| Previous Section | Index | Home Page |
17 Mar 2009 : Column 193WH—continued
There are still good examples of local care homes, such as Uplands, run by Lynne Gardiner, in my constituency. That is an ideal location for people who have lived in the area and want to stay in the locality in
the remaining years of their life. However, for every place with an Uplands, there are many other areas that have lost such locations.
The third issue, which the hon. Gentleman talked about, is staffing. I shall intertwine that into my short speech, because staffing is everything. We should also consider management. I think that we would all agree that a weakness in the area we are discussing is the fact that good managers are at a premium, and good managers who can be retained are at even more of a premium.
I know of some cases that I think are good examples of the problems. I hope that the Minister may want to examine not the particular cases, but the context that they give for understanding how the care sector operates. I call the first the Crystal Fountain case. It is a real-life case and I am still critical of the organisation.
Crystal Fountain care village was set up in my constituency. I believe that it got planning permission on the basis that it would provide a continuum of care from some bungalows and houses, with support, through more sheltered accommodation to, ultimately, a care home at the centre of the care village. Two years ago, having achieved planning permission, it announced that it was closing the care home, which is a purpose-built facility.
The residents, and certainly the relatives of the residents who remained there, were very disappointed, to put it mildly, because they felt that they had purchased their place on the basis of a continuum of care. The disappointing thing was that there was nothing that could be done about it. The company decided to charge individuals in the care home facility for every facet of the care on offer. That was clearly likely to mean that much more money could be made out of the individuals, but those people felt completely let down by the changed nature of the care. I suggest to my hon. Friend the Minister that we need to match planning and delivery to the eventual care outcome. Otherwise, we end up with a deficient number of care home places, which causes upset and removes any semblance of choice.
Another concern that I have is about the remnants of the outcomes of outsourcing stage 2 homes from the county councils, which always had the responsibility. That happened in the 1980s and we had a pretty bloody set of consequences in Gloucestershire. There was a takeover—in an in-house bid for an outsourcing contract, if that is not a contradiction in terms. Former social services staff ran an outfit called Coverage Care. The idea was that they would pay to take on remaining residents, but would rebuild and refurbish homes, and pay a bounty to the county council. It all ended in tears, but I will not go through the history of it.
Now, thankfully, a much better organisation—the Orders of St. John Care Trust—runs the homes. The old problems of homes in need of refurbishment remain, however. Where is the money to come from? The Orders of St. John has some ambitious plans, but I have now been talking to the trust for 18 months and there is not apparently a great deal of movement. That may be because of the market at the moment, but if there is a commitment to improving the quality of the care, we need to know where the funding will come from.
I am asking the Minister to help me with that dilemma. If the money is put in and is then reflected in increased fees, a quite difficult problem will result. Obviously, the self-funders will be the ones to pay for the increase.
However, adult care—social services as was—must also make a commitment to make up the additional fees. That is problematic in the context we are discussing and such matters are not always as easy as they sound.
We want better quality, but we certainly want to know how it will be paid for. In my area, the cost of care has risen dramatically, which leads to unavoidable consequences. Sometimes, one wonders whether people who should be in care are not, because they do not want to pay. That can be a problem.
Richard Younger-Ross: A county councillor on the executive in Devon, Sally Morgan, pointed out to me that people going into care have greater problems, and that only people with severe or critical needs are being placed in care by local authorities. If people have such needs, that leads to greater requirements and increases care home costs.
Mr. Drew: I agree. As a former county councillor, I remember going to what was effectively a rationing panel, although we did not call it that. It decided who went where and whether there was enough money for that provision. Then the issue arose about where the extra money was to come from if people’s needs increased dramatically once they were placed. To some extent, we were reliant on the homes effectively to subsidise some care, because there was never enough money to put in the pot.
The next area that I want to talk about is the inspection process. I am not critical per se of the idea of the Commission for Social Care Inspection. I dealt with several difficult cases during its previous incarnation, and I think that the inspection process must be independent and must be carried out in the way it is. I used to visit care homes as a county councillor; it was one of our responsibilities. We just took it on. We had no particular expertise, but it was important that we should try to do it to the best of our ability.
I welcome the setting up of CSCI, but the problem is that as we drive up standards, we drive some homes out of the marketplace. Even if they are not driven out directly—if some CSCI powers are not used carefully—what is written in the reports drives them out, because people are not encouraged to send their nearest and dearest to those homes.
I have talked to the Minister confidentially about the matter. I know of some cases in which inspections have been quite harsh and have quickly led to a legal process. My criticism is that there is not much room for negotiation. Once there is a bad report for a home with no stars, the legal process that gets under way and the quick progression to an independent tribunal give little room for manoeuvre. We must understand that we cannot have it both ways. If we want the homes at the cheaper end of the market, we cannot drive up the standards so that they cannot survive alongside the more expensive homes.
Mr. Stephen O'Brien (Eddisbury) (Con): The hon. Gentleman is making an important point about the effect of the inspection regime under CSCI. Most of us agree that that is an important part of the process. He has pointed out the problem, but has not given an alternative that would assist in driving up quality. We all agree with the hon. Member for Teignbridge (Richard Younger-Ross) that we want a rise in quality in all care home provision in this country.
Mr. Drew: There is a role that must be filled in adult care and there are issues with how county councils or unitary authorities are inspected. The dilemma is whether to support homes that need assistance by putting resources into them or to support the more expensive homes, which tend to be run better, although I do not want to cast any aspersions. The dilemma is whether local authorities want those homes to survive and flourish. That is true of Gloucestershire, where the authority is taking legal action over the loss of one of its stars.
There is a huge role for local authorities, but my argument is about whether they can dispense that role as well as they could and should. When a legal process is entered into, the clock cannot be turned back easily. Homes that could stay in place and provide a valuable service are sadly driven out for all sorts of reasons.
My last point on the inspection process is that it is quite closed; everybody knows everybody else. With the best will in the world, care homes know their inspectors and the inspectors know the home’s background. That may not always be healthy.
Specialist homes have not been mentioned. We are talking mainly about older people, but care homes contain many other people with different disabilities. My worry is that when one discipline takes the lead, the other disciplines tend to hide from their funding responsibilities. If there is a health-led funding arrangement, adult and children’s care tend to hide from their funding responsibilities.
I am dealing with a sad case of somebody who is disabled from the neck down. He is in great need of educational help and is very bright, but he can receive no help to get to the local college where he could carry out a course of study. That is belittling for him and unfair. I hope that the Minister will say how we can get more joined-up thinking and action.
I will finish on a positive note. For the last 20 years, I have been involved in the Standish project, which hopes to turn a former hospital site into an integrated care setting. In future, there must be better partnership between the public, voluntary and private sectors to run genuine integrated care. There are good examples, such as Horsfall House in my constituency. Sylvia Morris and Chris Booth, a local GP, saw that there was no care home facility and so provided it. It offers a genuine continuum of care that provides for people who are fit and able but in need of TLC, through to those with care needs who need to be in an intensive setting. I believe that that is the future. The issue is how we get there and who will fund it.
We would all agree that there is a huge onus on the person who is being cared for and their relatives to provide the lion’s share of the funding, unless they are entirely reliant on the state. That can be unfair and can leave people with dilemmas about how much they are prepared to pay, where they are prepared to send their relative and who they are prepared to pay.
11.45 am
Mr. Paul Burstow (Sutton and Cheam) (LD):
I am grateful for the opportunity to take part in this debate, Miss Begg. I congratulate my hon. Friend the Member for Teignbridge (Richard Younger-Ross) on requesting the debate and on being drawn out of the hat. It is serendipitous that the debate is taking place on a day
when there is media focus on the subject. It deserves far more media coverage than it attracts, not only on the bad things and the problems, but on the positive elements. All too often, debates of this sort are couched in terms of old age being a problem and a ticking time bomb that will explode under our welfare state and make it impossible for us to provide dignity in old age. Such debates focus on the need to find funding.
I agree with one of the concluding remarks of the hon. Member for Stroud (Mr. Drew) on the need to see the development of care as a continuum. I will take that idea one step further. As human beings, we are more capable than any other species of controlling our lifecycle. The effectiveness with which we have extended our lifecycle over the last century is of great note. We must now look at how we can reinvent the lifecycle and redefine what we mean by old age.
In this debate about care home settings, we must recognise something that was missed in the early ’90s, was not understood in the mid-’90s and is just beginning to be understood now. Although providing more care in people’s homes and supporting independence through personalised budgets are essential in creating and supporting a wider lifecycle, a proportion of the population will need more intensive forms of care that are more appropriately provided in care home settings. The care homes of the last 30 years are not the ones that we will need in the next 30 years. Nevertheless, because of the ageing population, a substantial number of people will still need care homes, even if the proportion of those people is a smaller share of the population.
I agree with my hon. Friend the Member for Teignbridge that there are many good care homes. I have the privilege of visiting some in my constituency and seeing good caring practice. That practice is rightly driven by assiduous attention not to ticking boxes, but to the needs, wishes, wants and feelings of the people who live there because it is their home. That is an important point. He was right to highlight the growing demand for specialist residential care and for elderly mentally ill beds and facilities. In a way, we all hope to go through that part of the life journey, when we will be more out of sight and out of mind than at any other point in our lives.
I will touch briefly on standards, ask a few questions about dementia and the Government’s strategy, which is welcome, and speak about dignity in the context of the personal expense allowance, which is important and overlooked. Last Friday, I attended a breakfast seminar organised by Anchor, which is doing some good work on dignity. There was an American speaker from the Eden project called Dr. Bill Thomas. He spoke about the changed expectations that have come with the baby boomers, not just because they are beginning to contemplate their need for care, but because their parents are experiencing care now. Many baby boomers find it hard to accept the limited choices with which their parents have been presented. Dr. Thomas also underlined a point that the hon. Member for Stroud made—that leadership is the absolutely essential element in organisations, that it is needed to drive changes in culture and behaviour and to make the changes stick, and that the issue is not just about dry regulations on a page, but about how human beings interact.
One point that has struck me about the standards regime in the 12 years since the National Care Standards Commission has been in existence is that, on the knottiest issues, such as medication, nutrition and hygiene, care homes have become more and more like Sisyphus, pushing the rock to the top of the hill only for it to roll back down again. The Commission for Health and Social Care Inspection has documented that in reports and pointed to care homes that can improve their performance in medicine management one year, only for their standards in that area to fall back the following year. That is a fault in the system, and it has yet to be satisfactorily addressed.
When one looks more closely at issues such as medicine review in care homes, it is remarkable just how few visits GPs pay to care homes. I am particularly concerned about that. The number of visits is extraordinarily small, yet that is the population most at risk of poly-pharmacy, of becoming the victims of the inappropriate use of drugs and of suffering from the overuse of drugs. From the figures in parliamentary answers that I have received, however, it appears that GPs do not cross the threshold of care homes frequently enough to do the necessary medicine inspections and reviews that are a key part of appropriate practice.
Richard Younger-Ross: One reason why care homes’ standards slip is changeover of staff. If we look at the figures, which I did not have time to discuss in my speech, we find that the turnover rate in the independent sector is almost 18 per cent.—17.9 per cent. If a care home has that turnover of staff all the time, it is difficult for the organisation to be consistent and to keep training the staff all to the same level.
Mr. Burstow: My hon. Friend earlier drew attention to what Laing and Buisson identified—namely, fragmented training at specialist units in this country—and also rightly identified from that research the fact that many of those homes do not have formal training programmes. I hope that the Minister will say something reassuring about how the new inspection regime will ensure that that finding does not become a long-term trend.
The Minister knows that for some years, I have raised questions about the appropriateness of using anti-psychotic medication in care homes, and I was pleased last year when his predecessor, the hon. Member for Bury, South (Mr. Lewis), announced a review of their use in the draft dementia strategy. The terms of the review, as I understood them at the time, were not so much to ask whether change was needed, but to plan for change. Although the review was and is long overdue, it was and is welcome, because those drugs reduce people’s quality of life, increase costs due to the need to treat side effects and cut lives short.
It is surprising that we tolerate the continued use of drugs off licence for a purpose that a growing body of evidence suggests is not appropriate in the long term. We know, however, that 100,000 people are routinely prescribed them and, from academic studies, that perhaps as many as 23,000 people die prematurely because of their excessive and inappropriate use. I hope the Minister will state when we might see a light at the end of that tunnel—when we will see the action plan that will produce the necessary change to practice.
That brings us to the wider issue of dementia, its care management and the study that Laing and Buisson published today, identifying the training issues that we have already talked about. I want to ask the Minister about the dementia strategy, because it is not a national strategy. It is not a national must-do: it is not in the Department’s strategy framework as something that must be done; it is on the framework’s next tier as something to be decided locally. Local decision is generally a good thing, but, on the national strategy that the Minister has rightly advanced, I should like some clarity about timelines, because that is what my constituents expect.
I want to ask about the implementation programme board, which I understand has not met yet. I assume that it will have a monitoring role, even if it will not provide an overly disciplined and prescriptive framework, because that is not the Government’s intention. When will its terms of reference and membership be finalised? There is a meeting on 31 March of the other body that is responsible for such matters That must mean that the implementation programme board will not meet this month, and that yet another month will have gone by without the monitoring framework to drive the strategy forward having been published. It would be good to hear what the Minister has in mind.
[Mr. Edward O’Hara in the Chair ]
I shall touch briefly on nutrition. A couple of weeks ago, the hon. Member for Eddisbury (Mr. O’Brien), the official Opposition spokesperson, and I addressed a meeting organised by the British Association for Parenteral and Enteral Nutrition, which has conducted some very good research, demonstrating malnutrition’s burden on our taxes. The group has created a nutrition action plan, which the Minister is considering. Until he has done so, however, he is unable to confirm whether that group will be able to continue tackling malnutrition in a multi-agency way, so it would useful if he said whether he believes that it has done a good job and whether he will allow it to continue.
From written parliamentary answers, I am surprised that malnutrition data are not routinely reported to Ministers or senior officials, and that there is no regular auditing of the adequacy of data that are collected. It seems extraordinary that while we focus on obesity, we know that there is a £13 billion cost associated with malnutrition. Surely that should be addressed.
Mr. Stephen O'Brien: The hon. Gentleman has made an excellent point about nutrition and malnutrition, and he is well aware of how keenly I follow the issue. I am concerned as to whether the Government have had a chance to uprate their performance in producing statistics and to monitor the situation, because the issue has effectively been unnoticed by them for more than a couple of years. More recently, their publication of statistics was delayed and, although we have now managed to extract them, they did not come via the normal parliamentary channels. There is deep concern about malnutrition becoming a head-in-the-sand issue, rather than something that we should tackle now.
| Next Section | Index | Home Page |