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Safeguarding Vulnerable Groups Bill [Lords]

The hon. Lady makes a valuable point. The Care Standards Act 2000 is clear in relation to the responsibility of care homes to carry out checks. When providing a service, it is important that the service is carried out to standards that are set down in legislation. It is only appropriate that those who are vulnerable and require the care and protection of agencies that are set up specifically to provide that care and protection should feel assured that the care setting, whether it is a care home, a domiciliary care setting or a day service provider, meets those minimum standards. I hope that anyone who sought to register to provide those services would be fully aware of the requirements to register and of the legislation that they were required to comply with. I hope that they would seek to do their best to do so. It is only fair to say that the majority of providers do that. The hon. Lady will be aware that the majority of care providers seek to meet the highest standards. Indeed, they seek to exceed the national minimum standards. Those that do not are the ones we need to focus on to ensure that they carry through their responsibilities at least to check whether staff have criminal backgrounds and to have appropriate checks such as references in place. Those are not onerous expectations. They are minimum expectations and I hope that they will be met. I have some questions for the Minister that I hope we will have get answers to. I would like reassurance that there will be one list for England and Wales. I support all those other hon. Members who have sought to ensure that those who are barred from working with children are also barred from working with adults. Experience shows that abuse is often related to power and that, once a person has power over a vulnerable individual, that power is where the pleasure comes. The abuse can be transferred to another vulnerable individual. I have some concerns about clause 6(5) and clause 43 in relation to private arrangements where care is provided by a member of a family or friend. I ask the Minister at some point to clarify what protection will be available where it is known that the family member or friend has a history of abuse or a criminal record relating to abuse. For example, that information may have been passed to a POVA or POCA co-ordinating team in a local authority. Will they be able to share that information with the family? That will be vital because we know that, often, sexual abuse happens in families. The anxiety and fear are often about stranger danger but the reality is that the building of trust within families can lead to abuse. I would welcome clarification of clause 44(9)(b) and (c) and schedule 2, paragraph 9(1)(a) and (d), which relate to hon. Members’ concerns on vulnerable adults. I have particular concerns about what happens when the condition of a patient in a hospital, as a result of the actions of staff, deteriorates. I cite an example that I raised in an Adjournment debate relating to Parkinson’s. If a Parkinson’s sufferer is not given their medication at the right time, the chemical balance in their brain is altered and disrupted. The disease becomes uncontrollable. With an uneven release of dopamine, a person may be suddenly unable to get out of their chair, to walk, or to get out of bed. Sleep can be disturbed. Bowel and kidney functions and digestion can be affected. The individual can suffer mood swings, hallucinations, anxiety and fear. What will be the implications for ward staff and for care homes if, as a result of their failure to provide medication on time, a person’s capacity to manage their life, to manage their bodily functions and to communicate is damaged? It can ultimately be destroyed for a number of months. From being someone who could rise out of bed and walk and talk, they can end up totally incapacitated purely as a result of the staff’s neglect and failure. That surely must be something that can be tackled under the Bill. Half of care homes in England and Wales are not meeting minimum standards in relation to medication. A large number of patients entering hospital find their conditions deteriorate because medication is not provided on time. I have seen service users behaving bizarrely and becoming aggressive and anxious because their medication has not been provided on time. For me, that is creating a situation where a vulnerable person is being abused and neglected. We have older people and people with learning difficulties going into hospital who, because of the poor quality of care they receive, develop bed sores. We have people going into hospital who, because of the poor quality of care and the poor quality of nursing staff making sure that they are regularly toileted, become incontinent. That is surely unacceptable and we should seek to utilise the capacity to refer people to the barring board for poor-quality care to stress the need to drive up standards. I cite another example of a service user whom I worked with. It was felt that abuse had happened within one of the homes in my constituency. The service user had been lying on the floor with his head against a hot pipe. As a result, he had burns on the top of his head. It was thought that that had been a situation of abuse and neglect, where the staff had failed to move the service user and had ignored the fact that he was lying on the floor. As a result, they were suspended and their behaviour examined under protection of vulnerable adults legislation. I carried out the inquiry into that matter, taking with me one of the directors of the company, who was horrified, when we went through all the documentation relating to what had been going on in that care home for six months, to discover that we had a severely mentally disturbed individual who, on two occasions, had held the entire home at knife point. He had prevented staff from leaving the room and other service users from getting access to care. The staff had failed to call for medical assistance for him even though he was begging for that help and support. In fact, the failure of medical staff to pick that service user up from the floor did not constitute abuse because lying on the floor was part of his normal behaviour pattern, but there was an overall failure to protect a vulnerable adult by not seeking the required medical assistance. I am sure that I am not the only Member who receives regular visits at surgeries from constituents who express concerns about the care in homes where members of their family are resident. Mrs. Bartlett visited my surgery because she was concerned that appropriate care was not provided for her mother, who was not fed and had lost a lot of weight. I am also concerned about day centres for people with learning disabilities. We need checks on those who regularly provide day care for such people and who are not covered by the current regulations. The independent barring board is not a name that trips off the tongue, but we need people to understand it. We must widen understanding of the implications of providing poor-quality care that leads to abuse and to vulnerable people having less protection and security than they should expect from those charged with their care and protection. Members have been careful to emphasise the point that no legislation can remove personal responsibility. As parents, relatives or carers, we have responsibility to ensure that those for whom we care are looked after by professionals in a professional manner to the high standard that we would provide ourselves. Through the legislation, we can prevent a repetition of the physical and sexual abuse of children and vulnerable adults in care that happened in Wales in the 1970s and 1980s. I hope that we shall also put a stop to a practice that is all too prevalent: English local authorities placing vulnerable people in care homes in Wales. In some cases that I came across, such vulnerable adults were not visited for more than 18 years. Local authorities do not follow through on their obligation to ensure that care is of the highest order. It is important that we ensure that, alongside the Bill, there is a full educational regime so that people understand their rights. Two thirds of children tell no one when they are sexually abused; they do not know how to report that they are being inappropriately touched and abused by adults they trust. Behaviour easily becomes institutionalised in care homes. If a person sees others not being fed or toileted, why would they expect to be fed or toileted themselves? When older people and vulnerable adults do not have the advocates they need, it is easy for their families and friends to be afraid of expressing concern about the care their family member is receiving. They are afraid of being criticised and told to take them away from the institution. It is important that local authorities take responsibility for their contracts with care homes. I had responsibility for a care home where a local authority was paying for five staff to provide care for one service user because a risk assessment showed that such a ratio was necessary for that person whenever they left the care home and went into the local community. The local authority carried out no checks until it was pointed out that, often, only three members of staff were on duty at the home so the service user rarely left it. We need to make sure that legislation for vulnerable adults and the implications of the independent barring board are highlighted for bodies that we would not think were normally affected by such measures––in particular, local authority staff responsible for tendering. In my local authority, a tender was put out to taxi firms and a list that was seven years old, giving full details of names, addresses, dates of birth and medical conditions, as well as pick-up, drop-off and return-home times to a range of schools, was circulated to various taxi companies. Some of them no longer existed and some had moved offices, yet they were given access to extremely sensitive information about vulnerable people. It is important that even agencies that we would not normally think had a responsibility for protection are aware of their duties. It is easy to express concern about a Bill such as this one and to point out that there are aspects that it does not cover. However, we have moved a long way in a short time to provide protection to vulnerable people and we should congratulate the agencies in local authorities, the providers of care and the hospitals and trusts that are working vigilantly and vigorously to raise standards and to ensure that much of the abuse that previously occurred no longer happens. We should welcome the fact that, thanks to the Criminal Records Bureau, 25,000 people who would otherwise have been working in care settings cannot do so. There have been changes and improvements and the Bill will add to the protection arrangements that we are beginning to set up, but it is only a beginning. Those of us who work in this field are increasingly aware that we must always move on to find new ways of working with people to protect them. The Bill moves on to areas of protection that are needed, so I welcome it.