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1 Apr 2008 : Column 218WH—continued
The Government also introduced the “No Secrets” guidance on the protection of vulnerable adults, which was, for the first time, a framework. We asked local agencies in every local community to work together to
ensure that, in line with the guidance, we had a much better system of adult protection than we had ever had previously. As the hon. Gentleman said, we made some significant announcements last week about how we want to toughen protection for vulnerable older people. We should reflect on the fact that the changing nature of society makes that a top public policy priority. As people live longer and longer, family members and carers are under pressure to fulfil the responsibilities. Demographic change—the ageing population—is increasingly a challenge for families, communities, Parliament and Government.
Last week, we announced a £2 million project in partnership with Comic Relief over three years to consider the risk of abuse faced by older people, specifically in institutionalised settings, but also more generally where older people are not treated with the dignity—that is not quite the same as abuse, but there is a continuum—that they should expect, whether on NHS wards, in residential nursing homes or in domiciliary care services. That prevalence study will take place over the next three years with the support of Action on Elder Abuse, and I should pay tribute to that organisation’s tremendous work in highlighting elder abuse. I was fortunate enough to speak at its annual conference on Monday where there was an impressive gathering. Its chief executive, Gary Fitzgerald, does a tremendous job in ensuring that the issue has the profile that it deserves.
Action on Elder Abuse also supported the study published last year, to which the hon. Gentleman referred, on the risk to older people of being abused in their own homes behind closed doors, because the other change in society is that an increasing number of older people are choosing to remain in their own homes for as long as possible. The debate about protecting older people tends to be skewed towards residential and nursing homes, but we must keep an eye on the fact that more and more people will be cared for at home. There is a question about domiciliary care agencies, their relationship with carers and so on.
Mr. Burstow: In the design of the prevalence study published last year, dementia sufferers were excluded. Clearly, in relation to institutional settings, people with dementia will have to be included. When designing the new study, will work be done to try to reach people with dementia in the community?
Mr. Lewis: The hon. Gentleman makes an important point and, interestingly, that will be one of the characteristics and key components of the new prevalence study. We estimate, as he knows, that approximately two thirds of people in nursing care have dementia, so one of the challenges of the prevalence study is to consider how to empower, enable and protect people in those circumstances. Older people who have different conditions and circumstances pose a separate challenge.
I shall address the hon. Gentleman’s specific comments about extension of the Human Rights Act 1998, which I must be clear about. When that Act was introduced, Parliament’s and Government’s intention was that publicly funded residents of private residential and nursing homes, as well as those in publicly provided residential and nursing care, should be covered. Subsequently, a House of Lords ruling put that in a lot of doubt. Therefore, the
Government will seek to amend the Health and Social Care Bill to ensure that we reinstate Parliament’s original intention, which was that the Human Rights Act should cover publicly funded residents of private establishments.
To deal directly with the hon. Gentleman’s comment, the 1998 Act is about the relationship between the state and the citizen. It is, therefore, entirely inappropriate to talk about extending the Act to include people who fund their own care. However, more significant safeguards to protect self-funders are needed. The hon. Gentleman will know that the transformation programme for adult social care begins today in every local authority area and that one of the new emphases is a responsibility to self-funders. Too often in local authority areas, self-funders are told that they are on their own. One of the key elements of the transformation programme is the provision of much higher-quality information and advice to self-funders and their families, and a much greater focus on the needs of all citizens—not just those who are publicly funded—who use social care. The Human Rights Act is not the mechanism to deal with people who are funding their own care because it is about the relationship between the state and the citizen.
The hon. Gentleman referred to our announcement last week that we will act to help people who fund their own care. At the moment, if those people have a complaint against a care provider, their complaint is considered only by the organisation that they are complaining against and there is no right of independent appeal beyond that process. We will introduce proposals to help such people, but we are not in a position yet to share the details with the hon. Gentleman. However, the proposals will ensure that self-funders who are dissatisfied with the handling of their complaint have the right to seek a review by an independent organisation. Following discussion and negotiation, we need to decide which is the most appropriate and expert organisation to fulfil that role.
Mr. Burstow: Will the Minister give serious consideration to ensuring that whoever discharges that adjudication role is fully subject to the Human Rights Act so that someone could take them to court if they fail to enforce human rights?
Mr. Lewis: In view of some of the things that I am reported to have said over the weekend, if I start speaking for the Ministry of Justice in debates such as this it may be one step too far. We need to consider the end point. If people are state-funded and are unhappy with their provider, they can refer to the local authority’s complaint procedure. Ultimately, they can go to the local government ombudsman if they are still dissatisfied. We must examine the chain for people to get proper and appropriate redress. However, I shall not make any specific commitments on that today.
I urge the hon. Gentleman to contribute to our review of “No Secrets”, which is starting now and will go on for the next few months. We will put out a consultation document in the summer, and I urge him to respond to it. I offer to meet him to discuss his views. We need to focus on prevention and early intervention in relation to crime and safety, to encourage a new wave of innovative practice, to increase responsiveness and local accountability, to empower local and vulnerable people and those who have not previously been adequately
safeguarded, and to develop new forms of support and encouragement so that people can improve their own health and safety. I urge him to be part of the debate about where we go next with “No Secrets”, and I will meet him specifically to consider his views, as he has taken a particular interest in the issues.
On the question of medication, the Government have done a number of things, but we need to reflect on the emerging evidence and, if appropriate, act in the short term. However, we will have to act following the publication of the national dementia strategy in the autumn. If we are to have a credible, robust national strategy to improve the quality of life and standard of care for people with dementia and their families, we cannot avoid tackling the issue. If measures can be taken in advance of the publication of that strategy, I am more than willing to consider them.
The hon. Gentleman may be aware that, on 26 March, I met the hon. Member for Rugby and Kenilworth (Jeremy Wright), who is the chairman of the all-party group on dementia. He is another hon. Member who does an excellent job championing what was once an unfashionable cause. Last August, we said that we would bring dementia out of the shadows, and we have been able to do that with the assistance of parliamentarians on both sides of the House. As the hon. Member for Sutton and Cheam will be aware, the all-party group is about to publish a report. The hon. Member for Rugby and Kenilworth was good enough to give me some advance notice of the kind of issues that were likely to be raised and the recommendations. We focused on a number of specifics. One of the major messages was the need for the training of front-line staff. There was a need for friends and families to be more involved in the oversight of care, to ensure consultation when crucial decisions are made about medication. There will also be a recommendation along the lines of a three-monthly review of medication for all residents. I cannot be specific about how the Government will respond to such recommendations, but we will take the all-party report seriously and respond to it, both in the short and long term. That will be a key element of the first ever national dementia strategy in the autumn.
The hon. Member for Sutton and Cheam might be interested in some specific statistics. Through the new general medical services contract, medication reviews for patients being prescribed four or more repeat medicines were included as one of the performance indicators in our quality and outcomes framework. In 2005-06, 95.8 per cent. achieved an acceptable level for that indicator. In the year ending 31 March 2007, 7 per cent. of homes inspected against the national minimum standards for care homes for older people failed the medication standard. Some 33 per cent. almost met the standard—I will give him more details about what that might mean—59 per cent. met the standard, which is a significant majority but nowhere near enough, and 2 per cent. exceeded the standard. That represents some minor improvement, but the figures are pretty stubborn: in the previous year, 8 per cent. failed the standard, 33 per cent. almost met it, 58 per cent. met it and 1 per cent. exceeded it. A hard core of providers are not meeting acceptable standards.
One of the difficult issues in this debate is professional judgment. I am not a doctor and some of the judgments are made by professionals using best available clinical evidence and acting, as they would see it, in the best interests of the patients. Ministers cannot possibly second-guess some of those clinical judgments. However, I agree with the hon. Gentleman that it is not acceptable for a modern health and social care system, as a first instinct, to drug inappropriately people who, as a consequence of dementia, are exhibiting potentially challenging behaviour. The approach is about cultural change, training and regulation.
Commissioning also has an important role to play in protection. If private homes are not fulfilling their responsibilities with regard to dignity or appropriate care, local authorities should stop commissioning services from them. There is not a magic bullet or a quick fix; we must do a whole series of things to ensure that people with dementia are not inappropriately drugged in a way that none of us would find acceptable for members of our own family. The Government will say more about that as we develop a national strategy this autumn.
Black and Ethnic Minority Pupils
1 pm
Ms Diane Abbott (Hackney, North and Stoke Newington) (Lab): I am grateful to have the opportunity to raise a key educational matter. I shall speak about the education system and black and minority ethnic children, and will specifically address the disproportionate levels of exclusion among black and minority ethnic children.
When my Government came to power in 1997, one of their themes was “education, education, education”. That was right, because education is not just the key to our society now, but to our competitiveness as society goes forward in a modern, globalised world. There is no doubt that the Government have many educational achievements to their credit. In my constituency, Hackney North, millions of pounds have been poured into the new academy programme and I have seen standards rise.
Since I have been a Member of Parliament, I have argued consistently that educational standards cannot be raised in the inner city overall without raising the standards of black children. Apart from anything else, that is a statistical point, because in the inner London boroughs, the majority of children are black and minority ethnic. In some of those boroughs—notably Brent and Lambeth—the largest single group of children are black children. Progress has been made on the issue, but, sadly, for many years the Department for Children, Schools and Families and the educational establishment generally have clung to a colour-blind approach to these matters. I shall demonstrate that that has been exemplified in the way in which the Department has approached exclusions. The colour-blind approach of which officials are so proud has failed at least three generations of black children.
Before talking about exclusion specifically, I want to paint a picture for the Minister about where we are in relation to black and minority ethnic children in the school system generally. I shall quote from a report from the former Department of Education and Skills on black exclusions that was published last year. This is the situation that now exists:
“Black Caribbean pupils are significantly more likely to be permanently excluded—3 times more likely than White pupils.”
The Minister will probably say that is because of their class background and the fact they have special educational needs. In fact, even when that figure is controlled, for the take-up of free school meals, which is a rough and ready indicator of class and special educational needs, black Caribbean pupils are still 2.6 times more likely to be permanently excluded. Black pupils are routinely punished more harshly, praised less, told off more often and are 1.5 times more likely than white pupils to be identified as having behaviour related to special educational needs.
In relation to base-line entry tests, black pupils outperform their white peers at the start of school, but the new observation-based foundation stage profile reverses that pattern. Black pupils are disproportionately put in bottom sets, and as someone whose child went through the school system and went to a state primary close to my home in Hackney, I have seen that with my own
eyes. The following is an interesting quote from a Department for Education and Skills report, “Evaluation of Aiming High: African Caribbean Achievement Project”:
“Whilst many teachers...believed setting to be based solely on ability, data indicated that African Caribbean pupils were sometimes relegated to lower sets due to their behaviour, rather than their ability.”
Finally, an important point to which I will return is that when we asked newly qualified teachers about how their training had prepared them to teach pupils from minority ethnic backgrounds, 22 per cent. rated their course as poor. Only 35 per cent. of newly qualified teachers rated their course as good for preparing them to teach black children, as opposed to the 60 per cent. who rated their course as good preparation for teaching children of all abilities.
That is the current picture. I say to the Minister that this issue is neither new—it goes back decades—nor marginal. It may seem a marginal problem in some parts of the country, but in all our big cities—London, Birmingham, Manchester and Bristol—the issue of minority ethnic educational underachievement and the problem of school exclusions that goes with it is the key to raising standards overall for children. The problem goes back at least to the 1970s. In 1971, the black academic, Bernard Coard, produced a seminal work entitled “How the West Indian is Made Educationally Subnormal in the British School System”. Since then, academics, activists, black commentators and educators have raised the issue of how the school system fails black children. However, they have not simply addressed issues relating to the mainstream school system. There is a proud history of community-based initiatives, Saturday schools and other projects through which the community has tried to help its children raise their standards.
Over the past decades, as well as in recent years, I have held five successive conferences in London entitled, “London Schools and the Black Child”. I have been privileged to hear Ministers speak at all of those conferences, and they have attracted the attendance of more than 2,000 black parents and educators. I cannot think of any educational conferences of that type in London that would have 2,000 parents and teachers queuing around the block at 9 o’clock on a Saturday morning. Officials who attended the conference can confirm that that was the case, and it shows how important education is to black parents. When we ask black parents informally and formally what the top issue is, they say it is exclusion. Again, the Department of Education and Skills priority review on the exclusion of black pupils, “Getting it. Getting it right”, discusses the iconic status of the exclusion issue for black communities. Black parents do not believe that the school system is meeting the needs of their children unless something is done about the disproportionate level of exclusions.
The issue may be new to some officials and the Minister, but the Department and Ofsted have been looking at the problem for more than a decade. In 1996, an Ofsted report showed that excluded black pupils did not have the same deprivation characteristics as excluded white pupils. In other words, the exclusion of black pupils was not wholly tied to class background and special educations needs; there were other factors involved. In 1996, a review of research into BEM education produced for Ofsted highlighted the dual problem of high exclusion rates and poor educational outcomes for
black pupils. In 1999, Osler and Hill did another piece of research that highlighted those twin interrelated problems: poor educational outcomes and high exclusion levels. Ten years ago, that piece of research pointed out that specific targets were needed to lower black exclusion levels.
In the late 1990s, the Runnymede Trust produced a report entitled “Black and Ethnic Minority Young People and Educational Disadvantage”, which found that despite the wealth of small-scale research into the problem of different exclusion levels for black pupils, there was no clear policy line on how to tackle the problem. In 1999, a briefing paper by the Runnymede Trust called for the Government to set specific national and local targets to reduce the disproportionate exclusion of black pupils. A book written in 2000 by a group of respected teachers and educators, “Race, Class and Gender in Exclusion from School”, discussed the interplay between race and gender in the construction of black boys as hyper-masculine. The Mayor of London, Ken Livingstone, has produced a number of reports on the issue and has called for an increase in the number of black teachers and for a teaching work force in London that looks like London. The London Development Agency undertook a major research review in 2003 and, among other things, found that many teachers have lower expectations of black pupils and that black pupils feel that they receive less positive input and, in some cases, even experience discrimination from teachers.
In 2003, the Commission for Racial Equality attempted to research to what extent schools have implemented the Race Relations (Amendment) Act 2000. It found many schools unwilling to partake in the research, and the schools to which it did manage to speak generally had not implemented the race relations duty and had no clear goals for improvement. In 2004, the Joseph Rowntree Foundation found that, in some areas, black Caribbean pupils were 15 times more likely to be excluded than their white counterparts. In 2005, a report commissioned by the Department for Education and Skills entitled “Minority Ethnic Exclusions and the Race Relations (Amendment) Act 2000” stated that despite a significant amount of literature from the CRE and the Department on exclusions and the race relations duty, that information was not impacting on schools or local authorities sufficiently. It is not me saying that, it is not campaigners and it is not the black community—it is the Department’s own report. The report’s authors found in their research that a significant minority of schools were failing to implement the duties in the race relations legislation, specifically regarding exclusion levels. In November 2005, the DFES high-level group on race equality identified the high exclusion rate of black pupils as a priority area for action. An academic working in the Department at the time produced a paper to introduce key arguments on institutional racism.
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