Private and Voluntary Health Care (England) and Care Home Regulations 2001

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Peter Bottomley: I am grateful for this chance to contribute to the debate on the regulations. Although we always give encouragement to the Minister and the Minister's advisers, we should also give them thanks, as putting these regulations together cannot be easy. Understanding the needs that people have to meet is not easy, consultations and analysing the responses to consultations is not easy and having to advise Ministers while hon. Members are asking questions cannot be that easy, either. I pay tribute to the Minister's advisers.

May I clear up one or two points, although in doing so I may perhaps make them more confusing? I quote:

    ''The provisions of this Part shall apply where any child is accommodated in the care home.''

That means that it could apply to a child of any age. The complication is slight but significant.

I want to address an issue raised by my hon. Friend the Member for West Chelmsford on regulation 19, which relates to ''Fitness of workers.'' I refer to all those who work in care homes in regular employment, whether part time or not—although I leave aside those with trivial roles, such as delivering the milk. If a threshold exists for part-time employment that should be known about, I hope that all the relevant professional and trade magazines will be informed. Someone reading the regulation might think that it included the person who came in for three hours a week to do gardening. They might ask whether those people were covered by the criminal records check. In practical terms, it would be useful for that issue to be considered and the information to be given out, as regards both what the law is and what the regulations are intended to achieve.

Agency staff may be employed in a care home, but most of their work may not be in care homes. Assuming that the agency does not simply organise their work but is an employer, does it have an obligation to ensure that criminal checks are made? I may sound as if I am trying to think up difficulties, but these are practical issues that apply to a significant number of people who are involved in this area as part of their work, if not their mainstream work. I do not expect to receive a detailed answer today, and I apologise to the Minister for not having put those questions to her before.

I turn to regulation 45, which is in the miscellaneous section. When I was a junior Minister, I always found that those were the most interesting sections in terms of deciding what we were trying to do and discovering what the impact might be on others. I raise the question of adult placements, because several constituents have mentioned it to me. I should be grateful to the Minister if she dealt with the overall question, but particularly with the number of service users accommodated in care homes. A number of other items are of interest in that regulation, but that is the most interesting one of all.

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I think I am right in saying that, if someone is caring for adults in their own home, they have up to now been able to have a higher number than three. A number of people will have to change their classification when the regulations come in, which specify that

    ''no more than three service users are accommodated in the care home''.

That will mean that a number of good, competent, experienced carers may find that they go out of business. If they have four people in their home at the moment, they will find that none will be able to continue with the accommodation and the care to which they have become used. Both the person making a living by providing care and the people receiving care will find their working lives, or their lives in general, disrupted.

What is the situation now, before the regulations impose the limit of three? How was the point covered in the consultation? What was the response to the consultation, and what change has been made in the proposed regulations as a result of the consultation? If the Minister answers those questions, we can ask her if she can give us some estimate as to what the consequences will be, if I am right in thinking that the figure of three is lower than the one that we have had up to now.

My subsidiary point may not be covered here, although I suspect that it is. An adult who is in a care home is expected to look after his own medicine. Up to now, the carer has been able to say that he will take control. However, if regulations—these or others—start saying that adults must be treated as if they can look after themselves and, therefore, their own medicine in the way that they are expected to look after their own money, are there issues on which the Minister may want to consult those who provide care within the domestic homes?

My final comment—to which the Minister does not have to respond—concerns regulation 44, which strikes me as one of the most sensible regulations, and is concerned with where more than one person is registered. It states that if the requirement is fulfilled by one person, it does not have to be fulfilled by the others. That strikes me as a good bit of plain English that achieves its task, and I congratulate the Minister and those who work with her.

6.30 pm

Jacqui Smith: I start by giving the context of the standards. I am glad that there has been a general welcome in Committee for the need to set in place new regulations and minimum standards. The old system is riddled with anomalies, and existing regulations and standards for care homes are administered in many different ways by different authorities, and some homes are not regulated at all. The Care Standards Act 2000, these regulations and the standards that underpin them enable us to change that and provide some consistency to service providers. Perhaps most importantly, they enable us to put service user's interests at the heart of the regulatory system.

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Committee members have not forgotten this today, but people sometimes do. We are talking about people's homes—the place where they live either temporarily or for many years. People who need residential services are entitled to as many as possible of the comforts of home life that the rest of us take for granted. The regulations and standards recognise that providers' and users' interests often overlap. Good, well-run homes should be allowed to carry on caring for their residents but, as in the national health service, we must ensure that the services are organised around the needs of the user and not the provider.

We must ensure that the standards are introduced in a way that both safeguards users and maintains good homes. That is why, after listening to the results of consultation, we made changes to the standards, putting off the environmental space standards until 2007 and ensuring that space could be used flexibly. I promised in the House to discuss with the National Care Standards Commission how it would undertake its regulation in a common-sense way. I have done that and announced today that we have issued statutory guidance to the NCSC to ensure that the application of the new standards does not close good quality care homes. The hon. Member for Oxford, West and Abingdon made a point about the architectural concerns that might prevent some environmental standards from being met. The guidance says that the commission should consider where the care homes could fulfil the needs of service users without making environmental changes. In other words, it puts the needs of the user at the centre of both the regulatory process and the way in which that process is interpreted by the NCSC.

The guidance has been welcomed by the Registered Nursing Homes Association, the National Care Homes Association and the Independent Healthcare Association. We undertook to make available an information pack for registered care providers and a helpline to answer questions about how the national minimum standards will apply to their service, so that we can achieve the objective of assisting care home owners to raise standards, while providing them with the maximum information necessary.

The hon. Member for West Chelmsford talked about a common-sense approach. Committee members may be interested to know that, in response to my discussions with the National Care Standards Commission, Anne Parker, who is its chair, wrote to me to outline the approach that it intends to take. In particular, she says:

    ''Our inspections will look to support and develop good practice. To this end, in our first year of operation we will be inspecting services, recording where they meet the standards, where they fail to do so and where they exceed the standards.

    We will be asking service providers to show us how they meet the intended outcomes for service users, which are set out in the standards.

    We will record their good ideas and take an holistic view of the service which is being provided. We will listen to the views of service users and discuss the improvements needed to meet the standards with service providers. Where providers do not meet the standards we will set priorities and timescales for action.

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    Where we find any circumstances that are harmful to service users we will act swiftly, using the powerful sanctions made available to us by Parliament.

    The Board of the Commission wants to see good quality service provision. The national minimum standards do not imply lacklustre uniformity and we will be keen to promote innovative good practice where we find it.''

I hope that that goes some way towards answering the point made by my hon. Friend the Member for Stourbridge about how we will conduct monitoring and ensure consistency. The standards in the regulations will form the basis of inspections by the National Care Standards Commission. As we discussed, care homes will need to be registered with the commission and will be inspected. Anne Parker's letter outlined the approach that it will take well. The commission has an important role to play in feeding information to the Government and the public about the quality of care providers that they inspect and regulate, and the extent to which standards impact on quality and capacity in the various sectors.

The hon. Member for West Chelmsford made a number of points, some of which we covered yesterday, but we can reiterate and expand on them. Under the current framework, police checks are required on people seeking registration as providers or managers of services. Most local authorities also require such checks before staff commence employment in children's homes and other children's services. The new regulations require that criminal record checks be undertaken for all people working with vulnerable adults before they start work. That mirrors the position on people working with children and is linked to our policy on the protection of vulnerable adults.

On the points made by the hon. Member for Worthing, West, let me say that all people who have contact with vulnerable service users must have an enhanced police check. That will include staff working as administrators, cooks and cleaners if they have contact with service users. Staff who do not have contact with service users must have a standard check. That will also apply to those who work part-time and agency staff. The important question is whether staff have contact with vulnerable adults. That is where we need to ensure that protection exists.

Under the current system, checks can take 12 weeks or more to be processed by local police forces. The Criminal Records Bureau will reduce that to 10 days for a standard check and to three weeks for an enhanced check. I am aware that some providers are concerned that the requirement will affect their ability to recruit staff, but we are committed to the principle that such checks should be undertaken before people provide intimate care to vulnerable adults. However, there is concern about the extent to which the Criminal Records Bureau will deliver the timings set out from the start. I reassure hon. Members that the Home Office advises us that it is confident that the CRB will be operational on 2 April. However, we have introduced transitional arrangements for providers, managers and staff in case of further delays to the commencement of the CRB. Additionally, existing

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staff in care homes will not be required to undergo checks until April 2003. Those are significant concessions.

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Prepared 30 January 2002