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Care Homes

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.