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3.20 pm
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
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 had
- indicated 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. 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
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 were
- put 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.
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
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.
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