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23 Oct 2007 : Column 49WH—continued
Ann Keen:
The Secretary of State has made it very clear that he is taking legal advice. Sadly, that is not going as fast as people in the Department, and
certainly Ministers would like. However, the Secretary of State is taking advice and meeting regularly with the strategic health authority and chief executives to address all of the other concerns that the right hon. Member for Tonbridge and Malling rightly raised in his contribution.
We cannot take this matter more seriously, because the most serious errors have taken place in Maidstone and Tunbridge Wells NHS Trust. I assure Members that the Secretary of State is working very closely, on a daily basis, with everybody, in order to bring these very sorry events to a conclusion, and to move on in the most positive way possible.
Many measures have been put into place in Maidstone to improve systems for monitoring all infections, which of course have to be in place in all trust and primary care trusts. In particular, I take note of the right hon. Gentleman’s comments about community trusts and community beds. I assure him that I shall go back to the Department and check up on that. I would be very happy to discuss my findings with him.
We have reviewed nurse staffing levels and are recruiting to enlarge nurse staffing numbers on wards. As a former nurse, it is beyond my comprehension how such a level of infection could take place in 2007. I accept that they are operating in very poor conditions, and I accept the point about the speed of the reconfiguration, and emphasised it to the Secretary of State, who is working very hard to address it.
We have extended cleaning in all clinical areas. Of course, we have relaunched the “Clean Your Hands” campaign. I am aghast that we have to do that, but we do, across the board, from the most senior medical consultants down to the most junior members of staff.
Mr. Jim Devine (Livingston) (Lab): I, too, am a former nurse, and I remember the smell of cleanliness in hospitals. Is the Minister aware that, in 1982, 170,520 ancillary staff worked in NHS hospitals in England, but, by 1995, that number had fallen to 66,760? At the same time, there was a corresponding increase in MRSA and other infections that have been highlighted. Does she agree that it is time that we got back to the domestic levels of cleanliness in hospitals that we had in 1982, prior to compulsory competitive tendering?
Ann Keen: I agree. Of course, given that we both worked in hospitals back then, we know how important domestic staff are to the well-being of patients and of the contribution that they make to the team. If they are designated to be in one ward or clinical area, they take pride, and always have done, in their work, and feel as responsible for the cleanliness and infection rates of their hospitals as any member of the professional team.
I agree with the right hon. Member for Maidstone and The Weald (Miss Widdecombe), whom I met this morning, and who said, in her own way, that an air of carbolic is required in our hospitals once again. However, we must look at individual practice in the case before us, which we have said was unacceptable. Now we have to look to the future and help to restore community confidence in the Maidstone and Tunbridge Wells area, and I know that hon. Members will work with us to help with that.
Targets have been mentioned, but the Healthcare Commission pointed out that targets in themselves did not create this problem, because other organisations meet targets while keeping patient safety as paramount at all times. Complaints must be taken seriously. In this instance, for those of us concerned with health care professionals, one complaint would have been one too many. We also need to look to how we manage C. difficile infection in the future. It has always been an infection in its own right, and the medical care of patients and the appropriate use of antibiotics is paramount, as well as the cleaning. We must take a team approach to this difficult infection. In many areas of microbiology, other countries are now looking to us to see how we can assist them.
We must not forget the hard work and dedication of our NHS staff who feel the anger and shame of what has taken place in Maidstone and Tunbridge Wells. We all understand that the public expect to be cared for in clean hospitals, which is why the Prime Minister announced the big spring or autumn clean—whenever it takes place— but that is just one thing. It is not sufficient, but it will start to give the public the confidence that they always had in the cleanliness of our hospitals. The way in which clinical matters are managed and run needs to be looked at again.
I could, of course, go back a few years when it was unheard of to have such a busy stream of people in and out of wards and clinical areas, and to see our hospitals used by so many people in so many different ways at the most inappropriate times. I have asked the chief nursing officer to look at that. Pilot projects taking place in parts of our hospitals are showing huge signs of saying, “We will have rules and all the clinical staff will obey them.” However, in this case, that is not enough. Senior people across the board will be, and have been, called to account. The Secretary of State and I want to work with a new chairman and chief executive, and to get round the table with all the hon. Members concerned to look at how best to do that.
My door is open to all hon. Members in order to get this right and to see how best to work with constituents so that we can restore confidence in the NHS, in which we still have great pride. That is a serious issue. We can balance books and meet targets, which have helped patients, but we also need future targets to reduce infection rates and to adhere to a very strict code of practice. The chief executive, David Nicholson, has sent out a very strong message to all NHS managers saying that an atmosphere of being unable to report situations and of complaints not being taken seriously will not be acceptable at any level. All members of staff must feel that they operate in an open and safe environment, and patients and communities must always feel that about our beloved NHS.
Senior Care Workers
1 pm
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) (Lab): The quality of the life of a nation is judged by how it treats people who are most dependent upon the care of others. In this country, the care of our elderly should be not only one of our most important concerns, but one that we constantly monitor and assume to be fundamental to the quality of their lives.
Some months ago, I was approached in my constituency by a series of Filipino care workers who, to be frank, I did not know existed in my constituency. They gave me the names of and information about three care homes, owned by Southern Cross Healthcare, which I did not realise existed. They told me that they, who had been working for periods of between four and six years in this country, almost all of them with children in local schools, mortgages and stable homes, had suddenly been confronted with a case that they had never expected.
The new Border and Immigration Agency had decided, without, as far as I can see, any consultation with Parliament, that the rules for care workers needed to be changed. The work permit applications for senior care workers were altered in such a way that people who had been working sensibly and quietly at difficult jobs were told that their work permits would not be renewed. I am glad that my hon. Friend the Minister is replying to the debate; but frankly, in the past three months, I have been appalled by the way in which his Department—the Department for the Home Office, or whatever it happens to be called presently—has batted me about from one area to another with the highly spurious argument that not one Department is responsible for that set-up.
The Home Office Border and Immigration Agency, however, directly changed the rules of the game. In other words, when those workers entered the United Kingdom, not only were they accepted as capable of acting as senior care workers, but no one ever questioned their status.
David Taylor (North-West Leicestershire) (Lab/Co-op): The situation that my hon. Friend describes is very much like that in North-West Leicestershire and elsewhere in care homes in Coalville and in Castle Donington, where Filipino carers have worked for several years. Its worst aspects are tardiness and uncertainty, because the Border and Immigration Agency and the Home Office are not replying to letters. I wrote to the Minister, whom I greatly respect, on 4 July—not a single reply yet. I raised the matter in the Chamber on 9 July with the Home Secretary. I hope that that speeds things up and that we receive replies, so that we can remove the uncertainty hanging over many hundreds of people who perform a vital role for the very elderly in our society.
Mrs. Dunwoody: I hope to set out exactly that set of circumstances, because the whole episode has been a stain on the responsibility and reputation of the United Kingdom.
Many of the Filipino care workers were told that they must apply through their existing management, who initially said that it was the Government’s responsibility and that the workers were not allowed to apply for an
extension. Then, when we obtained information from the Government, the management said that a certain rate of pay—£7 an hour for people of their status—had been imposed and that it had been made very clear that, unless the workers were paid that rate, they could not be employed.
Is the Home Office now in charge of wage negotiations for people employed in private care homes? If it is, I understand why the Department of Health sent me a letter that said:
“Matters relating to pay and conditions of employment of staff employed by independent care home operators are for negotiation for employers and employees and/or their representatives, taking account of relevant employment legislation...the Department of Health extends only as far as the regulations and national minimum standards governing the quality and safety of care”.
If that is true, how have we found ourselves in that situation? In reality, large numbers of private health care workers, working in many instances for American chains, have been told that they cannot apply for an extension of care. Owing to the fact that those women—they are largely women—are Filipino and Indian, very law-abiding and extremely worried about whether they will be able to remain if they do not have legal status, they have in some instances been driven out of the country at very short notice, and they are in others terrified that, in some way, they will contravene the rules.
Chris Ruane (Vale of Clwyd) (Lab): I congratulate my hon. Friend on securing the debate. She mentions that the Filipino workers are law-abiding. Does she agree that, of all the immigrant groups, they are probably the most industrious, well-motivated, law-abiding and socially integrated in our society? Does she agree also that the Minister should show some compassion when dealing with that group and that they should be allowed to work out their current permits? Their precipitous removal would be at great personal cost to the individuals, their families and the hundreds of thousands of elderly people who need that top-quality care.
Mrs. Dunwoody: I strongly agree with every word that my hon. Friend says. Let us enumerate the qualities of those women: they are English-speaking; they are enormously warm in their approach; and they do difficult jobs in care homes dealing with the elderly—in some cases for the minimum rates of pay. They are doing jobs that Britons do not want to do—jobs that will not be filled successfully by people who are non-English-speaking. However, that appears to be the burden of the argument: get rid of people who are without the European institutions and countries, and replace them with people from eastern Europe. If that is true, it has been done in the most astonishingly incompetent, insensitive and appallingly thought-out manner.
I wrote to the Prime Minister saying that I was being bounced from one Department to another without any clear statement about the circumstances. I shall quote a letter from a marvellous man called David Edgar, who has been doing his best to protect those workers, simply because he was so concerned about what was happening in the care homes about which he knew. He said:
“There is...abundant evidence that...many small care home companies who are desperate to employ experienced and qualified Senior Care Workers who...speak excellent English...are quite
happy to pay the imposed hourly rate however their nightmare is the constant moving goalposts of the Home Office, the rules are now so complicated and conflicting that care home managers do not know how to apply for Work Permits, Visas and...at a cost of £190 for each Work Permit...are very reluctant”
Those are the responsible companies. The irresponsible ones have simply told people that they will not apply for extensions, and they are leaving large gaps. In subsequent evidence, Mr. Edgar says that he believes that many of those women are “now being blackmailed” into doing much harder work to fill the gaps and that, in some instances, they are being told that, if they create any difficulties about their terms and conditions, the Home Office will be told that they are not to remain because the company will not apply for any extended permits.
I apologise, but only yesterday did it occur to me that I could not be the only Member who was dealing with the situation. As we can see from the number of my colleagues who are gathered in the Chamber for a half-hour debate, that is true. Some 24 Members e-mailed me with specific details. Some of them had as many cases as me—I have more than 20 in my constituency—and some Members have up to 50. Some of the cases involve the most appalling stories. In one case, six care workers had their work permits refused, even though they had been here for four years.
My hon. Friend the Member for North-West Leicestershire (David Taylor) and many others have given me detailed case histories that not only chime with what I have discovered but make it clear that the problem continues. My hon. Friend the Member for Eccles (Ian Stewart) has approached Ministers and been given the same sort of reply as me and has also been told by a care home:
“The handling of this matter by the Home Office has been shambolic...No one at the Home Office gives a damn about the effect these guidelines have had on staff welfare. This is nothing more than an effort to increase the deportation figures”.
I do not have to agree with every word of that to say that Members of Parliament are extraordinarily concerned about what has been happening to those people.
If the Minister gets to his feet and says, “Of course, this is not a matter for me; it is for the Borders and Immigration Agency”, I can say to him only that there is a lamentable failure in management care in the Government, considering that two major Departments seem totally incapable of deciding what they want to do. If there was wide consultation on the change in the rules, with whom did it take place? When was it brought before Parliament and why were we not aware of it before it happened?
Once Members of Parliament started to raise the matter, the Home Office mildly backed off by saying that there should be a degree of flexibility in how cases are handled. However, as far as I can see, there has been no plain statement of the status of the women in question, even though it is known not only that they are desperately needed in the care homes where they worked, but that their absence is putting enormous strain on the existing health care staff and the quality of life of the people living in those homes.
Since a Department of Health Minister is responding to the debate today, I want to know what the Department intends to do. Why is it not possible for the Home Office
to grant those women an amnesty for a minimum of three months after the expiry of their work, if it can clearly be proved that they have been working here, in some cases for up to six years, so that they can apply for other jobs? Let them apply for other jobs in the health service or the care homes sector. There is absolutely no reason why that should not be so.
Filipino nursing qualifications are extraordinarily good. It is all very well for the Department of Health to say, “Well, of course they can get themselves accredited and apply.” Those women have no support system, do not know what they have to do to get themselves accredited in a foreign land and face the considerable pressure of wondering whether they will be thrown out of the country in a short time. It is clear, since none of us seem to have accurate figures of the number people involved, that more and more people’s work permits will soon expire and their cases come to light. Their Members of Parliament will ask for clear protection for people from whom we have clearly benefited, yet seem prepared to abandon without a thought to their situations.
I shall not take the Minister through everything that has happened to senior care workers, but I shall say that David Edgar, who has been fighting this battle almost single-handed, dealt with another Southern Cross home, not in my constituency. He made a request to the Home Office in July, and the carers in question were ordered to leave the UK on 27 July. The Minister was served with a letter before action, and legal action is taking place. However, in August, Southern Cross—the very people who were saying to their workers, “Well, I’m awfully sorry, but as far as we are concerned, once your work permit ends, you are on your own”—signed up to a skills pledge. Like me, David Edgar then went to every relevant Department. There was a change on 13 August, when new work permit criteria were introduced.
A parliamentary Committee condemned the poor treatment, abuse and neglect that elderly residents receive in many care homes, at the same time that even more difficulty was being caused. David Edgar then made formal complaints on behalf of various care workers about the way in which they had been cheated out of money. He was received not only with little evidence that the police intended to investigate but with scant courtesy. Since the beginning of the episode, there has been an appalling set of circumstances that does nobody any credit.
I wish to ask the Minister a number of things. Has his opposite number in the Home Office said that he is prepared to assist those women if they can genuinely show that they have been here for a certain length of time and have the skills to find jobs in the health care sector? If not, is the Home Office prepared to make specific undertakings on how those workers can be assisted in the interim period to deal with the circumstances in which they find themselves?
The Minister will forgive me—I am allowed an elderly moment. I did not realise that he was indeed in the Home Office. I am surrounded by Ministries whose names I cannot pronounce and whose acronyms seem to produce such sounds as “Brrrrrr.” He will forgive me for not realising that he has moved on.
Although I am allowed senior moments, I, too, will need care at a certain time in my life. I shall want it to
come from people who are nice, warm and caring and have proper training. The group of women affected exemplify those standards and the best in care work. Many of them are now terrified—I use that word advisedly. I have had people wandering into my surgery, as I am sure other Members have, saying cheerfully to me, “Oh yes, I was refused the right to remain here”—10 years ago, in one instance. Yet these women come to me weeks before their work permits expire and say, “We are so frightened. What are we going to do? We will have to leave our homes and take our children out of school. We will have to deal with it.”
If a mistake has been made, which I believe it has—24 Members of Parliament are not making up the problems that they have told me about—the Home Office should simply say so. It should bring in interim arrangements and make them clear and public. It should stop running away from what it obviously perceives as a suggestion that it is giving special care to those who come from outside the European Community, and it should ensure that it does not impose such things as hourly rates and then tell me that the matters for negotiation are for those in the health care service. It is a case of one or the other: the Government might decide on home care rates—fine, I do not have a problem with their setting minimum rates—but they should make up their mind. When they do, they must remember that the people affected are not toys or counters; we are playing with people’s lives. So far, we have not done a very good job.
Rosie Cooper (West Lancashire) (Lab): I endorse everything that my hon. Friend has said. There have been such cases in my constituency, and we cannot get people to fill the jobs created. The ladies at Stocks Hall nursing home do a fantastic job. They are caring, diligent and everything that one would want. The residents want them and so do the directors, but they cannot afford to pay them £7.02 an hour. I ask the Minister whether it can really be fair to allow those individuals to come to England, take up employment, settle in the community and then face deportation after two years. They are efficient staff members and really needed.
Mrs. Dunwoody: The Minister knows the case. Let us hear his explanation or, better still, his excuses and decisions about what he is going to do to assist such people urgently. This is an urgent problem.
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