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Mr David Crausby (in the Chair)
We now come to the debate in the name of Nick Smith on the conduct and outcome of Operation Jasmine into care home abuse. Although elements of this subject would engage the House’s sub judice resolution, the Speaker has agreed that, because criminal proceedings now appear unlikely to go ahead in the foreseeable future, the resolution should be waived to allow the hon. Gentleman to air his concerns. I am confident that he will exercise due caution in what he says.
Nick Smith (Blaenau Gwent) (Lab)
I am grateful for the opportunity to raise this issue. I speak on behalf of the alleged victims of care home abuse in south Wales and their families. This debate is timely and of great concern. This matter deserves scrutiny for my constituents, the south Wales region and, indeed, UK colleagues.
We cannot underplay the significance of Operation Jasmine. Spanning seven years, it is the biggest investigation into care home abuse ever undertaken in the UK: 75 police officers and staff worked on the case; more than 4,000 statements were taken; 10,500 exhibits were collected; 12.5 metric tonnes of documents currently lie in a Pontypool warehouse; and it cost £11.6 million, including £500,000 for 11 experts to advise the police.
Chris Evans (Islwyn) (Lab/Co-op)
I commend my hon. Friend and parliamentary neighbour on his efforts in this campaign, and the work of Gwent police in putting together the investigation. Is he not concerned, as I am, that the case has taken seven years and cost £11.6 million, as he mentions? At a briefing, he and I saw harrowing photographic evidence of some of the alleged abuse. Is he not worried that that situation has caused more pain and anguish to the relatives, family and friends of those who suffered the abuse?
Nick Smith
I thank my hon. Friend for his point. That situation has caused much pain and anguish to relatives of the victims of the alleged abuse, which is why it is important to have this debate and seek more information about what occurred.
Paul Flynn (Newport West) (Lab)
Is my hon. Friend concerned that in Operation Jasmine, chlorpromazine was found in the hair of three of the victims? It is an antipsychotic neuroleptic drug that is meant to be used on the deeply psychotic. The misuse and over-use of drugs to turn patients into zombies and make the home cheaper to run is a significant feature of this disgraceful affair.
Nick Smith
My hon. Friend makes a powerful point. All the evidence collected by the police in this long-running case must be brought to the public’s attention, so that it is open and available for them and they can form their own views about what happened.
On 1 March, at Cardiff Crown court, the key prosecution collapsed, when the director of care home owners Puretruce was deemed unfit to stand trial. Relatives have been left angry and despondent. In the meantime, the human cost has been devastating: there are 103 alleged victims, 60 of whom have died since 2005. That cannot be the lasting legacy of the inquiry, or the legacy for those who died and their families.
In a former job, I was a National Society for the Prevention of Cruelty to Children campaigner, and I saw terrible images of child abuse. The pictures that I have seen from Operation Jasmine are no less terrible. I was shown graphic photos of pressure sores that proved fatal, and of sores that were so infected that the bone beneath was visible. They were sickening, and in the words of one expert, the worst that they had ever seen.
A senior employee in one home has told me that the director sought tight control of the business. If full-time staff were off, no agency staff were brought in. Budgets were squeezed across the board, and even food and incontinence pads did not escape budget cuts. Six Puretruce care homes were investigated for alleged neglect. In my view, there was a systemic failure across many of the homes, with residents’ care being compromised. It led to what police have called “death by indifference”.
In July 2007, the director was arrested on charges covering both neglect of residents and financial irregularities, but the charges of neglect faltered as the bar for conviction was said to be very high.
Jessica Morden (Newport East) (Lab)
I congratulate my hon. Friend on securing this debate for the families, the police and the Health and Safety Executive who have worked so tirelessly on this case for many years. The central issue here is that proving deliberate acts of harm is relatively straightforward, but proving deliberate neglect is hard, so does he agree that that is something the Minister should consider urgently?
Nick Smith
I agree with my hon. Friend, and it is one of the direct questions that I intend to ask the Minister.
In 2011, the Health and Safety Executive became involved, too, in the hope that its additional evidence would be the final push over that bar. Sadly, that did not happen. Instead, the charges against the director, who had a GP practice and 26 care homes across south Wales—a profitable empire—will lie on file.
A small number of convictions have been secured in relation to the neglect of elderly people, but no one served a custodial sentence. We have to ask ourselves whether that sorry conclusion could have been avoided. MPs have been told that a change in the QC part way through the case brought a different perspective as to the likely success of the case. We know that the Crown Prosecution Service decides the charges and the standard of evidence it requires, but given the enormous quantity of evidence collected, it does beg questions about the evidence threshold, how Operation Jasmine progressed and the management of the operation. It is clear, as others have said, that local police worked very hard on this case, but the results do not match that fine effort. Was there a well founded and unified understanding between the CPS and the police about what evidence was needed?
Given that the case took seven years, did anything slow down the operation and how could such roadblocks be avoided in the future? What advice does the CPS give to the police and others investigating abuses in care, and does it have a plan for lowering the bar for prosecutions in the future? Were high-level project management tools brought to bear on this investigation from the start, and is the legal definition of “neglect” fit for purpose in cases such as this?
Mr Andrew Smith (Oxford East) (Lab)
I congratulate my hon. Friend and colleagues in Wales on pursuing this case on behalf of the victims and in the interests of higher standards in home care. Am I correct in my understanding that while the principal prosecution collapsed because the principal defendant was unfit to respond to the charges, the co-defendant is not in such a position and yet action is not being proceeded against him? Does my hon. Friend have anything to say about that, and would he like to put that point to the Minister and ask why that person cannot be prosecuted?
Nick Smith
My right hon. Friend makes a fair point. That is indeed the case, and it would be good to hear from the Minister why that prosecution was not taken forward.
I have written to the Director of Public Prosecutions to ask for some answers. He has now promised a substantive reply, but further action might be needed. We have a duty to those elderly people who have passed away, the families who are still fighting on their behalf and those with no family and with no voice. We must ensure that their story is put on the record.
The inquiry into poor care at Stafford hospital showed how important it is to record individual cases and to make the information public. I want the QC’s final opinion on the allegations in this case to be made public, and the Director of Public Prosecutions or the head of the CPS in Gwent to meet MPs and members of the victims’ action group. I want them to be joined by representatives from the police, the Health and Safety Executive and the Care and Social Services Inspectorate Wales, and I want key evidence collected for this trial to be made public.
There have been calls for a public inquiry. I need to know what criteria the Minister will bring to bear when considering such calls.
Nick Smith
Thank you, Mr Crausby, for allowing me to continue my speech.
There have been calls for a public inquiry. I need to know what criteria the Minister will bring to bear when considering such calls, given that this case is the biggest inquiry into care home abuse in the UK. There are 106 alleged victims, the evidence suggests that there was systemic failure and there has been no closure for the victims. These calls for a public inquiry become compelling.
The deputy chief constable of Gwent police has said:
“There is a likelihood that there are cases like this occurring every day of the week across the country”.
Staff and relatives must not be afraid to challenge care that they are worried about.
Wayne David (Caerphilly) (Lab)
On the issue of an inquiry, does my hon. Friend agree that one of the major problems now is that, because one of the accused is unwell and is deemed unable—at the moment—to go on trial, information cannot be provided for any kind of inquiry because there may be a trial in the future? What is absolutely essential is that we get definitive medical advice on whether or not that accused person is able to stand trial in the near future—yes or no.
Nick Smith
My hon. Friend makes a powerful point. We have to take this further, if we can.
Paul Murphy (Torfaen) (Lab)
Does my hon. Friend agree that, even if an inquiry cannot be held at this stage because of continuing investigations, the Welsh Government, who I suspect could be responsible for an inquiry, could in principle agree to one as soon as the judicial proceedings are over?
Nick Smith
My right hon. Friend and neighbour is an experienced parliamentarian. He may have found a route through this, so that we can get to the bottom of this issue. His point should be explored.
Staff in such cases must also be supported if they draw attention to care that does not meet agreed guidelines. A woman told me that her mother suffered pressure sores while in the care of a Puretruce home. Even though the family had visited mam every day, they were never told about these sores. They only found out when the police investigation came to their door. She said:
“Only the families now know what went on. People need to be told.”
We must not ignore the lessons of this sorry tale. We all have a responsibility to see that residents are well fed and that rooms are clean. If not, we should be asking why and those concerns should be acted on.
Many people can expect to live for nearly 80 years. As we live with conditions such as dementia for longer, many of us will see a partner or loved one, or ourselves, in a care home at some time. Across the country, hundreds of thousands of people are well cared for: their care homes will be spick and span, and their health will be a priority. But we must ensure that a gold standard of care is there for everybody. Lessons must be learned. But with all the evidence Operation Jasmine has collected, there is no doubt much more for us to learn. We must keep the spotlight on residential care, to stop further abuse behind closed doors.
The Minister for Immigration (Mr Mark Harper)
It is a great pleasure to serve under your chairmanship, Mr Crausby. I congratulate the hon. Member for Blaenau Gwent (Nick Smith) on securing this debate on an important issue, and I agree with his concluding remarks. I am grateful to Mr Speaker for waiving the sub judice rules so that I can set out some details that the hon. Gentleman is familiar with, but which it would be helpful to get in the public record.
The hon. Gentleman has a particular interest in this issue because one of the care homes covered by the investigation was in his constituency. He and other hon. Members will know about family members of those who were neglected, or those who sadly died, who will be affected and will be concerned about what happened. I am sure that his interest, and the interest of other Opposition Members, will keep this issue at the forefront, to ensure that we learn lessons from it.
Simon Hart (Carmarthen West and South Pembrokeshire) (Con)
Marilyn Jenkins’s mother was in the Brithdir home and died. She is unaware whether her mother was properly treated or not. Will she ever be able to get answers to that question?
Mr Harper
I should have said that hon. Friends, as well as Opposition Members, will know of such cases, too. The hon. Member for Blaenau Gwent asked whether the prosecuting authorities would meet family members. That seems sensible. I have had experience of cases in the criminal justice system, in which—even if the outcome was not everything that people wanted—understanding what happened and having the facts, and understanding the thinking, at least gave people a sense that a proper process had been followed.
In my hon. Friend’s constituent’s case, and I suspect in that of many other families, even if they may not be happy with the outcome because the prosecutor has not been able to proceed with the case, it is important to know what happened to their family member and whether they were properly treated. Although that may not give them satisfaction, at least they may understand what happened and can ensure that they and other people learn the lessons, so that it does not happen again.
The hon. Gentleman is right. There is no place in our society for anyone who abuses anyone for whom they are supposed to be caring, whether a child, a vulnerable adult, or any other member of the community. We should always be vigilant about dealing with that.
Operation Jasmine was a long and difficult case for all those concerned, with 103 alleged victims, 63 of whom have subsequently died. That must be incredibly distressing for their families. I thought that it would probably help, given the hon. Gentleman’s questions, if I gave the House some facts about the operation and the outcome of the police investigation, which commenced in 2005.
Paul Flynn
In March 2000, a ten-minute rule Bill was introduced, seeking better control of neuroleptic drugs in residential homes. Some homes did not use the drugs at all, but in other homes 100% of residents were on those drugs, which meant that they often lived shorter lives and died in misery and confusion. Has there been any improvement since 2000?
Mr Harper
I am not familiar, apart from in general terms, with the specific point that the hon. Gentleman raises. I will draw that to the attention of my hon. Friend with responsibility for care standards. I am sure that the relevant Minister in the Welsh Government will also hear of the hon. Gentleman’s question.
The investigation commenced in 2005, when an elderly resident at Bryngwyn Mountleigh nursing home was admitted to the Royal Gwent hospital, where she then died. Partner agencies brought to Gwent police’s attention significant potential failings at Brithdir nursing home, mentioned by my hon. Friend the Member for Carmarthen West and South Pembrokeshire (Simon Hart). Both homes were owned by Dr Prana Das. Following the investigation into this incident at Bryngwyn, further investigation by Gwent police identified a series of deaths at the home that required further thorough investigation, with the police identifying a further 11 cases where elements of neglectful care may have been linked to the deaths of those residents.
Initial work at Brithdir nursing home identified 23 further cases of concern where allegations of neglect had been investigated. The operation eventually investigated allegations of abuse at two further care homes. Gwent police took this very seriously—I think that that was the general sense of the contributions from Opposition Members—and allocated a dedicated police lawyer and Crown Prosecution Service counsel early on in their investigation. I think that they sensed how significant it was going to be.
As the hon. Member for Blaenau Gwent said, it was a thorough police investigation, involving 75 police officers, more than 4,000 statements, more than 10,000 exhibits and 12.5 tonnes of documentation. The Home Office provided special grant support for the police authority in Gwent, so that the costs of this investigation did not fall entirely on the police authority and cause detriment to wider policing in Gwent. That was right and proper.
There were three convictions against care home staff in 2008 for wilful neglect. The investigation then continued with further charges being sought against the main defendant, which the hon. Gentleman mentioned, for manslaughter by gross negligence or wilful neglect. However, in February 2010 interim advice from CPS was that the cases had not reached the threshold required for criminal prosecution. The investigations were then completed. Further CPS advice to Gwent constabulary in February and June 2011 was that the threshold for manslaughter by gross negligence or wilful neglect had not been met in any of those cases.
I understand that the chief constable, not being satisfied with that advice, met the Director of Public Prosecutions to challenge the advice that he had received. The DPP reiterated the advice that, despite the thorough investigation, the case simply had not reached the threshold for reasonable prosecutions, given the difficulties of proving wilful neglect.
Hon. Members will be aware, from what the hon. Gentleman said, that the case was then taken forward as a joint investigation with the Health and Safety Executive. The decision was taken by the HSE to prosecute Dr Das, his company Puretruce Health Care Ltd and its chief executive, Mr Paul Black, in relation to neglect and fraud at two care homes, Brithdir and The Beeches in Blaenavon. The trial was set for January this year, but on 9 September 2012 Dr Das was badly assaulted in his home in an unrelated incident of aggravated burglary and has remained in hospital ever since, suffering from permanent brain damage. As the hon. Gentleman said, on 1 March Judge Neil Bidder, based on medical evidence that he had received, ordered that all charges relating to Das, Black and the company lie on file. If Dr Das ever recovers from his injuries, which I understand from the medical evidence is unlikely, the trial could continue.
I cannot remember whether the right hon. Member for Oxford East (Mr Smith) or the hon. Member for Caerphilly (Wayne David), who is sitting next to him, mentioned this, but the judge also ruled that Paul Black, the co-defendant, should not stand trial because it was not deemed appropriate to try him alone. I can understand, of course, that the fact the prosecution could not continue leaves families with a real sense that justice has not been done, but given that the judge decided the defendant is not in fit condition to stand trial, it is not obvious that there is an alternative prosecution scenario.
The judge also decided that, in the absence of the primary defendant, Dr Das, the company could not be tried either, because it is not possible for the company to have a fair trial given that the main individual controlling the company is not able to respond. The positive thing is that the charges lie on file, so if Dr Das ever recovers from his injuries, family members may be reassured that the case will continue, although, as I have said, the medical evidence is that that is very unlikely.
One of the questions that underlies what the hon. Member for Blaenau Gwent said is whether something like this could happen again. Important issues arise on whether we have proper arrangements to protect vulnerable adults from those who might seek to abuse and exploit them.
Wayne David
I heard what the Minister said about the evidence remaining on the table, as it were, but does he not accept my point that we need some sort of time scale? In theory, the evidence that has been accumulated could remain on the table indefinitely without there ever being an inquiry because it might not allow consent to be given for such an inquiry.
Mr Harper
I was just about to come on to the question of an inquiry. The right hon. Member for Torfaen (Paul Murphy) alluded to there being another factor in the case, because, obviously, some of these issues are for the UK Government and some of the issues on health and social care are for the Welsh Government.
If either Government decided that a public inquiry would be the right thing, they would need to think through whether the charges remaining on file were a roadblock and whether, therefore, steps needed to be taken. They would also need to consider the balance in terms of the interests of justice and openness.
At the moment it is important that lessons are learned, and I will set out what I think some of those lessons are. If we are to have a public inquiry, we need to think through the objective of that inquiry and what it is that we would learn that we do not already know. Given the exhaustive nature of the police investigation, and without doing some further thinking, I am not clear whether the answer to that question is that we would learn something from having a public inquiry.
Clearly, if it turned out that the fact the charges are lying on file and are pending is a roadblock, and if either Government wanted to have some sort of public inquiry, we would need to come back to that and the various agencies would need to think about the right solution. Without that being on the table, the fact that the charges are on file means that people can be reassured that there is no sense that someone could get away with it if they were ever in a position to stand trial. The fact is that the evidence is there, the charges are there and it would be possible for a prosecution to proceed if the defendant were ever in a position to be able to stand trial in a way a judge determined to be fair.
I have six minutes left, so I will try to address some of the other issues. As a result of the operation, 42 individuals were referred for consideration under the Care Standards Act 2000, which introduced a duty on care providers to refer care workers who have been dismissed or suspended or otherwise left their employment for misconduct that harmed a vulnerable adult or placed a vulnerable adult at risk of harm to the protection of vulnerable adults scheme. In October 2009, all cases under that scheme were referred to the Independent Safeguarding Authority, which has since been replaced by the new Disclosure and Barring Service. That is a mechanism for ensuring that any care worker who does not perform at the level they should is unable to work with vulnerable children or vulnerable adults in the future.
More widely, the Government are completely committed to protecting vulnerable members of the community. Work is under way, as part of a Department of Health-led, cross-Government effort on safeguarding vulnerable adults, to legislate to put safeguarding adults boards on a stronger statutory footing to ensure that they are better equipped to prevent abuse and to respond when it occurs.
Given the role of the Welsh Government, as the right hon. Member for Torfaen suggested, I have taken the trouble to understand some of the issues they were dealing with. I know they have maintained close contact with Gwent police throughout the police operation, and I know they have taken account of lessons from the operation in developing their own policies and legislation in this area. The Welsh Government have introduced new statutory guidance on managing escalating concerns within care homes. They funded a dignity in care programme to improve practice, and I understand that, later in the year, they will publish a White Paper on the regulation and inspection of social care. The Care and Social Services Inspectorate Wales has also modernised its approach to inspection and regulation to give a stronger voice to care home residents and their families.
Protecting vulnerable adults from abuse is clearly a core part of the police’s safeguarding and public protection responsibilities. The Association of Chief Police Officers recognises the importance of working together with statutory agencies, local authorities and their safeguarding partners.
ACPO has reviewed the overall learning from Winterbourne View, another very serious case in which adults with learning disabilities were treated incredibly badly. The one direct recommendation relating to the police was on the early identification of trends and patterns of abuse, the lessons from which will be disseminated nationally across England and Wales through training and practice.
Wayne David
Given that Gwent police has already said it is more than happy to co-operate with the Older People’s Commissioner for Wales on an immediate inquiry, does the Minister agree that that would be a positive step forwards?
Mr Harper
I will go away and look at that. From everything they have done, the police come out of this very well. The investigation was very thorough, and everyone seems to think they did the work that was required. The College of Policing has a public protection learning project that brings together a range of public protection disciplines, including adults at risk, and it will consider the training materials used by police forces across England and Wales.
What the hon. Member for Blaenau Gwent said at the end of his remarks is absolutely true. Protecting vulnerable members of our society is an absolute priority. This has been a difficult and disturbing case, and it has been very lengthy for everyone involved. The charges lie on file, and the case has happened.
From what the hon. Gentleman and my hon. Friend the Member for Carmarthen West and South Pembrokeshire have said, it sounds as if some work may be needed to ensure that all the families involved are properly briefed about what happened to each and every one of their relatives so that they fully understand the situation.
I listened carefully to what the hon. Gentleman said about the DPP and the CPS meeting the families, and I will raise that with the DPP through the Attorney-General—I cannot think of any reason why such meetings could not happen—and report back to the hon. Gentleman.
If there are lessons from the case, they clearly need to be learned. It is right that all parties, including the UK Government and the Welsh Government, should consider what they can do. I know the hon. Gentleman and his colleagues will continue to pursue the matter to ensure that whatever lessons can be learned are learned and that we are never here again with a similar case. I hope what I have said has helped the hon. Gentleman in what he has been trying to establish today, and I am sure this will not be the last time he raises the issue either in Westminster Hall or in Parliament more widely.