Residential Care: Vulnerable Adults (Hansard, 12 October 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, there are existing procedures for reducing the risk of abuse and inappropriate treatment of vulnerable people receiving care. It is unfortunately not possible to eliminate all risks. But current procedures should identify abuse and, if it occurs, enable appropriate action to be taken.

§ Lord Rix
My Lords, I thank the Minister for that reply. Will the department closely monitor the performance of local authorities when they place people in homes outside their area, and also those who register those homes, to ensure that they implement their joint and individual responsibilities towards those people, particularly in regard to their welfare in those registered homes?

§ Baroness Cumberlege
Yes, my Lords. Authorities which place people in residential homes have a 894 responsibility for their welfare. It should never be a case of out of sight out of mind. Local authorities have a long-term responsibility not only for those whom they place but also for those for whom they contribute towards the cost. The department's social services inspectorate is at the moment in the middle of a comprehensive programme inspecting all those who register homes to ensure that both parties are playing their part.

§ Lord Renton
My Lords, can my noble friend give an assurance that it is not intended to relax the conditions for the registration of these homes? Indeed, would it not be better to tighten the rules and to close the unsatisfactory homes?

§ Baroness Cumberlege
Yes, my Lords. The Act enables local authorities, social services departments and health authorities to close homes. The proposals that we are currently consulting on do not in any way weaken the fundamental regulatory system. Nor do they reduce the frequency of inspection. In fact essential safeguards are being retained.

§ Lord Ashley of Stoke
My Lords, does the noble Baroness accept that while these problems are left to the localities we are bound to have a patchwork provision? The only realistic way of tackling them is to insist on national standards, national monitoring and national sanctions. As those cost money, should not the Government provide it?

§ Baroness Cumberlege
My Lords, the Government believe it is important that local authorities should be involved. Increasingly we are seeing more independent homes being established, and it is right that local authorities should be the first regulatory authority. But the Government also have a responsibility, which we accept, and that is why the social services inspectorate has drawn up a comprehensive programme to see whether the Act is working well. Indeed, there will be a major review in 1995.

§ Lord Swinfen
My Lords, are the Government prepared to increase the dissemination of information into the prevention of sexual abuse within homes and to undertake research into abuse of other kinds?

§ Baroness Cumberlege
My Lords, we are anxious that local authorities should be aware of all the problems that can exist. We are doing our best to disseminate as much information as possible and we are also getting involved in training.

§ Baroness Masham of Ilton
My Lords, how many of the inspections are carried out by spot checks? Is it not a fact that homes with fewer than four beds are not inspected at all? Is it not also a fact that some owners buy several units, put them together and then opt out of inspection?

§ Baroness Cumberlege
My Lords, local authorities have a duty to inspect at least twice a year. If they have concerns about a particular home or independent hospital they can go in to inspect more often. We suggest to them that at least one of the visits per year should be unannounced. Homes with fewer than four 895 beds have to be inspected in the same way as other homes. However, we have told local authorities that although they have to comply with the requirements they should have a lighter touch.

§ Lord Molloy
My Lords, the Minister is no doubt aware that there are three types of old people's homes. There are private homes, homes run by local authorities and those run by the DSS. However, there are some amazing differences between them. For example, it is not uncommon for an old person in a private home who has left his or her own home to the children then to be compelled to sell that home. There are old people in local authority homes who are also in some difficulty where local authorities differ from one area to another. The DSS is doing as much as it can, but more old people are living longer than ever before in our history. There are now some 10 million old people. Should there not be co-ordination among all three types of home to ensure that fairness is observed at all levels?

§ Baroness Cumberlege
My Lords, the noble Lord is absolutely right to say that there are different sorts of homes. However, I should explain to him that no home is run by the DSS as such, although it will support people in independent, private and voluntary homes. I believe that the fact that we are all living longer is a great tribute to the National Health Service. I am very proud of that fact. Indeed, there is wonderful evidence of it all around us here this afternoon.

§ Baroness Gardner of Parkes
My Lords, is there not a particular problem in cases, for example, of brutality where patients, whether in a hospital or a home, are incapable of being able to speak up for themselves? Further, is it not important that our whole climate and attitude of care should be such that others would not permit that to happen in their presence?

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right. We recognise that brutality does not take place where there is a culture which is open and which involves other people. I know that MENCAP and other organisations are increasingly involving volunteers in the inspection process. I believe that that is a very good way forward. The more that we can involve the community in such homes, the less chance there is of abuse.

§ Lord Carter
My Lords, is the Minister aware that a recent report by the Royal College of Nursing into the regulation of private nursing homes and hospitals concluded that, the system for registering and inspecting the private homes and hospitals in England and Wales is inadequate. This inadequacy exists against a backdrop of confusion about whose responsibility it is to pay for continuing care for elderly people. The confusion has not been adequately addressed by the draft guidance issued in August 1994 by the Department of Health"? May I urge the Minister to consider that one practical and immediate step that the Government could take would be to end the four-year freeze on regulation and 896 inspection fees? Will she urge such action on her colleagues in the Department of Health and in the Treasury?

§ Baroness Cumberlege
My Lords, we welcomed the report produced by the Royal College of Nursing. We have drawn it to the attention of both health and local authorities because it was based on nursing homes and not on residential homes. We also asked the National Association of Health Authorities and Trusts to look at it and take account of it when drawing up its revised guidance. In our guidance, which is still in the process of consultation, with a closing date of 31st October, we raised the question of fees. There did not appear to be a problem.

§ The Countess of Mar
My Lords, before we frighten a great many old and disabled people into thinking that all homes are badly run, will the Minister agree that there are a great many nursing homes and residential care homes which are run to the very highest standards? I know that fact directly because I am associated with a number of them as I am chairman of an organisation which provides training for care assistants.

§ Baroness Cumberlege
My Lords, the noble Countess is absolutely right. In my experience, voluntary, independent and private homes have some of the very best care in the country but, I also have to say, some of the least good. Some of those that I have visited have the quality standard BS 5750; for example, the Kent Housing Trust is a housing association that carries out superb work and has improved very much on the quality of care that was given by the Kent County Council, which was the first to acknowledge that fact.