HL Deb 17 January 1994 vol 551 cc380-8

7.4 p.m.

Lord Ashley of Stoke

My Lords, I beg to move that the Bill be now read a second time.

This Bill was originally introduced by David Hinchliffe in another place, and I pay a warm tribute to him for his initiative in bringing forward this important measure. Sick and disabled people receiving domiciliary care are currently at risk. This Bill would give them protection. However, so far the Government have refused to enact the necessary legislation and I hope that the Minister will be forthcoming this evening with something far more constructive than we have heard so far.

The need for registration and inspection of some care services has been recognised by Parliament with the Registered Homes Act 1984. The stringent requirements of that Act include the registration of all establishments —and I emphasise establishments—providing care and the naming of a qualified person to be legally responsible for the operation of an establishment. Homes can be inspected by the local registration and inspection unit and where necessary registration can be cancelled. That is a powerful sanction.

It is a remarkable anomaly that those important legislative safeguards are not afforded to sick and disabled people receiving domiciliary care in their own homes. Such people can be relatively isolated, with little or no company, and they can be far more vulnerable than people in residential or nursing homes. They have no company. They have no one to chat to. They have no one to keep an eye on them. That makes them all the more vulnerable.

The Government can only offer a feeble excuse for refusing protection to those people. Ministers excuse their inaction by claiming that the contracting and purchasing arrangements provided by the National Health Service and Community Care Act 1990 are sufficient safeguards. I hope that the Minister will not peddle that weak line this evening because it simply will not do. In fact, the so-called safeguards in that Act are grossly inadequate.

It is true that local authorities contract with agencies for the provision of services in people's homes, but it is nonsense to imply that busy social service departments make regular inspections, a task which they are not currently required to undertake. To claim that incapacitated and sometimes confused people receive protection from contracting arrangements is misleading.

In addition, a growing number of people purchase these services privately without any form of local authority involvement. There is absolutely no protection for them.

Some voluntary registration schemes have been set up, but while they are welcome they are no substitute for legislation. There is no way of enforcing voluntary arrangements, and it is the good not the bad agencies which will voluntarily register.

The Alzheimer's Disease Society, together with many other organisations, strongly supports the Bill. People with that disease are particularly vulnerable and the society is very anxious that all providers of these services should be registered and independently inspected. It wants staff to be subject to police checks, to have initial and in-service training and proper supervision and monitoring. I believe that that is a sensible and sound list of proposals and it is an absolute minimum for providing proper care for vulnerable people.

The Government are not only unaware of the importance of the supervision of care; they have even called on care home proprietors to see whether inspections could be reduced. Fancy that, my Lords. Will the Minister explain why the Government are calling for those inspections to be reduced? That is exactly what is not needed. Sick and disabled people living in their own homes need inspections of care.

The Government should bear in mind that it is an issue which will not go away. It is being supported by an increasing number of individuals and organisations that feel deeply about the need for effective legislation. Without it there is a risk of disaster.

The Bill is a modest, reasonable measure, badly needed by a group of very vulnerable people. They are entitled to precisely the same protection, if not more, than those living in institutions. I hope that the Minister will reflect on those needs and offer to take on this necessary and important Bill.

Moved, That the Bill be now read a second time.—(Lord Ashley of Stoke.)

7.12 p.m.

Lord Swinfen

My Lords, I am delighted to support the Second Reading of this Bill so ably moved by the noble Lord, Lord Ashley. I am very pleased that he has brought it before the House. I should declare an interest. The organisation for which I work, the John Grooms Association for Disabled People, is in the process of setting up domiciliary care agencies. However, despite that, the association welcomes the Bill. It would very much like to see such agencies regulated. Regulation and control are needed to ensure that the Government' s aim of care in the community progresses satisfactorily and meets people's needs for personal care arid support in their own homes.

The cost of regulation and of administering the regulations will be a great deal cheaper than the cost of keeping a number of those people in hospitals or registered homes. Local authorities are expected to provide increasing home care services through a market mechanism using independent providers rather than providing direct services themselves. Targets have been set by the Government towards that end and the Department of Health has allocated special funds, as I understand it, to stimulate the development of independent agencies providing those services.

At present such agencies are entirely unregulated. Only agencies providing nursing care have a duty to register with the local authority. Therefore where the ministry helps with funding, it may not have a proper check on the spending of those funds if domiciliary care agencies are not properly regulated.

People, especially those in need of personal care and support services, are vulnerable in their own homes. Agency staff, unlike staff of residential homes, are not constantly and directly supervised. Regulation is required to afford some measure of protection to the public and to ensure that minimum standards are obtained.

The Government, and in turn local authorities, are anxious to develop value for money but at the same time quality of service. Thus regulation is quite appropriate to provide an operational minimum standard and to declare to the market clearly the levels and quality of service that are being sought.

It is clearly accepted that other forms of personal care and support provision are regulated; that is, residential care homes. Inspection is thus not a large economic or logistic difficulty. I can see no reason why the Government should not support the Bill.

It is only a short time since the Government agreed that taxi drivers should be properly monitored. Many Members of this House took part in debates on that subject, I think two years ago. People who take taxis probably spend only a short time with any one driver. Most of them are not vulnerable individuals. But we insist that the driver is properly vetted to ensure the safety of his passengers. How much greater then is the need to licence domiciliary care agencies when those for whom care is provided are by the nature of things all vulnerable, as attested by their very need for care. I hope that the Government will support the Bill and give it time not only in this House but in another place.

7.17 p.m.

Lord Monkswell

My Lords, with the leave of the House, I rise to support the Bill. Not having given notice that I wished to speak today, my contribution will be brief.

I speak because of concerns that have been expressed to me not only by officers of social services departments in the city council where I am a councillor but also by some of my constituents who are worried about the provision for those people who will receive domiciliary care in their own homes.

There are two significant changes which will affect the provision of domiciliary care. The first—it is one that I believe everyone would hope for—is an extension of the provisions to provide support for people to stay in their own homes rather than to become institutionalised and therefore for the individual to receive more expensive, but less satisfactory, care. Therefore the first point relates to the massive expansion of provision.

My second point refers to the commercialisation, if I may so refer to it, of provision. It is generally accepted that the vast majority of current provision is through local authorities or the National Health Service. Over the next few years we shall probably see the development of private contractors who do not have the same controls. They will be private companies predominantly run for profit. I am sure that there will be some non-profit-making organisations, but predominantly businesses will enter the field of community care in the way that we have seen a growth in the provision of residential homes over the past few years.

Effectively the people undertaking the task will be commercial contractors doing the job for the money. We shall not have the controls that exist in public service. I refer not only to the democratic controls from the top but to that ethos of public service that characterises the work of home helps and nurses throughout the country. I fear that we shall have a new breed of domiciliary care assistant who will do the job just for the money. That will be sad because I believe that those caring professionals contribute enormously in the way that they look after vulnerable people in their own homes.

7.19 p.m.

Lord Rea

My Lords, we on these Benches welcome the Bill, the purpose of which has been clearly explained by my noble friend Lord Ashley of Stoke, to whom we are grateful. It has also been ably supported by the noble Lord, Lord Swinfen, and my noble friend Lord Monkswell.

When the Bill was introduced under the Ten Minute Rule in March last year in another place by my honourable friend David Hinchliffe, Member of Parliament for Wakefield, it was given support in the Lobbies by both the Labour and the Liberal Democrat Parties, but so far as I can see almost no Government supporters entered the Lobbies. However, at least the Government did not choose to vote against the Bill but decided rather to allow it to die by not finding parliamentary time for it, as is the fate of most Ten Minute Rule Bills.

That was regrettable—I should not go quite so far as to say reprehensible—because the Bill has the support of the national bodies which are most concerned with domiciliary care in the community. My noble friend has not spelt out those organisations and it would be worth putting them on the record. The Bill is supported by the United Kingdom Home Care Association, which represents more than 300 voluntary and private agencies, the Joint Advisory Group of Domiciliary Care Associations, the British Association of Domiciliary Care Officers, the National Association of Inspection and Registration Officers, the British Association of Social Workers and the Social Care Association. It is also supported by the Association of Directors of Social Services, Age Concern and other interested organisations. It is important, so far as the Government are concerned, that the Social Services Inspectorate has, I gather, drawn Ministers' attention to the need for such a measure.

It is just as necessary, if not more so, for agencies which provide domiciliary care to be licensed and scrutinised as it is for those which provide residential care. Although, of course, care on the whole is good even under the present unlicensed system, whether it be provided by the private or the public sector, there are, unfortunately, always backsliders. They are probably equally divided between those who have fallen on bad times and are therefore cutting corners to avoid expense, and those who are running an agency where profit rather than service comes first, despite undoubtedly impressive and soothing words on their brochures.

The noble Lord, Lord Swinfen, pointed out that market mechanisms are increasing and that there will be a number of entrepreneurs coming forth to provide services. My noble friend Lord Monkswell put it a little less politely and said that they would be in it for the money.

Experience, both before the National Health Service and Community Care Act came into operation in April of this year and subsequently, has revealed the urgent need for a Bill such as this. I do not intend to go into details of cases to support those words, but I should be willing to do so if the noble Baroness wishes to ask me about them.

My honourable friend, David Hinchliffe, said in the other place: I would not be at all offended if the Government took the Bill off my hands and implemented it themselves". [Official Report, Commons, 24/3/93; col. 925.] I do not think that my noble friend wants the noble Baroness literally to take the Bill off his hands, but I very much hope that she will view it favourably and help to give it a rapid passage through this House.

7.24 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, when I learned that the noble Lord, Lord Ashley, had brought this Bill before your Lordships' House, my expectation was that the noble Lord and other noble Lords would show both compassion and knowledge—compassion for the needs of elderly, disabled and vulnerable people and knowledge of the services and the commitment of the people who work in those services. These expectations have been entirely fulfilled.

The reform of community care, while not altering the basic need for services, has quite deliberately given an extra emphasis to their development and expansion, so that people who continue to choose to live in their own homes in spite of increasing frailty may be able to do so. The reforms are intended to encourage and increase the supply and type of support by expanding domiciliary services through a wider variety of providers and stimulating suppliers from both the voluntary and private sectors. Until now the public sector, through local authority social services departments, has been the pre-eminent supplier. A study of home help and home care services organised for social services clients shows that only a tiny proportion of service is purchased from the voluntary or private sectors. The Government want to see the public sector using a greater range of providers who will supply in turn a wider range of services. To help in this development, the department has funded a special initiative to assist 15 social services authorities in England to find new ways to stimulate activity in the independent sector by working alongside actual and potential suppliers. The early results of this work are already being disseminated throughout the country by newsletters and conferences.

The current size of the independent sector, measured by the number of agencies, is not easy to establish. Up to 3,000 care agencies are licensed by the Department of Employment in Great Britain, but these include agencies supplying medical and nursing staff and are not confined to domiciliary-based services. Perhaps half this total would come within the term "domiciliary care agencies". What is undoubtedly true is that there is a recent increase, and the Government are pleased to welcome this. At the same time we recognise the fragility of these small businesses and the need to avoid the risk of stifling them by over-zealous regulation.

The noble Lords, Lord Ashley, Lord Rea and Lord Monkswell, and my noble friend Lord Swinfen drew the attention of your Lordships' House to the statutory inspection of residential and nursing homes. It can be argued that people who move into residential care are more vulnerable and open to exploitation compared with those who remain in their own homes. Those in residential care are potentially or actually reliant on their carers for every aspect of their daily lives. This is, except in the rarest instances, untrue of people who remain in their own homes, with neighbours, friends or relatives nearby or at least easy to contact and external carers not in a position of complete control. This is not to deny the risk but to place it in perspective.

I want to emphasise that the Government not only sympathise with but share the underlying objective of the noble Lord's Bill. We also want to protect vulnerable people from exploitation by the unscrupulous who masquerade as providers of essential domiciliary services, but we consider that there are methods, short of a specialised licensing requirement, to provide such protection. The Government have been encouraged by national organisations which have developed codes of practice for their members, such as the United Kingdom Home Care Association and the Federation of Recruitment and Employment Services, as was mentioned by the noble Lord, Lord Ashley. In particular we are aware of the work being done by the United Kingdom Home Care Association, alongside many local authorities and directors of social services. They use an agreed code of practice as a basis for ensuring standards of service delivery and in some areas local voluntary licensing schemes. It is the quality of service, whether specified in a contract between purchaser and provider or by a commitment to adhere to the code of practice of a national organisation, that will ensure that service users get the quality they are entitled to expect.

The Government's sympathy with the objective already extends beyond mere rhetoric. Our first priority is to develop standards for domiciliary services. 'The Social Services Inspectorate published last October a first report, Developing Quality Standards for Home Support Services, which was sent to all social services authorities and made available to independent providers.

My noble friend Lord Swinfen, who works for an organisation which I greatly respect, will be interested to know that the umbrella organisation, the United Kingdom Home Care Association, described the report as very impressive, with the emphasis it puts on outcomes and the focus on users and carers. The inspectorate itself will be carrying out a programme of inspection this year, using this report as one of the key documents, and will report on the requirements for more explicit guidance.

Local social services authorities already have quality control levers which they should use. Effective contract specification and contract monitoring are the key to ensuring that their service users get the standard of service they have the right to expect. Additionally, some authorities have been establishing local standards and accreditation schemes, in many cases working alongside the UK Home Care Association. They are developing on a voluntary basis local registration schemes and are extending the role of their inspection units to independent home support agencies. This is being led by the Association of Directors of Social Services. These local initiatives are welcomed, and are part of the flexible range of responses which the Government prefer at this stage. Not all local authorities or all agencies have reached this stage of development and it would not be appropriate at this time to impose a statutory requirement.

It would be ingenuous in this debate not to touch on the issue of resources, already raised by the noble Lord, Lord Rea, to operate the licensing system proposed in the Bill. Although the Government have not undertaken a detailed study, there will undoubtedly be an additional cost to public funds beyond that which can be recouped from fees. As a minimum, there will be the costs of work with potential agencies which do not result in the license application and the costs of operating the system for considering representation that is set out in Clause 3.

I hope that I have been able to make clear the reasons why, although the Government share the main objective of the Bill, this is not the appropriate time for such a measure. I regret that the Government are unable to support it. I realise that there will be disappointment, especially since the noble Lord has sought what may seem a sound basis by using the Employment Agencies Act 1973 as a framework for this Bill. Although the Government are unable to give their support to the noble Lord tonight, they are, however, prepared to undertake a review of the situation, including whether there might be a national scheme of regulation incorporating requirements proportionate to risks when they review social services inspection arrangements in 1995. I hope that that will afford a crumb of comfort to the noble Lord and to other Members of this House who have debated the Bill, although I recognise that it will in no way satisfy them.

7.32 p.m.

Lord Ashley of Stoke

My Lords, the Minister is, as always, typically understanding and constructive. We appreciate her comment that she sympathises with the Bill and shares the objectives. I am sorry that she could not go further and accept it. I believe that it is a very valuable Bill and one which will eventually be enacted.

The noble Baroness spoke about "over-zealous" regulations. That is the last danger in the world. The main danger lies in the lack of regulations. There is no point in worrying about "over-zealous" regulations. When this Bill in enacted we shall be very careful not to make the regulations over-zealous but lay them down in order to protect very vulnerable people.

The noble Baroness mentioned voluntary schemes. I agree that such schemes are welcome and are worth while. But they are simply inadequate and are no substitute for legislation. As a Minister, the noble Baroness must mention costs. But there is no astronomical cost. The Chancellor will not be broken, nor will the budget of the Secretary of State, simply by monitoring and ensuring that those sick and disabled people are protected. The review that she mentioned, although it is not sufficient, will be welcome. But why cannot the Government initiate that review immediately, pending Parliament's discussion of this Bill? I would like that to be done by the Minister, if possible.

I conclude by saying that when this Bill is enacted—and enacted it will be sooner or later because it is necessary —I hope that it will become known as the David Hinchliffe Act. I hope that the Bill will be accepted. I commend it to the House.

On Question, Bill read a second time, and committed to a Committee of the Whole House.

7.35 p.m.

Baroness Trumpington

My Lords, I beg to move that the House do now adjourn during pleasure until five minutes past eight.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 7.35 to 8.5 p.m.]