Abuse of Elderly People (Hansard, 21 April 2004)

§ Baroness Barker
My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as an employee of Age Concern England.

§ Baroness Andrews
My Lords, since 1997, the Government have done a great deal to address poor practice and to tackle the wilful abuse of elderly people. More initiatives are planned.
The Health Select Committee's recent inquiry into elder abuse is greatly welcomed. It draws public attention to an issue of great importance and confirms the Government's long-standing approach. Over the next few weeks, Ministers will carefully study the 40 recommendations made by the Select Committee, before issuing a formal reply.

§ Baroness Barker
My Lords, I thank the Minister for that reply. The Health Select Committee has accepted evidence from the National Care Standards Commission and from my honourable friend Mr Burstow that over-prescription of anti-psychotic and neuroleptic drugs is happening to vulnerable older people in care homes. Will the department, as a matter of urgency, issue regulations covering the administration of medication to vulnerable people, so that that abuse will stop? Will elder abuse feature in any future review of the National Service Framework for Older People?

§ Baroness Andrews
My Lords, the Select Committee referred to the Government's good practice in trying to restrain over-medication, which is something that we cannot tolerate. We would like to see it reduced, especially as it tends to become part of the culture of management, rather than being used to meet medical needs.
The current situation is that people who are on medication and are taking four or more medicines have their situation reviewed every six months, as opposed to the annual review for other people. Those provisions are monitored by the strategic health authorities. The NSF will come under review over the next six months, and it is likely that the issue of medication will be examined. However, the National Care Standards Commission and CHAI inspect the issue of medication robustly and in connection with national standards. We anticipate that next May the National Institute for Clinical Excellence will produce guidelines on dementia care, including the use of anti-psychotic drugs. We are keeping the situation very much under review.

§ Baroness Greengross
My Lords, does the Minister agree that people working with or caring for frail, elderly people need the support of trained staff, whether they work in the health service in the community or work in the community in social services? The number of health visitors who specialise in the field is virtually nil, and the number of trained social workers in the community is regrettably low. That situation cannot continue. If the help does not come early, we get terrible tragedies and abuses. What do the Government intend to do to remedy the situation?

§ Baroness Andrews
My Lords, the noble Baroness is right: the training and quality of staff are critical. One of the virtues of the definition of elder abuse that we have in our national minimum standards and guidance is that it ranges from casual indifference and neglect to physical harm. We care very much about the quality of training in care.
There are two changes that will make a real difference. Fifty per cent of care staff must now be trained to NVQ level 2 by April 2005, with a minimum of three days' training on that particular issue. For the first time, we have set a target that 50 per cent of domiciliary staff delivering personal care in the home, where, as the noble Baroness will know, most abuse occurs—often perpetrated by family members—must be trained by April 2008. We have already said that we will review that target, so we are taking urgent action.

§ Earl Howe
My Lords, does the Minister recognise the importance of the Select Committee's recommendation that we need a robust body of research into the extent and prevalence of the abuse inflicted on older people? Will the department follow up that recommendation without delay? It is fundamental to a proper understanding of the problem.

§ Baroness Andrews
My Lords, we will consider that recommendation in the context of all the recommendations. It is an important recommendation, and there a few things that I want to say.
First, we have provided considerable funding to Action on Elder Abuse—£400,000—for, inter alia, a specific project on data collection. The importance of that is that it will give us, for the first time, a chance to launch a national statistical collection, which can lead to performance indicators. That is an important step. Secondly, the guidance issued in 2001 requires local authorities, for the first time, to bring together information identifying and dealing with abuse. The important thing about that is that research is linked to observation and practice and is not simply an academic exercise. We know that the guidance works well; we are told that by the Centre for Policy on Ageing. We have a two-pronged approach. Thirdly, the Commission for Social Care Inspection generates information in its routine inspections. It is multidisciplinary in intent and will help to fill in a complex picture.

§ Lord Lipsey
My Lords, is not the root cause of the problem, in many cases, the inadequate fees paid by local authorities for the care of old people in residential homes? In turn, that knocks on into inadequate pay and training for the staff looking after our old people. Until we tackle that problem, nothing will happen.

§ Baroness Andrews
My Lords, the point about raising the standard of training for care staff, who do an incredibly important job in the domestic setting and in the care homes, is that it will attract people into the profession who will raise standards. Our approach to reducing and preventing abuse is to raise standards overall. That will make a significant difference to the quality of care.

Lord Renton
My Lords, will the Minister bear in mind that the proportion of older people in our society is increasing steadily and has done so for some years? Many of those who are of advanced age are nevertheless capable of leading a normal life and should not be penalised in doing so.

§ Baroness Andrews
My Lords, your Lordships' House is a good example of the productivity that comes with great age. We are approaching the concept of an ageing society much more positively. We are looking at and qualifying the notions of dependence and independence. The thrust of our policy is to keep people active, independent and healthy for as long as possible. That is why, for example, we are developing community care strategies, rather than putting old people into care at far too early an age. That is a positive policy.