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Care Services: Older Adults and Disabled People

My Lords, I thank the noble Baroness, Lady Fookes, for initiating this debate and for so ably setting the scene on a pertinent subject at the moment given the increase in the numbers of older people. Most elderly and disabled people wish to maintain their independence and dignity and it is important that everything possible is done to ensure that this is made possible by engaging, as we have already heard, whatever agencies are necessary, whether that is for care at home, residential care or hospital care. It saddens me as a retired practising nurse that the care of older people is having to call for remedial action in order to ensure that basic needs are met. Only this week, the regulating body for nurses and midwives, the NMC, has issued guidelines for the care of older people. The document highlights six key points of guidance that reiterate the requirements of basic care. The document was written by a nurse, who was so horrified at the treatment her father received before dying that she has, as a result, taken up the challenge and developed highly innovative ways of treating older people. She was commended at the recent nurses’ national award ceremony. This guidance is designed to demonstrate best practice for all nurses working in hospitals and the community. Much work has been done to improve the care of older people but more remains to be done. Five years ago, after a flourish of bad publicity on the care of older people, my noble friend Lady Cox and I, both retired from practice, thought we should find out whether there was any truth in these dreadful reports. This we did by bringing together a small group of senior nurses representing management, teaching, research and practice. After two meetings we agreed as a group that there was evidence supporting these reports and that we should try to do something about the situation. Two members of that small group were members of the Burdett Trust for Nursing who persuaded the trust to commission a piece of work, resulting in the publication in 2006 of a report entitled Who Cares, Wins: Leadership and the Business of Caring. The conclusions for healthcare providers were that they need to, ""clarify how the ‘business of caring’ will be led and managed in their organisation. Structures and processes for patient, carer and public engagement may need to be rethought … be specific about the quality measures they will achieve … establish a conducive organisational culture that puts patient experience at its heart"," and, ""agree appropriate indicators of how well they are performing in relation to patient experience"." The report was supplemented by an explanatory study of the clinical content of 60 NHS trust board meetings. Only 14 per cent of the 60 sets of minutes contained any clinical mention. Members of this House will be familiar with the great deal of progress that has been made since the publication of that report, thanks to the NHS review conducted by the noble Lord, Lord Darzi, with its strong emphasis on high quality care. In addition, the Burdett Trust for Nursing commissioned a further piece of work through the King’s Fund, which has just published a report entitled Ward to Board. This was a study of seven pilot units that worked through the recommendations of the Who Cares, Wins report. Within the past few weeks the Royal College of Nursing has published a further report, Breaking Down Barriers, Driving Up Standards, a study into the ward sister’s and charge nurse’s leadership and managerial roles. I hesitate to mention more reports, but these all point to the need for effective leadership, from the patient to the board, with the appropriate accountability and authority at all levels. There has to be a balance between finance and quality but, regrettably, the most recent Healthcare Commission report into the Mid Staffordshire Foundation Trust demonstrated clearly that the emphasis was on financial targets to the exclusion of high quality clinical outcomes. Against that background of needing to balance the delivery of high quality care through effective leadership roles with defined accountability and authority within the allocated financial resources, I shall move on to the principles that apply specifically to the care of older people and those disabled people requiring long-term care. That reminds me of the work that I did over a period of 10 years in the late 1970s and into the 1980s, with those suffering from learning disabilities and psychiatric conditions, with which my noble friend Lord Rix, will be familiar. These services had suffered as what were described as "Cinderella services" through a lack of resources in both finance and a specially trained workforce. Restoring the balance to high quality care required leadership, tenacity of purpose and the ability to champion change. During that time there were several inquiry reports all sharing 30 of the same areas of mistakes that led to poor quality care. Thankfully, we have moved on, but we cannot afford to ignore the signs that indicate that in some areas there is poor quality of care where clinical pathways have not been established and sufficient resources made available, either in hospital or the community. It is at our peril that we ignore the opportunities presented by the next-stage review, the other supporting reports and guidance from the regulator. Each indicate the direction needed to be taken to ensure that these groups of people receive the high quality care and support that they deserve, to allow so far as possible a fulfilling life of independence and dignity that does not impose impossible strain on their families and friends who undertake the caring function. The enabling legislation in the current Health Bill clearly sets out ways forward for raising standards. It is important that work is already in hand, led by the Chief Nursing Officer, Dame Christine Beasley, towards implementing the recommendations of the Minister’s review, encouraging the development of education for nurses and midwives both pre-registration and post-registration, bringing in teaching to establish best-evidence practice of high correlation of theory to practice and the work introducing measurement of quality care, all working towards enabling staff and empowering the people towards high quality care. However, could not further consideration be given to how implementation can be achieved by building on leadership skills, championing change processes within the appropriate attitudinal approach and sensitivity required for the compassionate care needed by this group of older people and those suffering from longer term disabilities?