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11 Dec 2007 : Column 46WH—continued


11 Dec 2007 : Column 47WH

Five years ago, care homes were inspected against 38 standards, but that number was reduced to 15 in 2004 and will be further reduced under the new Bill. Since 2006, the frequency of inspections has been reduced from once every two years to once every three years, with a proposal for even less frequent inspections for good homes. Parkfields care home, in which five people were allegedly murdered, and Laurel Bank nursing home, in Halifax, had both passed their inspections, so presumably they could continue abusing at will. What is more, one fifth of care homes in 2006 failed on inspection to meet the minimum standard for medication and nutrition three years after the new standards were introduced in 2003, so what earthly justification is there for loosening the inspection regime? Is it simply that an inconvenient truth arises from inspection: that the system has lost control? Worse still, is it that the Government cannot afford a high-quality inspection system? Is that why the Minister is proposing an inspection holiday to allow the new arrangements to settle in? Would that be acceptable for care settings with vulnerable children? I think not. Yet it is okay for adults.

Let me assure the Minister that I do not wish to blame him for past failings because that would be grossly unfair, but I want him to acknowledge that there are serious misgivings about his proposals among organisations that support elderly, vulnerable adults. I cannot understand—perhaps he will explain—why routine inspections by pharmacists have been discontinued when there is a significant question about the use of drugs and medicines in some care homes. Surely, it is essential that pharmacists can check the use of medicines to ensure, for example, that residents are not being over-sedated or wrongly prescribed anti-psychotic drugs.

Equally, why is it now acceptable for a social care inspector, not a registered nursing inspector, to inspect a nursing home? A social inspector cannot physically examine a resident for signs of neglect or abuse, and many are not even trained to look for the key symptoms. It would be unacceptable for a social care inspector to inspect when an elderly adult was in a hospital setting, but there is not the same level of specialist service when someone is discharged to a nursing home. Will the Minster therefore give me an assurance that the number of nursing inspectors will be increased under the new arrangements and that patients in receipt of medical care, no matter how minor, will be seen by registered nursing practitioners? In short, can he give a categorical assurance today that the new arrangements that he proposes will put in place an enhanced, professionally appropriate and, above all, independent inspection system?

I come now to the issue of complaints. Until 2006, complaints received by the regulator were investigated by the regulator, and despite some obvious failings, there was a logic to the service. Since 2006, the Commission for Social Care Inspection has referred complaints to the relevant care home to investigate. Effectively, a care home investigates itself, which is akin to asking Herod to investigate child protection. How on earth can that system be seen as protecting the vulnerable? We know from the Department’s own
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evidence to the Select Committee earlier this year, which is at paragraph 235 of the Committee’s report, that residents and relatives are often loth to report abuse for fear of reprisal or even the loss of their place. At paragraph 237, the report concluded:

Yet that is the system that the Government say will improve the way in which complaints are investigated. Surely, the need to have a complaint investigated independently is the most basic of human rights. Can the Minister give me an assurance that he will introduce appropriate regulations during the passage of the Health and Social Care Bill to ensure that we have an independent complaints process, and give vulnerable adults who do not have family or friends to advocate on their behalf access to an independent advocacy service?

Since 2002, the regulation and inspection of care homes has been in a state of almost constant change. I accept that much of that is the result of attempts to improve the system, and I say that quite openly and honestly. However, that does not help the vulnerable and it does nothing to drive rogue operators and poor staff out of the caring system. The vast majority of those who own or work in the country’s 14,000 residential homes and 4,000 nursing homes deserve our thanks and praise for the work that they do in caring for the vulnerable elderly. However, most homes are grossly underfunded, have difficulty recruiting and training staff and must often deal with inappropriate clients who are placed in residential settings not because of their needs, but because of budget availability in local authorities. The huge expected increase in elderly vulnerable adults, many of whom will develop various forms of dementia, will present the Government and our society with a stern test in the years to come. As someone who is fast approaching maturity, I await the Minister’s reply with interest.

12.43 pm

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Harrogate and Knaresborough (Mr. Willis)—if I may, I will call him my hon. Friend—on securing an Adjournment debate on this incredibly important issue, which, as he said, will become even more significant, given the demographic changes that are taking place. I also congratulate him on the insight that he gave us when he declared an interest in this issue. On a serious note, however, he will be a great loss to his constituents and the House now that he has decided to retire from Parliament. I think that it was Tony Benn who said that retiring from the House of Commons allows people to take up their involvement in politics again, and I am sure that the hon. Gentleman will follow that view of the world.

I agree with the hon. Gentleman’s statement about dedicated staff at the front line in our care system. Every day of the week, they do a tremendous job of caring for older and, indeed, disabled people in what are sometimes difficult circumstances. The vast majority do their job in a compassionate, sensitive and professional manner, and we must always put such debates into that context.


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I also want to use this opportunity to express my heartfelt condolences to the families of those who suffered as a result of the dreadful tragedy at Parkfields home, about which we have heard over the past week. It would not be appropriate for me to comment on the individual case, which is under investigation, as everyone is aware, but our sympathies go to the relatives who have been affected by that dreadful situation.

I also use this opportunity to put on record my thanks to Action on Elder Abuse and its chief executive, Gary FitzGerald, for the tremendous work that they have done recently to raise the status and profile of this issue in terms of public policy. Arguably, the debate about elder abuse is where the debate about child abuse was 20 or 30 years ago, and it is important to understand that. Sadly, child abuse has touched the lives of far too many people in our country through the generations, but it is only in the past 20 years that we have started to talk about it openly and to recognise that there needs to be a complete step change in public policy. I suspect that we are in a similar position on the abuse of older people, as the hon. Gentleman implied. Action on Elder Abuse and Gary FitzGerald are our partners in dealing with these issues and they do an excellent job.

It is probably right to say that before the Government came to power in 1997, the level of protection and regulation in the sector was appalling. It is interesting that Her Majesty’s official Opposition could not even be bothered to send a representative to the debate. Before 1997, we lived in a climate in which regulation was a dirty word, and the whole sector had been deregulated. Indeed, the ring-fencing of community care funding in the early 1990s was a deliberate and very effective way of privatising virtually the whole care sector. Now, roughly 75 per cent. of social care is provided by voluntary and private sector organisations. I do not want to make an ideological point, given that much of the private and voluntary sector does a wonderful and very positive job, but what happened before we came to power was the result of an ideological programme, and part of the ideology of privatisation was the decision not to put in place an adequate regulatory system.

When the Government came to power in 1997, we introduced national minimum standards and the protection of vulnerable adults scheme. I understand the hon. Gentleman’s reservations about elements of the performance of the Commission for Social Care Inspection, but it has earned a good overall reputation as a regulator, and standards have continued to improve across the sector. That does not mean that we are where we need to be, or that great concern does not continue to exist about areas where performance is simply unacceptable and where the regulator might have been tougher in using its powers. On the whole, however, I want to put on the record my appreciation for the work done by Dame Denise Platt, who leads CSCI, by Paul Snell, its chief executive, and by the many other people who work for the organisation.

As the hon. Gentleman said, the Government are introducing a new inspection and registration regime, which will culminate in the development of the care quality commission. The idea is to have a proportionate inspection regime that in some ways has more enforcement
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powers than the existing regime, and which focuses the new regulator’s resources on those providers that give us most cause for concern.

In a sense, however, the regulator’s role is just a small part of the story of how we not only protect older people, but ensure that the quality of care that they receive is what it should be. I want to do more than protect older people—I want to ensure that they have the greatest possible quality of life, and I know that the hon. Gentleman shares that aspiration. We therefore need to look at the other factors that will improve quality and, in doing so, enhance the protection of older people.

The first of those factors is the introduction of the new star rating system—a transparent system in which relatives and older people themselves will be able to make judgments about the quality of individual care. That is moving much further on: from a register that, in a sense, defines minimum standards and accords a home the right to exist because it meets the basics, to an attitude that says, “Let us be in a position to make judgments about the relative quality of care offered by providers.” The star rating system will make the sector more transparent and give people far better information on which to base decisions that are often incredibly difficult about their care or that of a family member.

The hon. Gentleman will know that I am already committed to a fundamental review of the adult protection framework—the process will begin early in the new year—including assessing whether the “No Secrets” guidance has had a sufficiently powerful impact, and considering the case for a stronger regime. I have said that I am willing to consider, in the context of the review of the adult protection framework, the case for new legislation, if that would add value and make a real difference. Too often in this place, we reach for the legislative solution when it does not always add value or make a difference. I and my ministerial colleagues will need to be persuaded that additional legislation is needed for adult protection. I am open-minded about the possibility, but the fundamental review is to take place and I shall be sincerely pleased if the hon. Gentleman contributes to it. We are also committed to further prevalence studies, specifically on the abuse of older people. There was a study earlier this year on the abuse of older people in their own homes, and we now need to consider a broader piece of work on evidence about elder abuse in a variety of care settings.

Commissioning is arguably as powerful as, or more powerful than, inspection and regulation, given the daily relationship within the community between the local authority or primary care trust and the care providers. We have made that clear in the context of world-class commissioning. Yesterday we launched our new concordat with local government and the NHS on the profound reform of adult social care in the next three years. A key element of that reform programme will be telling commissioners that they have a responsibility to reward and offer premiums and incentives to care providers that offer quality, dignity and excellence; and that, equally—the message is a tough one—they should take their business away from providers that cannot offer that quality and dignity. Commissioning is no longer about securing minimum standards. We are saying that world-class commissioning should be about securing
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high standards. The local authority has more of a day-to-day relationship with care providers within communities than any inspection and regulation regime has, given the number of inspections that can be carried out over a given period. Therefore, we must also put pressure on local authorities and primary care trusts regarding their commissioning responsibilities.

Mr. Willis: Does the Minister agree that the practice of placing vulnerable adults who need nursing care in residential care settings, simply because that is the only place in which the cash-strapped local authority can afford to support them, is unacceptable?

Mr. Lewis: It is unacceptable to place older people in inappropriate settings. The decisions should be focused on the needs of individuals and their care requirements. I recently issued new guidance, which took effect on 1 October, on the funding of continuing care, because we know that many primary care trusts have been attempting to abdicate their responsibility and to define particular care packages as social care when they clearly include a nursing element. I hope that the new guidance will begin to change some of the practices that the hon. Gentleman has in mind, but equally, we must be clear about what high-quality commissioning really is. Part of it is a question of removing business from providers that do not offer quality to older people.

Yesterday, we made announcements on reform of adult social care, including giving far more power and control to older people and their families, with personal budgets and a choice about where they want their care to come from; that is another powerful way of influencing the system. If those people have maximum control, it is far more likely that they will choose care providers who can offer what they need and want, rather than homes that do not provide good standards. Another element of yesterday’s announcement was making it clear that we see advocacy as very important for older people who do not have a family member to support them in making choices about their care services.

I agree entirely with the hon. Gentleman about human rights. The current state of affairs is an anomaly, and neither Government nor Parliament intended that publicly funded residents living in private sector establishments would not be covered by the Human Rights Act 1998. That is an unintended consequence, and we need to put it right. The Government have decided that the appropriate time to do that is when we consult on the new rights and responsibilities Bill, in the context of a new constitutional settlement, on which the Ministry of Justice will lead. The change that the hon. Gentleman seeks will be part of the process; we must put the anomaly right.

I agree with the hon. Gentleman about complaints, too. Publicly funded residents have the right to go through local authority complaints processes if they
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are dissatisfied with the way in which an individual home has dealt with their complaint. The problem is that self-funders, of whom there are an increasing number, have nowhere to go if they are dissatisfied with the way in which the provider investigates their complaints. The regulator, as things now stand, does not investigate individual complaints. On receipt of such a complaint, the regulator can visit the home, examine practices there and take action, but they cannot investigate the individual complaint. That is an important distinction. I am committed to considering how that can be put right. In a modern care system, it is unacceptable that self-funders should not have the protection that other residents have of being able to rely on an independent element in the process, if they are dissatisfied with the handling of a complaint by the very home that they are complaining about.

I have been leading a campaign in the past year to put respect for the dignity of older people at the heart of all care services, be they on NHS wards, in residential and nursing homes or, as is increasingly the case, in home and day care services. That is crucial. Some of the issues are about culture and attitude. We must make it clear that it is non-negotiable that, as a minimum, older people have the right to maximum dignity. Too often in various care settings, dignity is being disregarded. I shall continue and extend our national dignity campaign, and I shall be making announcements in the coming period about how we intend to do that. There is an important role to be played in every community by dignity champions—individuals, whether professionals or volunteers, in a variety of communities and care settings who are saying that we must prioritise the dignity of older people. The hon. Gentleman referred to dementia, and we are working with people in the health and social care worlds on producing the first ever national dementia strategy, which we shall publish next year. Many of the issues that he raised will be covered in that strategy.

Finally, the care system does not function in a vacuum apart from the rest of society; there are cultural and attitudinal factors in our view of older people. When I said that I want us to be as outraged by the abuse of an older person as we rightly are by the abuse of a child, I meant it. I do not think that we are at that point yet, and that should be a matter for concern. However, cultural and attitudinal change takes a long time. There is no one solution and no magic wand. Such change requires us all, at national and local level, in families and communities, to take responsibility. That is one of the great issues faced by society, because more and more people must make incredibly difficult choices for ageing parents and elderly relatives. Thankfully, more and more of us will live longer. Now, from the margins of public policy, the issue has become one of the great challenges that Government and society face; it is a demographic challenge. We must be up to the mark and ensure that older people have the quality of life, dignity and protection that they deserve in a civilised society.


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Cadbury’s (Keynsham)

1 pm

Dan Norris (Wansdyke) (Lab): I am grateful for the opportunity to debate Cadbury’s proposed closure of its Somerdale factory at Keynsham in north-east Somerset.

The only way that we can properly understand the huge impact and significance of the proposal is to look briefly at the history of chocolate making in the area. It is fair to say that Bristol has led the UK, and arguably the world, in chocolate manufacture. In the mid-1700s, chocolate was being manufactured in the many small factories in the city. Many of those factories amalgamated to form J.S. Fry & Sons, which, after the first world war, amalgamated with Cadbury’s, the other well known chocolate manufacturer.

Following that amalgamation in 1919, the company moved to its Somerdale site in Keynsham in about 1935. The site was specially chosen and purpose built, and it reflected the values and ethos of the Quaker families who owned and ran both Fry’s and Cadbury’s. It was a large site of many hundreds of acres. The idea was that the workers were not only units of production, but complete human beings. It was not only morally right to treat them well; it ended up being good business practice.

Of course, many people will be familiar with brands such as Cream Eggs, Mini Eggs and, perhaps most famously, Crunchies, which are made at Somerdale. Amazingly, someone calculated that a week’s production of Crunchies would stretch to the moon and back. That is how prolific the company is in making that famous product and others.

It must also be understood that changes in chocolate manufacture over the years have resulted in greater production with fewer people. At its peak in the 1950s, Somerdale employed about 5,000 workers. Ten years ago, that had fallen to 1,000, and there are currently 500. Of course, for those directly affected, the proposal to close the factory in 2010 is a great shock and a worry, which I am sure we appreciate.

Cadbury’s says that it proposes to close Somerdale because it faces an increasingly competitive global market—arguably, confectionery is one of the most competitive businesses. Cadbury’s looked at competitors such as Mars at Slough, Terry’s, formerly of York, and Nestlé, and saw that they had reduced their UK work force and moved production abroad. Although Cadbury’s is one of the last to reduce its work force in that way, it says that such action is inevitable if it is to remain competitive and secure the jobs of UK workers in future.

The company accepts that it is terribly sad to lay people off. It has had to close three factories around the country in the past five years and prides itself on working hard to provide good redundancy packages and training. Cadbury’s says that recent history shows that, by the time of closure, more than 90 per cent. of the work force will have found new jobs. It argues that, in a constituency such as mine, which in recent years has had the lowest unemployment in the UK, it is possible to ensure, with considerable effort and concern, to ensure that the impact is minimal, although what is happening is sad, regrettable and awful.


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