more they want to spend on social services in the future. I am sure that we shall return to that issue.
Conservative Members, but most particularly the hon. Member for New Forest, West, seemed to argue against the very principle on which the Bill is based, which is that it is not possible to drive up quality standards, as he and other Conservative Members desire, by relying on the market alone; we have been down that road, and we know absolutely that that approach would fail. The market itself is not able to deliver the high-quality standards provided for in the Bill.
§ Mr. Swayne
The hon. Gentleman, as a Minister, represents the taxpayer—who, overwhelmingly, is the greatest purchaser of those services. If the taxpayer puts his faith in certain standards, he should be prepared to pay a premium for them—as they are doing in Blackpool, as the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) said. Such a premium, much more than any regulation, would be the most powerful engine in driving up standards.
§ Mr. Hutton
Absolutely; of course that has an important role to play. However, to say that that is the only way in which we can ensure improved care standards in an important sector shows a complete misunderstanding of the situation and of the history of the evolution of the service.
The Bill, which delivers another of the Government's manifesto commitments, will improve both the quality and the consistency of the vital care services used by hundreds of thousands of people. It will close the gaps and loopholes created in our regulatory system by Conservative Members when they were in office. Those deficiencies protected the poor provider at the public's expense.
The Bill will help foster higher standards among the social care work force—80 per cent. of whom have no recognisable qualification of any type—who do some of 559 the most important jobs in our society. It will establish new and powerful safeguards that will better protect vulnerable people from the risk of abuse.
All of those are important objectives, which is why the Bill has received strong support from a wide variety of organisations and interests, and why I ask my hon. Friends to support it today. However, the Bill goes much further than that. Behind it lies a clear view of the importance of higher-quality public services, the need for effective and better regulation, and the need for improved public confidence in our system of inspection and registration—a confidence that has been severely shaken by a succession of appalling scandals of which right. hon. and hon. Members will be very aware.
The present arrangements are out of date and inadequate for the new challenges that lie ahead. That was recognised most recently in the Waterhouse report on child abuse in care homes in north Wales. Those challenges are in part the consequence of demographic changes. They are also in part the result of rising public expectations about the standards required from service providers and the need to ensure better protection for children and vulnerable adults. In future, the public interest must be better served in all those key areas. The Bill has the public interest at its heart and will make a positive contribution in maintaining confidence in all the services covered by its provisions.
The Bill proposes a radical redesign of the registration and inspection systems. A new independent organisation, the National Care Standards Commission, will be established in England. Similar arrangements will be put in place for Wales. The commission will have important new powers to promote consistent quality standards in all care homes, including children's homes. The loophole in the Children Act 1989 that allowed small children's homes to avoid any effective supervision and registration requirements will be closed. The commission will also have the power, for the first time, to regulate domiciliary care services, protecting people in their own homes from poor standards and inadequate care.
Private health care will also fall within the scope of the commission—an important extension of patient protection and safeguards. The new General Social Care Council, which has been widely welcomed by Labour Members, will work to raise the standards of the whole social care work force. As many of my hon. Friends have argued, the establishment of such a body is long overdue.
Those are only some of the main changes that the Bill will bring about. The others include: new institutions to develop a new emphasis on higher-quality services; a level playing field for the first time as between public and private sector providers; greater consistency and an end to the current variation in care standards; better protection; and improved public confidence. The Bill complements the Government's wider initiatives to improve the standards of other key services such as education and the national health service. We believe in public services and we want their performance to be improved. The Bill provides further support for our programme of modernisation and reform.
The Bill sets a new course and a new purpose. It brings an end to the sterile and damaging ideology of the past. For the Conservatives, the only question that mattered was who provided the service. After two speeches from the Opposition Front Bench, we are none the wiser about their 560 policy. They remain stuck in the comfort of their collective memory of how things used to be. In the mean time, the public have moved on and have left the Conservatives behind. For the Government, the issue is the quality of service. That is where the Bill makes a significant step forward.
There will be many beneficiaries of our new approach to raising quality standards. Children in care homes will be better protected. Older people in care homes or being cared for at home can be more confident that they will receive the best possible care. Bringing together the regulatory systems for child care and nursery education will result in an improvement in the quality of early-years services, benefiting young children and their parents. Part VI provides important additional protection to vulnerable adults who require residential or home care services. Care providers will benefit from a streamlined and consistent regulatory system—something that providers have been seeking for a long time and that the Conservatives conspicuously failed to deliver.
Above all, the public will benefit from the Bill, because their wider interests are clearly being advanced. Judging by their contributions to the debate, the Opposition have nothing positive to offer. Their position today has been a depressing mix of cynicism and willingness to sacrifice higher-quality standards to commercial interests, finished off by an astonishing attempt to rewrite their record in office. That response is not credible and not good enough.
The Government's approach is different. In voting for the Bill, my hon. Friends can be sure that they will be serving the best interests of all their constituents.
§ Question put, That the amendment be made:—
§ The House divided: Ayes 120, Noes 274.563
|Division No. 200]||[6.59 pm|
|Amess, David||Forth, Rt Hon Eric|
|Arbuthnot, Rt Hon James||Fraser, Christopher|
|Atkinson, David (Bour'mth E)||Garnier, Edward|
|Atkinson, Peter (Hexham)||Gibb, Nick|
|Baldry, Tony||Gill, Christopher|
|Bercow, John||Gillan, Mrs Cheryl|
|Beresford, Sir Paul||Gorman, Mrs Teresa|
|Blunt, Crispin||Green, Damian|
|Boswell, Tim||Greenway, John|
|Bottomley, Peter (Worthing W)||Grieve, Dominic|
|Bottomley, Rt Hon Mrs Virginia||Gummer, Rt Hon John|
|Brady, Graham||Hammond, Philip|
|Brazier, Julian||Hawkins, Nick|
|Brooke, Rt Hon Peter||Hayes, John|
|Browning, Mrs Angela||Heald, Oliver|
|Bruce, Ian (S Dorset)||Hogg, Rt Hon Douglas|
|Burns, Simon||Horam, John|
|Butterfill, John||Howard, Rt Hon Michael|
|Chapman, Sir Sydney (Chipping Barnet)||Howarth, Gerald (Aldershot)|
|Chope, Christopher||Jack, Rt Hon Michael|
|Collins, Tim||Jackson, Robert (Wantage)|
|Cran, James||Johnson Smith, Rt Hon Sir Geoffrey|
|Curry, Rt Hon David|
|Davis, Rt Hon David (Haltemprice)||King, Rt Hon Tom (Bridgwater)|
|Day, Stephen||Kirkbride, Miss Julie|
|Dorrell, Rt Hon Stephen||Laing, Mrs Eleanor|
|Emery, Rt Hon Sir Peter||Lait, Mrs Jacqui|
|Evans, Nigel||Lansley, Andrew|
|Faber, David||Leigh, Edward|
|Fabricant, Michael||Letwin, Oliver|
|Flight, Howard||Lewis, Dr Julian (New Forest E)|
|Lidington, David||St Aubyn, Nick|
|Lilley, Rt Hon Peter||Shepherd, Richard|
|Loughton, Tim||Simpson, Keith (Mid-Norfolk)|
|Luff, Peter||Soames, Nicholas|
|McIntosh, Miss Anne||Spelman, Mrs Caroline|
|MacKay, Rt Hon Andrew||Spicer, Sir Michael|
|Maclean, Rt Hon David||Spring, Richard|
|McLoughlin, Patrick||Stanley, Rt Hon Sir John|
|Madel, Sir David||Streeter, Gary|
|Malins, Humfrey||Swayne, Desmond|
|Maples, John||Syms, Robert|
|Mates, Michael||Tapsell, Sir Peter|
|Maude, Rt Hon Francis||Taylor, Ian (Esher & Walton)|
|Mawhinney, Rt Hon Sir Brian||Taylor, John M (Solihull)|
|May, Mrs Theresa||Tredinnick, David|
|Moss, Malcolm||Trend, Michael|
|Nicholls, Patrick||Viggers, Peter|
|Norman, Archie||Walter, Robert|
|O'Brien, Stephen (Eddisbury)||Waterson, Nigel|
|Ottaway, Richard||Wells, Bowen|
|Page, Richard||Whitney, Sir Raymond|
|Paice, James||Whittingdale, John|
|Paterson, Owen||Willetts, David|
|Pickles, Eric||Wilshire, David|
|Portillo, Rt Hon Michael||Yeo, Tim|
|Prior, David||Young, Rt Hon Sir George|
|Redwood, Rt Hon John|
|Robathan, Andrew||Tellers for the Ayes:|
|Robertson, Laurence||Mr. John Randall and|
|Rowe, Andrew (Faversham)||Mr. Geoffrey Clifton-|
|Abbott, Ms Diane||Clarke, Tony (Northampton S)|
|Ainsworth, Robert (Cov'try NE)||Clelland, David|
|Allan, Richard||Coaker, Vernon|
|Allen, Graham||Coffey, Ms Ann|
|Anderson, Donald (Swansea E)||Cohen, Harry|
|Austin, John||Coleman, Iain|
|Barnes, Harry||Colman, Tony|
|Barron, Kevin||Connarty, Michael|
|Beard, Nigel||Cook, Frank (Stockton N)|
|Beckett, Rt Hon Mrs Margaret||Cook, Rt Hon Robin (Livingston)|
|Beith, Rt Hon A J||Cooper, Yvette|
|Bell, Stuart (Middlesbrough)||Corbett, Robin|
|Benn, Hilary (Leeds C)||Corston, Jean|
|Benn, Rt Hon Tony (Chesterfield)||Cotter, Brian|
|Bennett, Andrew F||Cousins, Jim|
|Benton, Joe||Crausby, David|
|Bermingham, Gerald||Cryer, Mrs Ann (Keighley)|
|Best, Harold||Cryer, John (Hornchurch)|
|Betts, Clive||Cunningham, Jim (Cov'try S)|
|Blears, Ms Hazel||Curtis-Thomas, Mrs Claire|
|Boateng, Rt Hon Paul||Darvill, Keith|
|Borrow, David||Davey, Edward (Kingston)|
|Bradley, Keith (Withington)||Davey, Valerie (Bristol W)|
|Brand, Dr Peter||Davidson, Ian|
|Brinton, Mrs Helen||Davies, Geraint (Croydon C)|
|Brown, Rt Hon Nick (Newcastle E)||Dawson, Hilton|
|Browne, Desmond||Denham, John|
|Burden, Richard||Dismore, Andrew|
|Burstow, Paul||Dobbin, Jim|
|Butler, Mrs Christine||Dobson, Rt Hon Frank|
|Byers, Rt Hon Stephen||Dowd, Jim|
|Campbell, Mrs Anne (C'bridge)||Drew, David|
|Campbell, Ronnie (Blyth V)||Drown, Ms Julia|
|Cann, Jamie||Dunwoody, Mrs Gwyneth|
|Caplin, Ivor||Eagle, Angela (Wallasey)|
|Caton, Martin||Eagle, Maria (L'pool Garston)|
|Cawsey, Ian||Ennis, Jeff|
|Chapman, Ben (Wirral S)||Field, Rt Hon Frank|
|Chaytor, David||Fitzpatrick, Jim|
|Clapham, Michael||Flint, Caroline|
|Clark, Rt Hon Dr David (S Shields)||Flynn, Paul|
|Clark, Paul (Gillingham)||Follett, Barbara|
|Clarke, Rt Hon Tom (Coatbridge)||Foster, Rt Hon Derek|
|Foster, Michael Jabez (Hastings)||McDonagh, Siobhain|
|Foster, Michael J (Worcester)||McDonnell, John|
|Foulkes, George||McGuire, Mrs Anne|
|Fyfe, Maria||McIsaac, Shona|
|Galloway, George||McKenna, Mrs Rosemary|
|Gapes, Mike||MacShane, Denis|
|Gardiner, Barry||Mactaggart, Fiona|
|George, Bruce (Walsall S)||McWalter, Tony|
|Gibson, Dr Ian||McWilliam, John|
|Gilroy, Mrs Linda||Mahon, Mrs Alice|
|Godsiff, Roger||Marsden, Gordon (Blackpool S)|
|Goggins, Paul||Marshall, Jim (Leicester S)|
|Golding, Mrs Llin||Maxton, John|
|Gordon, Mrs Eileen||Meacher, Rt Hon Michael|
|Griffiths, Jane (Reading E)||Meale, Alan|
|Griffiths, Win (Bridgend)||Merron, Gillian|
|Grogan, John||Michie, Bill (Shef'ld Heeley)|
|Hall, Mike (Weaver Vale)||Milburn, Rt Hon Alan|
|Hall, Patrick (Bedford)||Miller, Andrew|
|Hanson, David||Moonie, Dr Lewis|
|Harman, Rt Hon Ms Harriet||Moore, Michael|
|Heal, Mrs Sylvia||Moran, Ms Margaret|
|Healey, John||Morgan, Ms Julie (Cardiff N)|
|Heath, David (Somerton & Frome)||Morley, Elliot|
|Henderson, Doug (Newcastle N)||Mountford, Kali|
|Hepburn, Stephen||Mudie, George|
|Heppell, John||Mullin, Chris|
|Hesford, Stephen||Murphy, Jim (Eastwood)|
|Hewitt, Ms Patricia||Naysmith, Dr Doug|
|Hill, Keith||O'Brien, Bill (Normanton)|
|Hinchliffe, David||O'Brien, Mike (N Warks)|
|Hodge, Ms Margaret||O'Hara, Eddie|
|Hoey, Kate||Olner, Bill|
|Hoon, Rt Hon Geoffrey||O'Neill, Martin|
|Hope, Phil||Osborne, Ms Sandra|
|Howarth, Alan (Newport E)||Pearson, Ian|
|Hughes, Ms Beverley (Stretford)||Pickthall, Colin|
|Hughes, Kevin (Doncaster N)||Pike, Peter L|
|Hurst, Alan||Plaskitt, James|
|Hutton, John||Pollard, Kerry|
|Iddon, Dr Brian||Pond, Chris|
|Jackson, Ms Glenda (Hampstead)||Pound, Stephen|
|Jackson, Helen (Hillsborough)||Prentice, Ms Bridget (Lewisham E)|
|Jenkins, Brian||Prentice, Gordon (Pendle)|
|Johnson, Miss Melanie (Welwyn Hatfield)||Prescott, Rt Hon John|
|Jones, Ms Jenny (Wolverh'ton SW)||Purchase, Ken|
|Jones, Jon Owen (Cardiff C)||Rapson, Syd|
|Jones, Dr Lynne (Selly Oak)||Raynsford, Nick|
|Jowell, Rt Hon Ms Tessa||Roche, Mrs Barbara|
|Keeble, Ms Sally||Rooker, Rt Hon Jeff|
|Keen, Alan (Feltham & Heston)||Rooney, Terry|
|Keen, Ann (Brentford & Isleworth)||Ross, Ernie (Dundee W)|
|Kelly, Ms Ruth||Roy, Frank|
|Kemp, Fraser||Ruane, Chris|
|Kennedy, Jane (Wavertree)||Ruddock, Joan|
|Khabra, Piara S||Russell, Bob (Colchester)|
|Kidney, David||Ryan, Ms Joan|
|Kilfoyle, Peter||Salter, Martin|
|King, Ms Oona (Bethnal Green)||Sarwar, Mohammad|
|Kumar, Dr Ashok||Sawford, Phil|
|Ladyman, Dr Stephen||Sedgemore, Brian|
|Laxton, Bob||Shaw, Jonathan|
|Leslie, Christopher||Sheerman, Barry|
|Lewis, Ivan (Bury S)||Shipley, Ms Debra|
|Lewis, Terry (Worsley)||Singh, Marsha|
|Linton, Martin||Skinner, Dennis|
|Lloyd, Tony (Manchester C)||Smith, Angela (Basildon)|
|Lock, David||Smith, Jacqui (Redditch)|
|Love, Andrew||Smith, Llew (Blaenau Gwent)|
|McAvoy, Thomas||Spellar, John|
|McCabe, Steve||Starkey, Dr Phyllis|
|McCafferty, Ms Chris||Stevenson, George|
|McCartney, Rt Hon Ian (Makerfield)||Stewart, David (Inverness E)|
|Stewart, Ian (Eccles)|
|Stinchcombe, Paul||Walley, Ms Joan|
|Stoate, Dr Howard||Ward, Ms Claire|
|Strang, Rt Hon Dr Gavin||Wareing, Robert N|
|Stringer, Graham||Watts, David|
|Stunell, Andrew||White, Brian|
|Sutcliffe, Gerry||Whitehead, Dr Alan|
|Taylor, Ms Dari (Stockton S)||Wicks, Malcolm|
|Taylor, David (NW Leics)||Williams, Rt Hon Alan (Swansea W)|
|Thomas, Gareth R (Harrow W)|
|Thomas, Simon (Ceredigion)||Williams, Alan W (E Carmarthen)|
|Timms, Stephen||Williams, Mrs Betty (Conwy)|
|Todd, Mark||Wills, Michael|
|Tonge, Dr Jenny||Winterton, Ms Rosie (Doncaster C)|
|Touhig, Don||Woolas, Phil|
|Trickett, Jon||Wray, James|
|Truswell, Paul||Wright, Anthony D (Gt Yarmouth)|
|Turner, Dennis (Wolverh'ton SE)||Wright, Dr Tony (Cannock)|
|Turner, Dr Desmond (Kemptown)||Wyatt, Derek|
|Turner, Neil (Wigan)|
|Twigg, Derek (Halton)||Tellers for the Noes:|
|Twigg, Stephen (Enfield)||Mr. Tony McNulty and|
|Vis, Dr Rudi||Mr. David Jamieson.|
§ Question accordingly negatived.
§ Main Question put forthwith, pursuant to Standing Order No. 62 (Amendment on second or third reading), and agreed to.
§ Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).