HC Deb 07 November 2000 vol 356 cc35-44WH 12.25 pm
Mr. Tony Baldry (Banbury)

I am very grateful for the opportunity to raise this issue, and to the Minister of State for being here to respond not only to my concerns but to those of many who are involved with the adult placement scheme throughout the country.

There may be people who are unaware of what the adult placement scheme does. In Oxfordshire, and in counties and local authorities across the country, there are a number of adults who need to be looked after but for whom traditional social services are not the answer. It has been found that the best way to provide them with the care that they require is to offer them the chance to live or stay in someone's home. That scheme is called adult placement.

The scheme gives those people many of the important things that only a real home can offer, such as help with day-to-day living, their own personal space, emotional as well as physical support, and a sense of belonging to and being part of the community. Those who need such care have a variety of needs. Some are physically handicapped, some have learning disabilities, some have suffered mental health problems and some are frail and elderly.

The adult placement scheme relies for its success on people who are happy to open their home to those who need help and care, either on a long-term or a short-term basis. Carers in Oxfordshire come from all kinds of background, but they have in common the lasting contribution that they make, not only to the life of an individual adult, but to the whole community. The people being helped by the adult placement schemes have a range of challenges, from handicaps and learning disabilities to mental health problems and problems relating to the frail and elderly. Those tend to be conditions that benefit from emotional as much as physical support, and many of the people concerned want company, apart from anything else, and understandably prefer a more personal environment.

Adult placement carers are committed to ensuring that the care that they provide is given in the most professional way. One of those carers has written to me, and says simply: We are Adult Placement Carers recruited by the Oxfordshire Adult Placement Scheme…to support and care for people who have disabilities or are vulnerable. The scheme in Oxfordshire is well monitored by the Scheme managers through Social Services. There is a close working relationship with the local Registration Inspection Office which advises both carers and managers when necessary. The approval procedure for recruiting carers devised by the Oxfordshire scheme is extensive and together with references and police checks enforces the high expectations of good care standards. We believe we offer a very professional and valuable service. However we are encouraged not to be complacent and strive to extend our skills through training and continually looking for ways to improve what we do. The sort of people whom such carers help have a wide variety of backgrounds and needs. For the benefit of hon. Members, I shall give four examples of constituents of mine who are being helped through the adult placement scheme. For obvious reasons, which I am sure that hon. Members will understand, I shall refer to people by letters rather than by name. Mr. X is a comparatively young man with learning disabilities and physical disabilities. He is a wheelchair user, has challenging behaviour and is occasionally violent. He was brought up by foster carers who are now elderly and can no longer care for him. Mr. X was placed in residential care in a staffed group home, which did not work due to his high level of support needs and disruptive behaviour. He was then placed in an emergency bed of a larger residential home while a more permanent placement was found. The care package was extremely expensive; extra staff had to be brought in to deal with the challenges that he presented to the service.

A couple of years ago, Mr. X was referred for adult placement, and a family with suitable ground-floor accommodation and the necessary skills to support him was identified. A carefully planned introduction programme to the family took place, with overnight stays increasing until Oxfordshire county council felt that the time had come when the placement could succeed.

Earlier this year, Mr. X moved into his new adult placement home. Since then, his behaviour has improved considerably. He has learned more socially useful behaviour from the family, which has, in turn, improved the responses that he gets from the general public when he is out in the community. That makes him feel happy and builds up his self-esteem and confidence, giving him the clear message that what he is doing is right. He says that he is very happy with the adult placement scheme—among other things, he likes the cooking.

Another constituent of mine, Mrs. Y, is a lady in her mid 60s with paranoid psychosis and serious alcohol problems who has taken overdoses of medication and has had recurrent suicidal tendencies. She was sectioned under section 3 of the Mental Health Act 1983 and placed in a hospital for older people with mental health problems. Earlier this year, Mrs. Y was introduced to an adult placement carer, who visited her in hospital and gradually gained her trust. Mrs. Y had a trial period staying with the carer, who has a nursing qualification, and a couple of months later moved in full time.

During the first few weeks, Mrs. Y tested the adult placement carer's patience and commitment to the limit, but everyone persevered and Mrs. Y's mental health has improved greatly since moving in. Her drinking has reduced dramatically and she takes pride in her appearance, mixes socially with the adult placement carer and the family and has started to access local community facilities such as day centres and clubs for older people. She now has someone to talk to who genuinely cares for her and sees her through the bad spells, and there has been no further talk of suicide since she moved in.

Mr. Z

is a middle-aged gentleman who had an accident in 1993 that caused severe head injuries. After major surgery on his brain and a long stay in hospital, he returned home to his wife and young daughter. He had been left with poor memory, poor concentration, little insight and extremely high levels of fear and anxiety. He forgets things that have been said to him a few minutes earlier.

About five years ago, Mr. Z was referred to adult placement because his young daughter was having great difficulty in coming to terms with the fact that her father was behaving like a small child and could not be left alone. She was having behavioural problems herself, both at school and at home. Mr. Z's wife was trying to cope with her own grief at the loss of the husband she knew, as well as with his care needs, and the family was in crisis.

Mr. Z

was given an introduction, over a long period, to an adult placement family. He had a great fear of leaving his wife and home to go into respite care, and forgot who the adult placement carers were after each visit. The whole process was traumatising for him, his wife and his daughter. Mr. Z has been going into respite care every month since 1995, which has enabled Mrs. Z to have time with her daughter and to support her through this difficult time. The daughter's behaviour improved as time went on, and she is now coping again at school. Mrs. Z's knowledge that she has access to respite care enables her to carry on caring for her husband at home.

This is a matter not only of full-time placements, but of respite care, and even, in the case of my fourth and last example, of occasional nightly care. Miss B has learning disabilities. She attended a large day centre five days a week, which gave her carers a break. She started to become depressed, her behaviour deteriorated and she refused to go to her day centre. That put her carers under great strain, and they talked of no longer being able to care for her at home. Miss B was therefore introduced to two different adult placement carers—one to provide regular respite care and one to provide care for two days a week. The smaller, quieter environment of the adult placement carers' homes, and the one-to-one attention, has proved to be what Miss B needed. She has attended those placements for more than five years and is still at home with her carers. The adult placement carers are paid £33 a night for respite care and £23 for day care. Hon. Members will agree that that cost is small, compared with that of the residential care that would have been required if her carers had not been given that support.

Adult placement carers are also available at times of particular need, and have great flexibility. For example, last Christmas the care management team of Banbury's Redlands centre, which looks after adults with learning difficulties, wrote to the leader of the adult placement team to express gratitude for its work and flexibility in the Christmas-new year period, and for finding suitable placements at very short notice and in difficult circumstances. Care managers said that the work was done well and helped to create a supportive environment at a difficult time.

I think that everyone would agree that the service is extremely impressive. It provides personal care for some very vulnerable people in a flexible, dedicated, committed and targeted way, and at no particular financial cost to the community. Certainly, it represents good value, so why are there concerns? According to Oxfordshire's social services department, the adult placement service has grown up over the years in an ad hoc manner and at different times has been sucked into other developments such as the Registered Homes (Amendment) Act which has produced an uneasy fit between Adult Placement and the present small homes regulatory framework. Oxfordshire county council's carers are registered with the local authority, and the council works with the county's inspection unit to ensure high standards. Potential difficulties arise for adult placement schemes because of the regulation proposed by the National Care Standards Commission, brought into being by the Care Standards Act 2000. If adult placement carers continue to be regulated in the same way as small care homes, the future of an adult placement scheme such as the successful schemes in Oxfordshire will be under threat. That is the crunch issue.

If carers who take people into their private homes are treated and regulated as though they were small, residential care homes, the future of this scheme will look pretty bleak. First, the standards and requirements set for small care homes will be inappropriate for normal family homes. Oxfordshire county council is worried that it will lose, and be unable to recruit, carers who cannot adapt their normal domestic accommodation to meet the levels set for small care homes. Even where accommodation can be adapted, the social services are concerned that the domesticity and normality that is so important in adult placements will be lost.

Secondly—and, I suspect, even more importantly—charges for registration of small care homes will not be on a scale that normal families or individuals can afford. Nor will it be easy for social services to meet those charges. I understand that the new National Care Standards Commission will be self-funding. According to a recent paper that was published by the university of Kent's personal social services research institute, the cost of registration for small homes could rise from £252 to £1,960 a year, while annual inspection costs could rise from £42 to £1,100 a year. As Oxfordshire county council currently has around 100 carers, the annual cost of inspection alone could exceed £1 million. The figures are ludicrous and would threaten the viability of the scheme not only in Oxfordshire, but throughout the country. Oxfordshire and other local authorities would be unlikely to recruit carers if they were expected to meet those costs, which, if we cannot find an alternative, would undermine a useful scheme.

Oxfordshire county council favours effective regulation and protection for service users, but believes that that could be achieved more appropriately by regulation of the adult placement schemes. I hope that the Minister and his Department will consider that option. The Department would have to be satisfied that Oxfordshire county council was implementing the adult placement scheme in a fit and proper way, inspecting individual homes and taking care to ensure that carers were delivering a high standard of care. There has not been a scintilla of a suggestion that the council is doing anything other than that at present, or that adult carers are not delivering the most gentle and worthwhile personal care for anyone in need in their homes. If the Department were minded to regulate the adult placement schemes instead of individual carers, we might have an effective and proportionate system of regulation.

I wrote to the Minister of State enclosing a copy of a letter from Oxfordshire social services, and I expected to receive a reply stating that my fears were misplaced, that the Department understood the concerns about adult placement care schemes and that proportionate regulation would be introduced. However, the Minister did not state that. Instead, he stated: The development of national minimum standards is part of the reforms that this Government is putting in place to modernise the current regulatory system for social services and nursing homes. My argument is that the homes are not nursing homes but private homes offering care. The Minister continued: The Care Standards Act…will bring about these reforms, including the establishment of a National Care Standards Commission to regulate social services and private healthcare. National standards, which will apply to all providers across the country, will mean that providers will be clear about the standards they will have to meet to gain and maintain registration. Users and their carers will know what they can expect as a minimum. Homes, which provide good quality care, should have nothing to fear from the introduction of national standards. I suggest that the word "homes" is confusing in that context. The homes covered by the Care Standards Act 2000 are residential care homes, which usually have a number of residents and are usually run for profit. The homes that I am discussing in the adult placement scheme are not homes in the institutional sense, but those in which individual carers provide individual care in their own home and often to a single person.

The Minister's reply continued: National standards are currently being developed for a range of services to be regulated by the Commission including…care homes for adults with disabilities. Again, those care homes are not institutional homes, but may be individual homes in which adults with disabilities are looked after. The Minister continued: Regarding the latter, a reference group has been set up which inputs to the development process and the National Association of Adult Placement Services (NAAPS) is represented on that group. I trust that you will be reassured to know that consideration is currently being given to having a separate sub-set of standards for adult placement carers. I think that I understand that. However, I would welcome it if the Minister said that it did not mean that the bureaucracy and associated cost of registration would continue; that the Department recognised that adult placement schemes were different from residential care homes and that it was dealing with a group of people whose care could perfectly well be monitored, inspected and regulated by social service authorities such as that in Oxfordshire; and that the Government would introduce a scheme that was not over-bureaucratic or over-costly. Those schemes should be encouraged to develop and grow, and should not be threatened.

The Minister of State continued: As a separate exercise, the Department of Health also plans to issue guidance to local authorities and the independent sector on the running of adult placement schemes. I understand that Oxfordshire county council already has fairly rigorous guidance; over the years, it has developed its own practice standards, which are good.

The issue turns on a narrow but important point. We have some excellent adult placement carer schemes in Oxfordshire, and others are in place throughout the country. They involve hundreds of committed carers giving invaluable care to some of the most vulnerable members of the community. Perhaps unwittingly, that care and those schemes may now be threatened by over-regulation under the Care Standards Act 2000. I hope that the Minister can say today, clearly and without reservation, that the Government recognise that that is a potential problem and that they will be able to respond in such a way that adult placement carer schemes are not put in jeopardy.

12.47 pm
The Minister of State, Department of Health (Mr. John Hutton)

I thank the hon. Member for Banbury (Mr. Baldry) for giving us the opportunity to discuss the future of adult placement schemes. We agree that they are important. I am particularly grateful to the hon. Gentleman for the careful and sensitive way in which he set out his arguments, and I shall try to give some of the reassurances that he and the Oxfordshire service seek.

As the hon. Gentleman said, Oxfordshire social services has operated a successful adult placement scheme for many years. It provides flexible, practical and emotional support for vulnerable adults. Carers offer long-term, respite and short-term care, and emergency or day care, either in the adult placement carer's home or the home of the service users.

I understand that service users are charged according to the type of service that they receive. Those who are placed in homes classified as small are charged according the national regulations set out in "Charging for Residential Care". Those who are supported in the community are charged under Oxfordshire's charging policy for people with a disability and, therefore, according to their own financial needs.

Recently, as the hon. Gentleman will know, the scheme was the subject of a social services committee report which resulted in members' wisely agreeing to increase the number of people employed in order to match service users to carers—the adult placement scheme workers themselves—and the formation of an approved panel of carers. Those were sensible and prudent decisions. The Oxfordshire adult placement scheme is one important part of the range of social services that are provided by many authorities.

We estimate that about 10,000 people may now be using adult placement services in about 6,000 homes. However, not all those homes require registration, but only those that provide personal care. About 85 per cent. of the schemes are run by local authorities, 60 per cent. of service users have learning disabilities and about 15 per cent. are elderly, and the services are used also by people with a wide range of needs. The services enable people to enjoy a better quality of life than would otherwise be possible, and the Government fully recognise their valuable contribution. I can tell the hon. Gentleman that we certainly will not be taking action that might jeopardise their viability.

The Government are committed to promoting people's independence, improving protection and raising standards. In recent years, social services have become more responsive to individual needs, but there are failings in the present system that must be tackled. That is why the Government introduced the Bill that became the Care Standards Act 2000, which received Royal Assent in July, to put in place key building blocks of our programme for modernising health and social care, and especially for improving the quality of protection in those services. There are many well-run, good-quality services but some have fallen short of acceptable standards, as several inquiries into abuse of vulnerable service users have testified. Providers of services therefore need to know what standard they should meet and service users also need clarity about the standards that they may expect.

The new National Care Standards Commission, to which the hon. Gentleman referred, which will be set up under the Act, will be an independent body with the welfare and safety of vulnerable people at its heart. It will regulate children's homes and care homes for elderly and disabled people; it will also regulate other care services for the first time, including care to people in their own homes and fostering agencies, and in time it will also regulate day centres. It will advise the Government and inform the public about care services generally and about monitoring trends and national quality.

The deficiencies of the present regulatory system have been well documented and exposed by scandals such as those at Longcare in Buckinghamshire. Such abuse cannot be tolerated and we are determined to improve the protection of people who use these services. The homes where standards are shoddy and the quality of life poor do not hit the headlines, but we are equally determined to improve those services. However, in doing so we will not impose unreasonable burdens on those who provide that type of family-based service. I reassure the hon. Gentleman that it is not the Government's intention to make life unnecessarily difficulty for local authorities or for adult placement carers. It would be counter-productive to strangle these valuable schemes with red tape and we will not do so. We shall ensure that the new regulatory regime is flexible and proportionate to the type of services being regulated.

The hon. Gentleman quoted several figures for the cost of registration and inspection to small homes, which have been circulating for some time. I reassure him and the interests that he articulated that no decisions have been taken about the final level of fees. Although it is our policy intention that ultimately the system of regulation and inspection should be self-financing—the previous Government, of which the hon. Gentleman was a member, was also committed to that policy—let me reassure him that recognition will be given to the particular nature of adult placement carers when we set the appropriate fee structure. I hope that he is also reassured that we will consult fully on the issue before final decisions on fees are taken.

All adult placement carers are required to be registered if they are providing accommodation, board and personal care; that has been the position since the Registered Homes (Amendment) Act 1991, introduced by the hon. Member for Bournemouth, West (Mr. Butterfill), which had wide cross-party support. You were a Member of the House at that time, Mrs. Michie, but I was not. I reassure the hon. Member for Banbury that the Care Standards Act 2000 has carried forward the position outlined in that measure, and that we have not changed the basic requirement of registration in that regard. However, we anticipate that adult placement carers and their homes, which need to be registered, will be treated as a separate category under the new regulations. We shall be able to tailor the regulatory demands to ensure that those placed on adult placement carers are kept to a minimum. The standards to be applied to adult placement schemes will therefore be different in nature from those applied to registered care homes—that point was raised, sensibly, by the hon. Member for Banbury—and will in future recognise the special characteristics of the schemes. The hon. Gentleman described many of them as being the small, private homes of individuals and we shall take that into account.

National standards are being developed for a range of services to be regulated by the National Care Standards Commission, including care homes for adults with disabilities. We have been anxious to ensure that the standards take account of the needs of the various client groups who use the services and of the nature of the services that are being provided. We have an advisory group helping us on the development of the standards for care homes and, as the hon. Gentleman said, the National Association of Adult Placement Services is represented on that group. As part of that work, a separate set of standards specifically for adult placement carers is being drafted. We intend that a consultation document on the national standards for residential services for adults should be published later this year, together with those for adult placement carers. We are trying to fix the appropriate level of regulation in this area in a fully open and consultative manner. I hope that the hon. Gentleman can lend his support to that approach.

Given the breadth of the Oxfordshire scheme, which includes services provided in people's homes, it is worth mentioning that under the Care Standards Act 2000, Ministers have a new power to issue statutory guidance on charges for non-residential care provided by local authorities. That measure was necessary because of the unacceptable degree of variation in the way in which local authorities operate their charging regimes at present. We have been consulting a wide range of groups, including representatives of service users, and we intend to consult formally on new statutory draft guidance this autumn and issue final guidance by April 2001.

I agree wholeheartedly with the hon. Gentleman that adult placement schemes are a valuable resource. When they work well they can provide good-quality individual care. However, we must recognise that when they are not properly regulated or supported they carry similar risks for service users as do large care homes. Indeed, the potential for service users to be isolated and unable to voice complaints may be even greater in some cases. That is why regulation continues to be necessary, but it will be proportionate. Those who already provide good-quality services should not find it burdensome.

We are also taking a number of steps to raise the quality of services for individual client groups. Thus we have already introduced a national service framework for people with mental health needs and are currently developing a national service framework for older people, too. We are also developing a national strategy for people with learning disabilities—a client group that is frequently the major user of local adult placement schemes. Such placements are one way of enabling them to be included in the local community by receiving the support that they need.

It is worth pointing out that it is nearly 30 years since we took a comprehensive look at learning disability services, their rationale, relevance and effectiveness. Services have changed a great deal in that time, but the quality and quantity still vary considerably from area to area. That is unacceptable. The time is therefore right to modernise and improve our whole approach to supporting people with learning disabilities, both to reflect user concerns and to tackle some fundamental issues that we still clearly need to address. I hope that the hon. Gentleman can also lend his support to that process. We intend to publish the new learning disability strategy as a White Paper early next year.

People with learning disabilities are clearly among some of the most socially excluded and vulnerable groups in our society. We want to ensure that help and support are in place to foster independence, provide new opportunities and deliver high-quality services. I hope that the new strategy will seek to eliminate the current inconsistencies in the quality and quantity of services. As a Government, we are determined to ensure that services continue to improve and that those who use them may do so confidently and safely.

I am grateful to the hon. Gentleman for giving me the opportunity to clarify our intentions. I believe that the measures that we are taking will help to drive up standards. We need greater consistency in regulation, and the 2000 Act has given us new powers to root out abuse and unacceptable care standards. We need to use those powers appropriately and sensitively. I can assure hon. Members that the regulatory regime that we are in the process of setting up will be sensitive to the different needs of individual client groups as well as to the different type of provision that is being regulated. We shall therefore continue to involve a wide range of interested parties, including service users. We are particularly grateful to have had the expertise of NAAPS to assist us in that work, and we shall continue to involve it in future.

I am grateful to the hon. Gentleman for the way in which he has marshalled his arguments and put his case this afternoon. I hope that he has been reassured, at least in part, by what I have said. We do not intend to go about the business of ensuring that regulation is appropriate with a heavy hand or an iron boot. We intend to develop policy in this area carefully and sensitively. If the hon. Gentleman would find it helpful to see the draft minimum standards that we intend to consult on later in the year, I will arrange for him to have a copy so that he may give us his opinion of how we are going about that process. I hope that he will work with us to ensure that the new regulatory arrangements are sensitively introduced and do not have the unintended consequences to which he alluded, which would certainly not be in the interests of vulnerable people and would not address the wider concerns that we need to tackle if we are to improve quality standards in the country.

Question put and agreed to.

Adjourned accordingly at one minute to One o'clock.