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I have particular concerns about what happens when the condition of a patient in a hospital, as a result of the actions of staff, deteriorates. I cite an example that I
raised in an Adjournment debate relating to Parkinsons. If a Parkinsons sufferer is not given their medication at the right time, the chemical balance in their brain is altered and disrupted. The disease becomes uncontrollable. With an uneven release of dopamine, a person may be suddenly unable to get out of their chair, to walk, or to get out of bed. Sleep can be disturbed. Bowel and kidney functions and digestion can be affected. The individual can suffer mood swings, hallucinations, anxiety and fear. What will be the implications for ward staff and for care homes if, as a result of their failure to provide medication on time, a persons capacity to manage their life, to manage their bodily functions and to communicate is damaged? It can ultimately be destroyed for a number of months. From being someone who could rise out of bed and walk and talk, they can end up totally incapacitated purely as a result of the staffs neglect and failure. That surely must be something that can be tackled under the Bill.
Half of care homes in England and Wales are not meeting minimum standards in relation to medication. A large number of patients entering hospital find their conditions deteriorate because medication is not provided on time. I have seen service users behaving bizarrely and becoming aggressive and anxious because their medication has not been provided on time. For me, that is creating a situation where a vulnerable person is being abused and neglected.
We have older people and people with learning difficulties going into hospital who, because of the poor quality of care they receive, develop bed sores. We have people going into hospital who, because of the poor quality of care and the poor quality of nursing staff making sure that they are regularly toileted, become incontinent. That is surely unacceptable and we should seek to utilise the capacity to refer people to the barring board for poor-quality care to stress the need to drive up standards.
I cite another example of a service user whom I worked with. It was felt that abuse had happened within one of the homes in my constituency. The service user had been lying on the floor with his head against a hot pipe. As a result, he had burns on the top of his head. It was thought that that had been a situation of abuse and neglect, where the staff had failed to move the service user and had ignored the fact that he was lying on the floor. As a result, they were suspended and their behaviour examined under protection of vulnerable adults legislation.
I carried out the inquiry into that matter, taking with me one of the directors of the company, who was horrified, when we went through all the documentation relating to what had been going on in that care home for six months, to discover that we had a severely mentally disturbed individual who, on two occasions, had held the entire home at knife point. He had prevented staff from leaving the room and other service users from getting access to care. The staff had failed to call for medical assistance for him even though he was begging for that help and support. In fact, the failure of medical staff to pick that service user up from the floor did not constitute abuse because lying on the floor was part of his normal behaviour pattern, but there was an overall failure to protect a vulnerable adult by not seeking the required medical assistance.
I am sure that I am not the only Member who receives regular visits at surgeries from constituents who express concerns about the care in homes where members of their family are resident. Mrs. Bartlett visited my surgery because she was concerned that appropriate care was not provided for her mother, who was not fed and had lost a lot of weight. I am also concerned about day centres for people with learning disabilities. We need checks on those who regularly provide day care for such people and who are not covered by the current regulations.
The independent barring board is not a name that trips off the tongue, but we need people to understand it. We must widen understanding of the implications of providing poor-quality care that leads to abuse and to vulnerable people having less protection and security than they should expect from those charged with their care and protection.
Members have been careful to emphasise the point that no legislation can remove personal responsibility. As parents, relatives or carers, we have responsibility to ensure that those for whom we care are looked after by professionals in a professional manner to the high standard that we would provide ourselves. Through the legislation, we can prevent a repetition of the physical and sexual abuse of children and vulnerable adults in care that happened in Wales in the 1970s and 1980s.
I hope that we shall also put a stop to a practice that is all too prevalent: English local authorities placing vulnerable people in care homes in Wales. In some cases that I came across, such vulnerable adults were not visited for more than 18 years. Local authorities do not follow through on their obligation to ensure that care is of the highest order.
It is important that we ensure that, alongside the Bill, there is a full educational regime so that people understand their rights. Two thirds of children tell no one when they are sexually abused; they do not know how to report that they are being inappropriately touched and abused by adults they trust. Behaviour easily becomes institutionalised in care homes. If a person sees others not being fed or toileted, why would they expect to be fed or toileted themselves? When older people and vulnerable adults do not have the advocates they need, it is easy for their families and friends to be afraid of expressing concern about the care their family member is receiving. They are afraid of being criticised and told to take them away from the institution.
It is important that local authorities take responsibility for their contracts with care homes. I had responsibility for a care home where a local authority was paying for five staff to provide care for one service user because a risk assessment showed that such a ratio was necessary for that person whenever they left the care home and went into the local community. The local authority carried out no checks until it was pointed out that, often, only three members of staff were on duty at the home so the service user rarely left it.
We need to make sure that legislation for vulnerable adults and the implications of the independent barring board are highlighted for bodies that we would not
think were normally affected by such measuresin particular, local authority staff responsible for tendering. In my local authority, a tender was put out to taxi firms and a list that was seven years old, giving full details of names, addresses, dates of birth and medical conditions, as well as pick-up, drop-off and return-home times to a range of schools, was circulated to various taxi companies. Some of them no longer existed and some had moved offices, yet they were given access to extremely sensitive information about vulnerable people. It is important that even agencies that we would not normally think had a responsibility for protection are aware of their duties.
It is easy to express concern about a Bill such as this one and to point out that there are aspects that it does not cover. However, we have moved a long way in a short time to provide protection to vulnerable people and we should congratulate the agencies in local authorities, the providers of care and the hospitals and trusts that are working vigilantly and vigorously to raise standards and to ensure that much of the abuse that previously occurred no longer happens. We should welcome the fact that, thanks to the Criminal Records Bureau, 25,000 people who would otherwise have been working in care settings cannot do so.
There have been changes and improvements and the Bill will add to the protection arrangements that we are beginning to set up, but it is only a beginning. Those of us who work in this field are increasingly aware that we must always move on to find new ways of working with people to protect them. The Bill moves on to areas of protection that are needed, so I welcome it.
Mr. Andrew Turner (Isle of Wight) (Con): It is a pleasure to follow the hon. Member for Bridgend (Mrs. Moon), who has painstakinglyalmost painfully illustrated some of the devastating difficulties that she has become familiar with and that some of us have sadly become familiar with through our surgeries. That sets in context a couple of the rules that I almost invariably come to the House with. One is that there is no problem so great that the Government cannot make it worse and the second is that a Bill that has all-party support is almost certainly either wrong or inadequately scrutinised, or both. This is not such a Bill.
The broad shape of the Bill is reasonable. Difficult judgments have to be made and many difficult lines have to be drawn in what is inevitably a grey area. It is as well to recognise that, although we are working hard to get that right, we might wellon both sidesget it wrong in good faith. Whatever we do and however hard we try, we cannot guarantee safety either for the vulnerable adults or for the children who are the subject of the Bill. The best people to safeguard children are their parents, acting together and making decisions on the basis of their knowledge of their children and of the people who are to work with their children, and, in many caseslet us be honest about iton the basis of their gut instinct.
A friend of mine had a dog that gave birth to six beautiful puppies a few days ago and she remarked to me how wonderful it was to see that new mother bite the umbilical cord. What taught that dog to bite through the umbilical cords of those puppies? It was nothing other than instinct. The instincts of parents will quite often point them in the right direction. No amount of regulation or legislation can do that.
One of the things that most concerns me about the action of professionals in all sorts of areas is that they inadvertently undermine parents confidence in their instinct to act in a particular way. We are as bad sometimes, because we illuminate and flag up difficult cases, and we frighten people who need not necessarily be frightened. If they look after their children to the best of their ability and knowledge, they are certainly going to safeguard them more than any number of politicians or professionals can. If they exercise their knowledge of their children and exercise trust in those whom they know, and if they have some choice in where their children are educated, they will be making good decisions. To those who say that most sex abuse takes places in the home, I would mention that most sex abuse that takes place in the home takes place between people who are not blood relations. It is as well that we should recognise that and not use that point as an excuse to undermine what goes on inside the home.
There have been a couple of welcome changes in the Governments position in recent days. One is the recognition that there is a shortage of prison places in this country. The protection of vulnerable people is, in part, assisted by the imprisonment of those who would exploit or abuse them. There is a lot wrong with our prisons, but the aphorism that prison works is certainly true in one respect: it takes out of circulation those who would exploit or abuse young people and adults.
Anne Main: The point about prison, whether it works and how long we imprison people for has been a subject of much debate. For example, in my constituencyI know that this is fairly typical Mr. Michael Marsh, who had already served a sentence for sexual assault on an 11-year-old and had been let out, was convicted again on Friday for the abuse of a six-year-old boy, but his case will probably be eligible for consideration in 2008, despite the probation service saying that, in its opinion, he will remain a constant danger. Surely that is all part of protecting our vulnerable young people. If those people are in prison, we must make sure that they stay there for the correct sentence.
Mr. Turner: We must indeed make sure that they stay in prison. We must make sure that the judiciary are enabled to imprison them for an appropriate length of time and that the judiciary and the Prison Service are enabled to provide appropriate services in prison so that, for example, prisoners are not shunted from one prison to another in the middle of courses that may be designed to address their offending behaviour. There is a lot that is right about imprisonment, but there are some things that are wrong about the way in which our prisons work and we would do well to recognise those things.
Another way in which the Government are moving in the right direction is when they talk about
examiningI hope re-examining, because I hope that this was not ruled out in a knee-jerk reaction in the pastthe implementation of Megans law in the United States or Sarahs law, as we might call it here. Megans law, or Sarahs law, is not a charter for vigilantes. It gets to the heart of whether people can trust the state. If the state is going to lie to parents when they ask, Is the man round the corner a sex offender?that is what the absence of Megans law, or Sarahs law, says; it says that the police are going to liepeople will cease to trust the police and public authorities. I strongly advocate that we examine with an open mind whether it is better for people to know who the local sex offenders are than for those matters to be concealed from them and for them no longer to trust public authority. That will lead to people being treated more reasonably, not more unreasonably.
I will illustrate that point with an example from my constituency, where a particularly disgusting offender was released recently. He was released back on to the estate on which he had lived for most of his life. Most people knew that he had offended. In this case, it did not take the police to tell them; they recognised him. Parents knew him and knew that it was appropriate to tell their children to avoid himjust as in villages parents sometimes know and make it clear to their children that it is unwise to visit a particular house as a child on ones own. It is greatly to our advantage to trust people and, in particular, to trust parents with that knowledge. By all means take rigorous measures against those who indulge in vigilantism, but let us start by trusting the people, rather than telling them that they are wrong and that the professionals and politicians know better than they do.
There are two other areas where I fear that there is still a great deal more work to be done with offenders. As my hon. Friend the Member for St. Albans (Anne Main) has just suggested, one area is follow-up for those who are released. It is very concerning that people can be released from prison on parole or probation without even being interviewed face-to-face by the authorities that make that decision. I hope that, in future, in no case involving a child or a vulnerable adult will such parole be given without an interview. I hope that the Minister can give us that assurance from the Front Bench when he winds up.
On the second area in which the Government have not done all the things that they could do, I am sure that the Minister will be aware of the debate on the implementation of the Bichard report, which took place in Westminster Hall on 8 February. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) was present. The IMPACT database was recommended in June 2004, with a full business case to follow in March 2005. However, we were told that a full business case still was not in place by March 2006. Has that full business case yet been produced? Has the implementation date for the IMPACT database slipped beyond 2007? I certainly got the impression from the then Minister, the right hon. Member for Salford (Hazel Blears), that the date had slipped to 2010, so I hope that the Under-Secretary of State for Education and Skills, the hon. Member for Gloucester (Mr. Dhanda), can reassure me that I have got that wrong.
The Bill contains a wide range of provisions. My hon. Friend the Member for Basingstoke (Mrs. Miller) and the hon. Member for Mid-Dorset and North Poole (Annette Brooke) were right to say that the Bill is too broad and hollow and that it contains far too much regulation-making power, but far too little detail. We want clarity and certainty when dealing with such matters because as hon. Members on both sides of the House have observed, the proprietors of small care homes are not blessedif that is the right wordwith an army of lawyers.
I wonder why governors will come under the provisions of the Bill on regulated activities because they are not normally left in sole charge of individual pupils. I also therefore wonder why governors in schools, but not colleges, will be covered, and why people will be covered if they become governors in 2007, but not if they became governors in 1997. The Bill gives no particular justification for such peculiar arrangements.
My hon. Friend the Member for Basingstoke and the Minister for Children and Families referred to foreign workers. Should it not be an offence under clause 7 for foreign nationals who have been convicted overseas of a crime for which they would be convicted in this country to apply for employment in a regulated capacity? If a person with convictions that are akin to those that would bar a person in this country does any of the things covered by clause 7, surely it should be offence. Bizarrely, it will be easier to employ someone with a Criminal Records Bureau check that is five years old, or indeed someone with no CRB check at all who comes from a country in which records are not kept, than a college leaver in this country, given that the CRB sometimes produces responses to inquiries very slowly. I hope that that matter will be addressed.
Will the Under-Secretary give us some assurances about the behaviour of fellow patients, especially patients in mental health units, and, for that matter, fellow pupils and students in colleges? Health workers and others have a responsibility to those who have been sectioned under the Mental Health Act 1983, for example, to ensure that other people in similar circumstances are not a threat to those patients. If those people are a threat to those patients, health workers and others must be given sufficient information to know that those people are a threat to the patients and must take measures to protect them. Nurses and health workers are sometimes a little too inclined to feel that they must give patients the right to make a choice, rather than protecting patients who are perhaps unable to exercise such choice in the rational manner that we would expect.
Hywel Williams: I fully accept the hon. Gentlemans point about people in psychiatric units. Does he also accept that it is extremely difficult to foresee the people who might be a danger in one way or another? That is one of the reasons why the Government have experienced such difficulty in introducing a new mental health Bill to replace the 1983 Act.
The hon. Gentleman is absolutely right. No one is pretending that the problems are easy to solveI think that the Under-Secretary is agreeing. If
the problems were easy, we would have solved them years ago. However, the situation must be addressed.
We need to address children who commit offences against other children. I include in that category lads of 18 who have sex with girls of 14. It is a matter of concern to at least one of my constituents that such circumstances are not only apparently passing unpunished, but unrecognised by a school as a matter about which it should be worried. The issue is not taken sufficiently seriously. The Bichard report said that every case should be notified to the appropriate authorities because only those authorities could assess whether that case was part of a pattern of behaviour. However, some authorities are trying to row back from meeting that requirement by suggesting that social workers should make a judgment, rather than the police. The police areor, at least, are more likely to bethe people in possession of the full facts about a putative offender. The Bichard report thus said that they should be given such information.
Of course, rightly, not every case will lead to a prosecution. However, a failure to report followed by a failure to prosecute means that those who might turn out to be repeat sex offenders in later life have two opportunities to avoid scrutiny. Of course, not all those who are prosecuted will be added to the sex offenders register, which creates a third route. Additionally, not all those who are added to the sex offenders register will be recorded by the independent barring board because the Bill says that the question of whether even sex offenders between the ages of 16 and 18such people might have been prosecuted successfully for a sex offenceshould go on the register will be a matter of discretion.
I remind the House that Ian Huntley started his offending when he was under the age of 18. As I said earlier, at least one of the murderers of Mary-Ann Leneghan was under 18 when he committed that dreadful offence and at least one of the others had started committing pretty serious offences when he was under the age of 18. I thus hope that the Government will examine how the staff and governors of schools can not only be informed of sex offenders among the pupils at those school, but be empowered to take the necessary steps to restrict the activities of those children, at least while they are on school premises and under the control of the school, so that other pupils can be protected.
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