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Care Homes

I congratulate my hon. Friend the Member for Teignbridge (Richard Younger-Ross) on securing this important and timely debate. How often have we said how important and timely this subject is? It is not only an enormously important subject for hon. Members, but an important and emotive subject for families throughout the country. More than 400,000 people are living in care homes in the United Kingdom. As all hon. Members know, and as has already been mentioned, with almost a quarter of the population estimated to reach pensionable age by 2032, we have to address this matter now. I shall start by echoing some of the comments made by other hon. Members about the wonderful work that goes on. It is always important to say that. I echo comments made by the hon. Member for Stroud (Mr. Drew) about care homes in his constituency, and comments made by other hon. Members who have made it clear that there are wonderful examples of care homes in the public, private and voluntary sectors that are delivering excellent care. It is always important to say that and use those as real examples. Unfortunately, I am sure that I am not the only hon. Member who is sick of having to highlight the fact that too many care homes—perhaps a hard core of care homes—repeatedly fail to meet the basic standards of hygiene and infection control. Only last week, a freedom of information request to the Commission for Social Care Inspection revealed that 169 homes in England had recorded major failures in unannounced inspections—28 of them on more than one occasion. Inspectors in those cases had found residents forced to wear coats because the homes were so cold and found homes that smelled of faeces and urine. One home had such appalling standards that inspectors issued a notice under the Police and Criminal Evidence Act 1984 to take photographic evidence of, for example, bags of used incontinence pads left outside attracting vermin, dining rooms with food stuck to chairs and walls, commode bowls and urine bottles left to soak in a bath and dirty razors that may have been shared by residents left in bathrooms. The research also uncovered one case where major failings had been noted, but CSCI does not appear to have returned to re-inspect the home for over two years. The inspection process has not been working adequately. Perhaps more worryingly, follow-ups are not necessarily happening. The inspections are identifying problems, but action is not being taken in respect of the follow-up. I am sure that the Minister agrees that we must, regardless of the effect on the profitability of private homes, have basic minimum standards of care for hygiene, nutrition and malnutrition, as my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) has mentioned—I pay tribute to him for his work leading on that issue—and for dignity and respect. It is vital that we have that. If homes cannot meet that standard, their business model is wrong. I have no qualms in saying that the worst homes should be shut down. From 1 April, we are moving to the Care Quality Commission, which is currently consulting on standards and, specifically, on how it will enforce them. I am sure that all hon. Members agree that it is vital that the CQC uses the new powers to ensure that those key principles—those minimum standards—are adhered to. I ask the Minister to outline progress on that and what we can expect from 1 April. My hon. Friend the Member for Teignbridge has already mentioned staff training. I am sure that we all agree that there are concerns that the stipulations on care staff are not adequate. The story today, in terms of the lack of specialist instruction with regard to people with dementia, as the findings of the research show, is that the training is "fragmented and ad hoc". Clearly, under the remit of the national dementia strategy, which we have all welcomed as an important step forward, we need to move away from training being fragmented and ad hoc. Will the Minister give us his thoughts on that? He has made positive comments about the need for specialist dementia training in particular, but generally how will that lead to a much better national framework of training for people? My hon. Friend the Member for Sutton and Cheam, who has highlighted this issue powerfully, made the point about the use of anti-psychotic drugs, which is a scandal in our care homes. As we thankfully move away from this practice—all hon. Members warmly welcome that direction of travel—we have to face up to the implications of doing so, which mean that there will be a need for better services for people with dementia and therefore for better staff training. That will put the situation in greater focus. We had much discussion about the human rights loophole, which I am pleased was closed by amendments in the House of Lords that meant that people in private and voluntary care homes providing services to local authorities were covered again by the Human Rights Act 1998. I want to bring to the Minister's attention self-funders, who are 40 per cent. of people in care homes. Some 115,000 self-funders—27 per cent. of care home residents—are still not covered by the Human Rights Act. The Government have said that that will be dealt with in the equality Bill, but I ask again for reassurance that that is going to happen and for the Minister to say when it will happen. Funding is important. It is not possible to take this debate forward without a genuine commitment to funding, and we are all on tenterhooks waiting for the Government paper looking at that. I am sure that the Minister accepts the frustration felt by organisations about this having taken so long, because we still do not know what levels of funding we need. The simple reality is that the system is broke and it needs fixing more quickly than is currently suggested by the direction of travel. The Minister may wish to criticise and make party political points about where money is coming from and realistic levels of funding, but the Liberal Democrats have committed in our manifesto for the next election to £2 billion of investment into the care system to pay for a personal care grant that would give a minimum standard of care—going back to that vital word—for everyone over 65 who is assessed as needing care. The reality is that, at local authority level, we are seeing the narrowing of criteria and increasing problems with people not getting care that we all agree in principle that they need. I ask the Minister to bear that in mind. We hope that there will be a significant commitment to filling that funding gap. Immigration is an important issue. One of the problems in care homes is not only recruiting staff, but retaining them. There is an unfortunate issue with the points-based immigration system. I support that system, because it is clearly a sensible way of dealing with immigration and the skill needs of this country, but is there a way to recategorise senior care workers in particular, so that they can work in care homes and plug the gap? That would be a big step forward. This is an enormously important debate. We agree on an awful lot, and all hon. Members in the Chamber are passionate about people in care homes. I simply ask the Minister to take our points from this debate and to answer our questions. The issue will become even more pressing because of the numbers involved, so will he give as much positive news as possible today, particularly about standards and what will happen on 1 April when the Care Quality Commission comes into being? With only a few weeks to go, it would be great to hear about the positive changes that it will make.