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Vulnerable Adults (Residential Homes)

I am grateful for this brief opportunity in a packed Westminster Hall to raise the issue of vulnerable adults in residential nursing and care homes in England. I pay tribute to the exceptional level of care that the majority of elderly, vulnerable adults receive from the dedicated private, voluntary and public sectors. It is important to put that on the record. More than 280,000 adults receive care in a variety of settings, and I know from my constituency, where I rarely receive a complaint, that the level of care is generally outstanding, despite the ever-decreasing fees to support top quality care. However, the reality is that abuse takes place, and we know from last week's ICM poll in The Guardian that 66 per cent. of adults are frightened by the prospect of going into care homes. We were reminded only yesterday of the need for vigilance, high-quality inspection, investigation of complaints and prompt action when the owners of Parkfields care home near Glastonbury were arrested on suspicion of murdering five elderly adults. I hope that the Minister will give a further assurance today that the protection of all vulnerable adults is high on his priority list. He has recognised the challenge facing the Government, and on 20 February he addressed Age Concern's Age Agenda conference and said:"““I think we need to create a society over time where people are as outraged by the abuse of older people as they are rightly about the abuse of children.””" He then said that"““we are a long way from getting there. I'm afraid in the months and years ahead, we'll have to face up to some pretty uncomfortable realities about the abuse of older people in our society””." This week gave us a taste of that. What, in effect, the Minister was saying was that of the 500,000 older people who are believed by Help the Aged to suffer abuse today, some will die because of our inability to act quickly enough to protect them. Some, particularly those with dementias, and those who are immobile or unable to communicate, will not even be able to voice their concerns before they die. That is unacceptable. The Minister was right when he said that we would not accept that for our children, and we should not accept it for our elderly people. I hope that today the Minister will set out clearly the steps that he intends to take to build on the excellent initiatives already announced, and set a binding timetable for action to give vulnerable elderly adults the same protection as our children. That is what I am asking for. He could start by agreeing to two relatively straightforward measures. First, he could take steps to recommence the collection of data on elder abuse and to publish them, along with outcomes. It is not right that the Department does not collect those statistics. The £360,000 grant to Action on Elder Abuse is an important step forward, but it should not allow the Department not to collect those vital statistics. Secondly, the Minister could take immediate steps to extend to care home residents full rights under the Human Rights Act 1998—as recommended in the recent Joint Committee on Human Rights report on the human rights of older people in health care—by including an amendment to that effect in the Health and Social Care Bill, which is before Parliament. Given the Minister's statement to the Age Concern conference, surely he cannot be content that the residents of 90 per cent. of care homes and 60 per cent. of domiciliary care agencies run by private or voluntary organisations are excluded from human rights protection. He knows that I have a long-standing interest in this area, largely as a result of the unacceptable handling by various inspection and regulatory bodies of the complaints of abuse that occurred at Gargrave Park nursing home in North Yorkshire between April and October 2002. The elderly residents at Gargrave Park who were subjected to physical, mental and sexual abuse cannot expect justice today because they are no longer with us, but their legacy could be an inspection and complaints regime that gives the elderly in care at least the same level of protection that we demand for children in care. My constituents Ruth Poole and Julie Dale, who were both registered nursing inspectors, exposed the dangerous and life-threatening practices at Gargrave Park, but when they produced evidence about the levels of abuse—supported by other professionals, including a consultant psychiatrist, GPs and social workers—sadly, the authorities sought to discredit the inspectors and not the abusers. Hiding behind a web of obfuscation and petty bureaucracy, those organisations charged with protecting the vulnerable—the Nursing and Midwifery Council, the National Care Standards Commission and the Commission for Care Standards—all failed in their duty of care to residents and to the inspectors. They were often more interested in procedural point scoring than in protecting the vulnerable. The appalling incidents highlighted in February by the ““Panorama”” programme ““Please Look After Mum”” again demonstrated familiar failings by the inspection regime to find out what was happening, despite clear evidence from a whistleblower. Last week's ““Panorama”” programme ““Please Look After Dad”” exposed a worrying trend in the use of anti-psychotic drugs to sedate residents with Alzheimer's, despite evidence from Professor Ballard of King's College and others that such drugs often have little positive effect and could shorten the lives of people with dementia. All those cases—and, indeed, many more highlighted by the Select Committee—point to the need to improve the quality of professional inspection of care homes. I want to challenge the Minister on that. I recognise that the Minister is about to embark on another round of changes to the inspection system to merge the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission into the care quality commission. On the face of it, getting rid of three organisations and merging them into one is a sensible way of moving forward because such organisations often inspect the same institutions and individuals, but what assurances can the Minister give that this is not just another step along the route of de-professionalising the whole inspection regime? Is it not simply recognition that we have far too few inspectors of sufficient status and quality to safeguard the vulnerable in society's care? 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 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:"““We were shocked by the number of witnesses who told us of people who had faced eviction from care homes because they or their relative or carer had complained.””" 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.