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20 May 2008 : Column 40WH—continued
Barts was a challenging place, and some senior nursing officers could have come straight from the “Carry On” films. They had buxom figures and were terrifying, but they reminded us that nurses in charge of a ward were in charge of a place that was someone’s home for the time being and that we should treat everyone as if they were in their own home. The bar was extremely high on
standards: nothing less than the best would do. I hope that the Government will continue to engender those feelings.
Hon. Members do not often recite poetry in this Chamber, but a poem that appeared in a textbook, “An Ageing Population”, in 1981 has become famous. It refers back to the point made by my hon. Friend the Member for Newbury about photos above people’s beds. It was found in the locker of a lady who had died and who had been unable to speak, and I shall read the beginning and the end.
The Minister may introduce strategies and policies, but when thinking about how to address the dignity of older people, will he take himself out of his shoes, turn himself around, put himself in another pair of shoes, and see himself in 20 years, 30 years, 35 years, or even 40 years on? Will he think of himself having to be cared for and saying, “Once, in 2008, I was a Government Minister.”?
12.14 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw):
How does one follow such poetry? With reference to the final remarks made by the hon. Member
for Guildford (Anne Milton), as a teenager I nursed my mother through Alzheimer’s to death, so I know a little about looking after elderly patients and caring for them, their needs and their dignity.
I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this debate on such an important issue, and apologise to him and other hon. Members that the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for this policy area, is not here to respond to the debate. He is absent from the Chamber for very good reasons, which I shall come to later.
We all agree that how we treat the most vulnerable in society, including the elderly, is a measure of our civilisation. We have a growing elderly population, who are healthier, longer lived and more materially comfortable than any previous generation. We also have a society in which people have higher expectations of their health and social care, and their quality of life. People not only expect that for themselves, but we in the Government expect the private and public sectors to provide it.
Although many elderly people are living longer and healthier lives, many need care in hospital or a care home, and stays may be more frequent or longer than previously. As the hon. Member for Leeds, North-West (Greg Mulholland) acknowledged, all parts of the Government, but not just the Government, have a responsibility to ensure that people enjoy dignity in old age. I shall outline some of the matters for which my Department is responsible.
First, statutory guidance in both the health service and social care places a legal obligation on all staff to ensure that people are treated with dignity. It provides a complete definition of abuse and a framework for public bodies to work with the police, the NHS and regulators to tackle abuse and prevent it from happening in the first place. It also sets out the framework for partnership working throughout Government and other agencies to deal with and prevent abuse of vulnerable adults. As well as that, we have a new local performance framework for the NHS, which builds on that and means that every nurse and every health care professional has a responsibility to safeguard and respect an individual’s dignity.
Subject to parliamentary approval, the Health and Social Care Bill will create a new, integrated, independent health and social care regulator—the Care Quality Commission. The hon. Gentleman is aware that we are seeking to amend the Bill to reinstate the Government’s original intention when passing the Human Rights Act 1998, which is that the independent care home sector should be directly subject to duties under that Act for the publicly arranged residential care that they provide.
Whatever the care setting, the Care Quality Commission will provide assurance that services are safe, people are not put at risk of harm and essential levels of service quality are maintained. The requirements that providers will have to meet will be set by the Government in secondary legislation—we debated that at length in Committee—and monitored and enforced by the Care Quality Commission. They will replace the existing core standards for better health in the NHS and the national minimum standards and regulations that apply to social care and independent sector care providers.
The independent Healthcare Commission’s most recent survey, of 14 May, states that overall satisfaction with care remains high and is increasing with 92 per cent. of
patients saying that their care is either good, very good or excellent. The same survey shows that only 3 per cent. of patients say that they have been treated in an undignified way. The survey also shows improvements on some other issues that hon. Members raised, such as food quality. I shall come to some specific matters in a moment and explain how we hope to do better.
The national health service operating framework is basically the orders that go out to the service from the chief executive of the NHS, David Nicholson, setting its priorities in every year. For the last year, it has contained for the first time a core strategic requirement for a good user experience so that users of the health service feel that their dignity is respected. Health and social care providers will be measured against that standard.
A number of hon. Members talked about the importance of investment in nursing and the quality of nurse training, including issues of dignity. I am sure that they are aware that we have invested considerable extra resources in the number of nurses and in nurse training. There are 80,000 more nurses in the NHS than in 1997, 51 per cent. more students entered training to become nurses or midwives during the same period, and there are more senior nurses to help to drive up standards, including 831 nurse consultants and a commitment to increase the number of matrons to 5,000 to improve the quality of nursing.
I assure the hon. Member for Leeds, North-West that dignity is a core part of nurse training. The issue is not that it is not there and needs to be introduced. No nurse has ever been educated to say to anyone, “Go in the bed.” That was one of the appalling findings that came out of the Tunbridge Wells and Maidstone inquiry.
Greg Mulholland: I wish to clarify the fact that, regarding dignity being a core value, I was talking about organisations such as NHS trusts, rather than nurses.
Mr. Bradshaw: I hope the hon. Gentleman will forgive me if I misunderstood, but I thought he implied that he would like dignity to be a core part of nurse training. It already is. However, it is also a core part of what is required from health providers. He can check the record on that if he wishes.
Greg Mulholland: On training, I said that we need more and more specific training. I mentioned mental health specifically.
Mr. Bradshaw: I suggest that the hon. Gentleman check the record.
The hon. Member for Newbury mentioned the case of one of his constituents, Jenny Pitman, who had a terrible experience in relation to a parent who was in hospital. My information is that the trust concerned is working closely with Jenny Pitman. She has quarterly meetings with the director of nursing to monitor progress on infection control; I think she has such a meeting next week.
On the general issue of infection control and health care-associated infections, I am sure that the hon. Gentleman will be pleased to note that the latest Health
Protection Agency figures show a 30 per cent. decrease in MRSA—methicillin-resistant Staphylococcus aureus—to December 2007, for the last 12 months for which figures are available. There has been a decrease in C. difficile of 23 per cent. during the same period.
The hon. Gentleman’s local hospital, which I imagine is the Royal Berkshire in Newbury, has had an encouraging 60 per cent. decrease in MRSA in just six months between April and December 2007. That is a tremendous tribute to the hard work of the staff and management of that hospital, which also had a 15 per cent. reduction in C-difficile in the same period. I hope that he welcomes those great strides forward by his local hospital.
The hon. Gentleman was kind enough to acknowledge that overall the NHS does an excellent job, that heroic work is done and that millions of people get excellent treatment—indeed, the hon. Member for Guildford (Anne Milton) said the same from the Conservative Front Bench—but he gave a number of specific examples of the service that people received not coming up to scratch.
The examples used by the hon. Gentleman related to unacceptably poor treatment. It is important that if a patient—an elderly patient or, indeed, the relative of an elderly patient—experiences what they believe to be unacceptable treatment, they use the robust and independent complaints process that is now in place to put those matters right. I have seen a number of cases involving people who have gone to the newspapers or come to my surgery to make such complaints. People need to have more confidence in the independent complaints process.
We have an independent Healthcare Commission to deal with such matters and an ombudsman, which is the second tier for complaints. It is important that people use that system because in the annual reports of the Healthcare Commission trusts are judged by the number of complaints made and how they dealt with them. If people do not bother to complain, the danger is that there will not be an incentive for the service to get better.
Anne Milton: Is the Minister aware that last year a report by Which? stated that people are concerned about what to do when an elderly relative is already in a care setting? There is huge concern—I have felt it myself—that if a complaint is made, it will be taken out on the relative who is still in the care setting.
Mr. Bradshaw: Yes, I am aware of that report. As politicians, it is important that we all encourage people to have faith in what most of us accept is a sound and robust independent complaints structure. It would be completely unacceptable for any organisation or trust to take it out on anyone who complained, as the hon. Lady mentioned. In my experience, only by using the complaints process are some of the problems uncovered and therefore resolved.
Incidentally, I also encourage staff to complain. I think the hon. Lady said that staff are often nervous of complaining when they see substandard behaviour in their own hospitals. We have a culture of encouraging whistleblowing in the health service and it is important that staff feel confident to complain—anonymously if they prefer to do so—to ensure that problems are dealt with firmly and robustly.
A couple of surveys on mixed-sex wards have been published in the past few weeks. One was from Ipsos MORI and the other was included in the annual Healthcare Commission patient survey. Both found a welcome decrease in the number of patients who reported sharing a sleeping area with a patient of the opposite sex. We welcome that. However, we also acknowledge that there remains some way to go for us to deliver on our commitment to reduce mixed-sex accommodation to a minimum.
Although occasionally the need to treat and admit a patient has to take precedence over complete gender separation, everything possible should be done to maximise privacy and dignity in those situations. We do not think it desirable to turn patients away just because the right bed is not immediately available.
This year’s NHS operating framework states that, at local level, primary care trusts should assess the situation in all trusts in their area and agree, publish and implement stretching local targets for improvement. Given that, we hope and expect to see significant improvement in the Healthcare Commission survey scores for next year.
As I mentioned, my hon. Friend the Member for Bury, South normally speaks on this issue, but he cannot be with us today because he is launching the latest strand of the dignity campaign, which he established in 2006. As a number of hon. Members are, I am sure, aware, the purpose of the campaign is to create a health and social care system in which there is zero tolerance of abuse and disrespect for older people. That includes simple things that many hon. Members have mentioned, such as respecting privacy, helping people to use the bathroom, addressing people in the way that they prefer, listening to people, helping people to eat food if necessary, and ensuring that food is placed where it can be reached. All those small things can make a huge difference to an older person who is staying in hospital.
The hon. Member for Newbury and his Front-Bench colleague, the hon. Member for Guildford, mentioned nutrition. We had a long discussion about that in the Health and Social Care Bill Committee. I wish to correct the hon. Gentleman: the issue was not that the Government were not interested in doing anything on nutrition, as he implied. As my right hon. Friend the Member for Oxford, East (Mr. Smith) made clear, we are doing a lot in relation to nutrition and nutritional standards are improving all the time, although they are improving more quickly in some hospitals than in others.
The Government resisted an amendment tabled by the hon. Gentleman’s party to include a requirement in the Bill for nutrition to be part of the new system that the Healthcare Commission will police, alongside health care-associated infections, which are fatal in many cases, as he rightly outlined. However, we have made it clear—we are consulting on this—that, under the new auspices of the Care Quality Commission, nutrition and nutritional quality should be part of the registration standards. Therefore, in extremis, if a hospital was not providing adequate nutrition or adequately helping patients with eating and feeding, it could lose its registration and therefore its licence to operate.
We also had a long debate on the issue of people who come into and go out of hospital suffering from malnutrition. If the hon. Gentleman is interested in the matter, he may want to check the record. Without going over the matter in great detail, one has to be careful about taking the statistics at face value. If someone goes into hospital with an underlying malnutritional problem, that will often not be the first episode for which they are treated, so they will be registered as being treated for something else apart from malnutrition. Only after they have been in hospital for a while and when the initial superficial condition for which they are being treated or operated on is dealt with will malnutrition be registered as an episode. That can often be the last episode, which is why, when one considers the stark figures, it looks as if more people leave hospital malnourished than enter hospital malnourished. That is not the case, and it is important that we bear that in mind when we make such claims.
On the dignity campaign, we now have a network of more than 1,800 dignity champions who are out in the community, improving dignity in their local areas, putting dignity on the local agenda and tackling bad practice when they see it. They are unpaid volunteers who are often managers, councillors, health and social care staff and ordinary members of the public. They are making a difference.
As Nursing Times has pointed out, the number of cases of abuse of older people coming before the nursing regulator has halved in the last year alone. In addition to the dignity champions, to whom I have already referred, thousands of people in care homes and hospices have benefited from the—
Mr. Eric Martlew (in the Chair): Order. We must move on to the next debate.
BBC World News
12.30 pm
Mr. John Grogan (Selby) (Lab): It gives me great pleasure to introduce this short debate on the future of BBC World News. In our roles as Members of Parliament or Ministers, occasionally we have the great privilege of going abroad to represent Parliament or the Government. For example, I note from yesterday’s press conference involving the press officers to my right hon. Friend the Prime Minister that my hon. Friend the Minister for Sport is, quite rightly, going to the European cup final tomorrow in Moscow, accompanied by my right hon. Friend the Secretary of State for Culture, Media and Sport. The press spokesman for the Prime Minister said that that would be the only occasion on which the Secretary of State, who is an Everton supporter, would ever get to such a European final. The Minister for Sport, as well as being a Bradford City supporter, is a Manchester United supporter, so he is in a happier position.
I am preparing for my sixth visit to Mongolia in my role as chair of the all-party group on Mongolia. I will be representing Parliament and the all-party group. Why do I mention that? I do so because as MPs or Ministers, we find ourselves in hotel rooms around the world, and what do people do when they go into a hotel room for the first time? I stress that I am talking about when they are on official business. They might look at the view. They might look at how big the bathroom is or see how comfortable the bed is. They might even be tempted to look at what is in the mini-bar. However, when I go into a hotel room abroad, I look straight away at the list of channels on the TV. If I am in a region of the world for some days, it is with great relief that I see that there is not only CNN on the news channels but BBC World News and that there will not just be an American perspective while I am there.
BBC World News is increasingly successful at getting its coverage into hotel rooms. It is in 1.3 million hotel rooms around the world, which represents a 25 per cent. increase over the past two years. In China, a very important market, BBC World News is in 250,000 hotel rooms—a 40 per cent. increase in the past two years. BBC World News is now available in 281 million homes around the world and 1.3 million hotel rooms, as I said, and on 48 cruise ships, 37 airlines and 29 mobile phone platforms. With 76 million viewers a week, it is the most watched BBC television channel.
I have initiated the debate for several reasons: first, to consider the financial model of BBC World News, which is a success; secondly, to consider the quality of programming; and thirdly, to consider the future of BBC World News. It is an example of what I understand is commonly known in diplomatic circles these days as soft power. The British Council, the BBC World Service on the radio and online and BBC World News represent a great influence for our nation among key decision makers. I would put the BBC on a level with other things that Britain is known for—premier league football and popular music from the Beatles onwards. The BBC stands in that trinity of things with which Britain is seen to make its mark in the world.
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