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2 Nov 2000 : Column 940

Care in the Community

Motion made, and Question proposed, That this House do now adjourn.--[Mr. Betts.]

7.1 pm

Helen Jones (Warrington, North): I am grateful to have the opportunity to raise the regulation of care in the community schemes. I do so following problems with a charity in my constituency called Integrate Services, which I have previously raised in the House. Now that the Charity Commission has made its report on Integrate, it is time to learn the lessons of the whole sorry saga and look at ways of preventing similar occurrences elsewhere.

Despite the problems, I believe strongly in the principle of care in the community. Properly regulated schemes offer their residents a much better quality of life and much better opportunities to participate in the world around them than would otherwise be the case, but it is important that we get the framework for the schemes right. They must be properly regulated precisely because they deal with some very vulnerable people.

Care in the community schemes have not always been properly regulated. The problem goes back to the way in which schemes were set up. In the 1980s, there was much pressure to move some of the responsibilities of health and social care on to independent providers. There is no doubt that that move was partly ideologically driven. At the same time, the pressure was on to empty our long-stay hospitals, and little thought was given to the legal framework within which the schemes operated, to their governance or to the need to protect the rights of residents. At the same time, as my hon. Friend the Minister will be aware, major changes were taking place in the health service, with purchaser-provider splits, the reconfiguration of health authorities and the creation of trusts.

It was the combination of that ideological pressure and the constantly changing roles of staff that meant that the necessary checks and balances were not built into the system. The system relies largely on good will. If we are honest, good will usually works, but we have to have a system that caters for the worst cases and has at its heart the protection of vulnerable people, many of whom, like those with whom I have dealt at Integrate, are without friends or family to speak on their behalf.

As my hon. Friend knows, the real problem is that the schemes are hybrids. They are often run by charities, but many of the charities are not fundraising organisations. They rely almost entirely on public money--usually on section 64 grants. Yet charity law is designed mainly to deal with fundraising organisations. The charities that run care in the community schemes have contracts with health authorities, but health authorities cannot force them to comply with certain requirements because the charities are regulated by charity law. The position has not been thought through.

Following the problems in my constituency, I spoke to many people in the health authority, in social services and in the voluntary sector. I am grateful to them for taking the time to discuss the matter with me. I want to offer a few modest proposals to take us forward.

It is clear that many health authorities do not have a strategic policy for developing care in the community. There is no requirement on them to assess client needs,

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to look at how those needs will change over time or to produce projections of likely demand. The staff who have most contact with people in care in the community schemes--general practitioners and community staff--are not brought into the process at all. In some respects, the whole modernisation agenda has passed care in the community by. I suggest that we should deal with that by requiring health authorities to include in their health improvement programmes an explicit section on care in the community, so that schemes can be planned and developed in conjunction with the providers.

The relationship between the health authority and the various providers will always be difficult. Too much contact will provoke allegations of interference, but too little means poor oversight of how public money is being spent. We need a simple mechanism to deal with that. Conditions should be attached to the award of a section 64 grant that would require care in the community organisations to make a brief annual report to the health authority.

In its report on Integrate Services, the Charity Commission recommended such an annual report. That report should deal with such matters as the funds that have been obtained, how they were spent and how much surplus was retained. When a charity is involved, the report should also notify the health authority of any changes in the objects of the charity. It should list the appointment of new trustees, the reasons for their appointment and the skills that they bring to the organisation.

I realise that some of those points might be somewhat contentious, but my experience with Integrate--when a charity changed its objects so as to widen its area of operation, but was under no obligation to notify the health authority, its main funder, despite the fact that the health authority had the locus only to fund care in Warrington--leads me to believe that such provisions are essential. There are other examples relating to that charity. Friends of the chief executive were appointed as trustees. One of them had been dismissed from the health service for gross misconduct. As the Charity Commission report pointed out, the trustees had very little concept of what their duties were.

I hope that my hon. Friend the Minister will encourage health authorities to look again at their contracting process. Contracts should cover matters such as the training that staff can expect. Authorities should ensure that there are schemes to deal with providers obligations under the Public Interest Disclosure Act 1998. In the case of the charity to which I referred, it was clear that staff had not always received the training that they had the right to expect. There was no procedure for dealing with whistleblowers, who were harassed and intimidated by management.

We should encourage health authorities to go even further in their contracts. They should ensure that independent advocates have a right of access to care in the community schemes and that there is agreement on how residents' personal finances should be dealt with. In the case that I mentioned above, when the health authority decided to change the provider, independent advocates spoke to residents and uncovered some heart-rending stories. If the advocates had had access earlier, many of the problems might have been prevented.

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The Government rightly want to ensure that advocates are included on hospital trusts; how much more important it is that people with mental health problems or learning difficulties, who have no friends or family to speak on their behalf, should have access to advocacy. That is a matter of basic human rights--as is ensuring that residents have access to their own benefit entitlements, instead of being dependent on cash handouts from staff. I hope that my hon. Friend the Minister will discuss with our friends in the Department of Social Security the current practice of allowing the mobility component of disability living allowance to be paid to managers of residential homes. In my view it is a pernicious practice and contrary to the rights of residents.

Health authorities should ensure that they have in their contracts an agreement on surpluses. Everyone accepts that organisations need a reasonable operating surplus, but the situation that occurred at Integrate--which, on an annual turnover of about £700,000, was building up a surplus almost equivalent to that of its successor organisation, which had national revenues of £22 million--cannot be allowed to occur again. It is a matter of ensuring that money given for the care of residents is used for that care, not to build up other assets for a charity.

Each contract should include an agreed exit strategy, so that if the health authority decides to move to another provider, it is able to contact staff to say what is going on. In my constituency, the health authority had no right to the names and addresses of staff working in Integrate Services, and they were fed a host of rumours by their management about what would happen to them.

That process of ensuring that proper matters are dealt with in the contract and in an annual report would seem to me to go a long way to improve the situation. The health authority could then annually conduct a short, sharp accountability review before it decided whether to make another grant.

Health authorities on their own cannot resolve the problem. I know that my hon. Friend the Minister is not responsible for the Charity Commission and I do not have time tonight to list what I believe to be all the faults in the Charity Commission's procedures, but it is undoubtedly true that it is too slow in conducting section 8 investigations. In the case of Integrate Services, the commission was notified in May 1999 of concerns about the charity but did not begin an investigation until September of that year, and did not report until September this year--long after the health authority had moved to another provider. That is simply not acceptable in a case that involves vulnerable people in residential homes, and it allows a crisis to build up.

In my view, the Charity Commission does not take these cases seriously enough, as instanced by the fact in this case that it was March 2000 before it appointed new trustees to the charity, as it was perfectly entitled to do, and that it never served an order on the charity requiring the production of papers. There are still allegations that the chief executive removed various papers from the charity. It is not surprising, then, that the Charity Commission could not reach a final view on many of the allegations because paperwork simply was not there.

The Charity Commission should do more. It should become much more proactive in giving advice to charities on governance and good practice, instead of waiting until problems occur. It needs to give advice on trustees'

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duties--such as advice on their relationships with chief officers, and on the sort of professional advice that they should be taking on certain matters. That is particularly crucial in small organisations, and if that had happened in this case, we might not have seen the problems that occurred with trustees. We might not have had the nonsense whereby an officer of the Royal College of Nursing acted as adviser to the trustees, when many of the complaints dealt with one of the senior officers of the charity, who was herself a former senior officer of the RCN, and no one saw that there was a conflict of interest. Trustees should have been given advice on that. I hope that, in future, my hon. Friend the Minister will discuss those matters with the Home Office, to see how we can proceed.

Lastly, I want to touch on the subject of the regulation of residential homes. We can talk about the duties of trustees--and they are very important--but everyone knows that much of the day-to-day care depends on senior managers who are running those homes. The Care Standards Act 2000 is a great step forward in improving residential care, but I hope that my hon. Friend will consider carefully whether inspectors should not also have the right to satisfy themselves about the arrangements for the recruitment, appraisal and monitoring of registered managers in such homes. They have the crucial day-to-day role. If inspectors have any concerns, they should also be able to call for a care audit by an outside organisation.

Our aim should be to prevent problems from arising and, when they do, we should ensure that they are dealt with a soon as possible. It is my firm view that the previous Government left us with a mish-mash of regulations on care in the community that simply do not work when problems occur. Our aim should be to ensure that vulnerable people are much better protected than they are and that we have a coherent strategy for providing and monitoring care in the community and for ensuring that such people receive the best possible services that we can provide. I hope that my hon. Friend will consider what his Department can do and, in the longer term, will examine the issues that need to be discussed with other Departments.

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