(10 years, 4 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Gavin Shuker (Luton South) (Lab/Co-op)
Social care is changing. All parties in this House are rightly committed to giving disabled people more choice and control over where and how they live.
If I were to acquire a serious disability, I would hope to spend as long as possible in my own home. I hope that the care system would provide me with high quality care that allowed me to enjoy a good quality of life close to my friends and family. That is an increasingly normal model, but it has not always been that way.
For decades, it was conventional for most severely disabled people to move into a residential home. Today, some disabled people prefer to live in a residential home where they can be part of a community of staff, relatives and other residents. There will always be some people whose condition is severe enough to rule out other options of care.
Residential home closures, whatever the motivation behind them, pull apart existing communities. They are people’s homes. It may be that many disabled people wish to move from their existing setting, but others do not.
Robert Holmes is 39. I met his mother, Grace, two months ago when out knocking on doors in my constituency. She told me about the excellent quality of care that Robert, who has cerebral palsy, receives at Scope’s residential home, Hampton House in Northampton.
Gavin Shuker
Grace also told me of Scope’s proposals to close Hampton House and relocate the residents apart from one another. She said:
“All of the residents there are like brothers and sisters to Robert—and some have been there for 39 years. The staff are brilliant. Even when residents go to hospital they have a staff member with them 24-7…I felt happy knowing that if anything happened to me Robert was in a place where he was loved and cared for, but now I worry constantly about it.”
Ann and Richard Fensome are also my constituents in Luton South. Their daughter, Joanne, is also 39. Ann and Richard report that Joanne, who has cerebral palsy and is severely disabled, does not wish to move from Wakes Hall in Essex—another Scope home earmarked for closure. They are not alone, and I thank the families who have taken time to contact my office to share their personal and emotional experiences of support for their loved ones at this time.
Scope has proposed to close eight residential homes and modify another three in the coming years, but it is not alone in pursuing such proposals. We are seeing the same thing happen with the Guinness Partnership, Home Farm Trust and other smaller charities who feel that residential homes are no longer in step with the Government’s decision and direction on care provision. This debate is important because we must ask: what about the voice of those disabled people who wish to live in such facilities, but who lose that right because of home closures? What happens when these homes no longer provide the same kind of care they would once have done? Who ultimately steps in?
I do not have one of the proposed home closures in my constituency, but I easily found families who will be profoundly affected by Scope’s decision, and in that sense I suspect that every Member in this place will be affected in some way. The two families I spoke of earlier came to Parliament last month to lobby MPs along with Labour’s parliamentary candidate for Northampton North and former Member of this House, Sally Keeble. She has been tireless in her work on this issue, but she has not been alone. Indeed, I have spoken to a number of Members from across the House who have raised their concerns directly with me.
The hon. Member for Northampton North (Michael Ellis), who is in his place, has challenged the decision to consult on shutting Hampton House in his constituency. The hon. Member for Witham (Priti Patel) has shared her concerns with me about the decision to consult on the closure of Wakes Hall in the nearby constituency of the hon. Member for Harwich and North Essex (Mr Jenkin), and I know that she spoke at a lobby on that issue last month. The hon. Member for Ribble Valley (Mr Evans) and former Deputy Speaker spoke with me about his concerns for the residents affected. In my constituency office in Luton, Grace Holmes and the Fensomes highly praised Scope’s approach to care. They spoke of the quality of support that their children receive, and the relationships that they have built with the staff over the years. As an example of their gratitude for the charity’s work, they shared how they have actively supported Scope for a number of years. Perhaps that is why they are so disappointed by Scope’s proposals. They raised concerns with me about the consultation process, the upset it was causing residents, and a number of process issues. At the core of their argument, however, was the issue of choice.
Peter Walker, Scope’s regional director, recently told a local newspaper that the charity was looking to close care homes such as these,
“because we don’t think this kind of old-fashioned care home offers disabled people the kind of say that everyone else has over where they live, who they live with and how their money is spent”.
Scope states that the closures are necessary in order to comply with the direction of Government policy, which is to encourage those with physical and learning difficulties to enjoy independent living and choice about the care they receive. I have no reason to doubt that assertion, and that Scope’s desire is to give future service users an experience that reflects their expectations. I am fully supportive of the move towards more independent living for those who believe that they will be able to lead better lives in that way. My hon. Friend the Member for Leicester West (Liz Kendall), the shadow Minister for care and older people, has similarly expressed her support for those laudable aims in correspondence with Scope’s chief executive, but for Joanne and Robert, who do not wish to move, their choice is not being enhanced; it is being taken away. I understand that they are among the most vulnerable of Scope’s clients. They are the people that the charity was set up to care for. For them, round-the-clock care does not come towards the end of their lives, and they will continue to need such care for decades to come.
The Department of Health website looks towards a new system under the Care Act 2014 that will be
“built around each person—what they need, how they can best be cared for, and what they want.”
The tone is very purposely set to encourage patients to have more confidence in the choices available to them, yet the most important expression of choice is that of my constituents—their choice is to stay in the home that they know and love, and they want their families to be assured that their loved ones continue to receive good quality care by those whom they trust.
Scope has made efforts to bring residents on board with its new strategy. Hampton House residents have had the opportunity to visit the type of independent housing that Scope envisages—small clusters of individual properties. Although that will appeal to some, the overwhelming feedback was concern. They fear that the move will result in the residents becoming more isolated, and in a loss of the easy mobility and companionship that they currently enjoy. The move will appeal to some, but we should take note of that overwhelming feedback.
I would appreciate the following response from the Minister. First, I should like him to review that broad issue and report to the House. The review should set out what work the Government have done on the changing culture—the shift from residential care home settings for disabled people while at the same time preserving the rights and choices of people such as Joanne and Robert to stay in residential home settings.
If the care home residents were tenants in the housing market, they would have tenure rights, exercisable through the courts. As customers of a business or clients of a charity, they can lose their homes on the whim of a change in strategy by the organisation. That could happen even in the case of Hampton House, where one resident has lived for some 39 years.
The review should examine the issue of choice. Questions have been raised about the working of the Mental Capacity Act 2005, and about the exercising of choice by people who have profound learning difficulties. Who is best able to interpret and assist in their choices: the charity that provides their accommodation or their family members?
The review should examine the accountability of charities and the private sector. If those homes were run in the public sector, there would be a statutory requirement for public consultation. The issues and information would be public, and the results would be open to legal challenge. In the case of Hampton House, Scope has said there will be a consultation, but it has told family members verbally that that is unlikely to change the decision to close the home. The decision is not open to scrutiny or challenge in the same way.
The review should also examine a national framework of safeguards. People with very complex needs require security in their housing and care arrangements throughout their lifetime, which may extend well beyond the lives of their parents or other close relatives. We know that age is a key factor in the argument. Some charities say that younger disabled people want to live independently and, anecdotally, I have been told that more independent living is a trend that is better reflected among some younger disabled people. However, that leaves us with a challenge, particularly for some older disabled people, such as those in their 40s or 50s. In some cases, the intentional communities in which they live have been their homes for all their adult lives. The Government should examine whether their sectoral needs are being well met, and what safeguards should be appropriately awarded to them.
Will the Minister review Scope’s proposed consultation and examine whether more can be done to protect the rights of disabled people who wish to live in these residential settings right now? Indeed, a number of families, accepting Scope’s position that it does not wish to continue actively supporting these institutions, ask whether facilities could be transferred to another charity to run. That would provide continuity of service. I understand that Scope’s position is that it is not an economic concern that has led it to take this route of consultation and closing homes, so it is credible to believe that another organisation could absorb them.
I do not doubt the Minister’s sincerity in seeking to move to a care system where disabled people have greater choice, voice and control over their own lives. It would, however, be the greatest of ironies if, in undertaking such a shift, we were to leave a generation or a group of severely disabled people behind.
Michael Ellis (Northampton North) (Con)
I congratulate the hon. Member for Luton South (Gavin Shuker) on securing this debate. I am grateful to him, and to you, Madam Deputy Speaker, for permitting me to contribute to this important Adjournment debate, as the regular proceedings do not normally allow for that. The hon. Gentleman spoke very well and advocated his position very effectively. I agree with much of what he said.
I admire Scope, as I am sure the hon. Member for Luton South does. It is an excellent charity and its staff do wonderful work. They clearly care about the people in their charge, for whom they are duty bound to care. Hampton House, in my constituency, should not close. It should not close for the very reason that it is not an institution, but a home for more than a dozen people. We are told that this is not about economics, Government policy or local authority decisions; it is a policy shift. There has been a decision to move away from a residential setting to more of a care home setting. This may well work in many cases—the hon. Gentleman alluded to them—especially for those who are disabled who are entering this kind of care arrangement, but it does not work, and is not working, for those who have lived in Hampton House in my constituency for literally decades, and in one case nearly four decades.
In the very short time allowed to me in this instance, I want to put on record my suggestion that we work with Scope to find an alternative to its proposal to close Hampton House, and ask it please to look again and please think again. Those who have lived there for decades are firmly wedded to its atmosphere, staff and ambience—to everything about a home—as you or I, Madam Deputy Speaker, would be. There must be alternatives.
John Howell (Henley) (Con)
The point is that the sense of community is being destroyed. Whatever arrangement we come to with Scope, we have to find a way of keeping that sense of community for the people who want to keep it.
Michael Ellis
I agree: it is a sense of community and a sense of belonging. It is very easy for those outside that community to think that this is an institution that needs change—that we need to modernise and move forward. There may be—indeed, there is—room for such modernisation and moving forward in many cases, but not in every case and not by taking a broad-brush approach. There must be alternatives. I would respectfully ask Scope to work with us across the political divide and with the residents. Let us find an alternative.
The Minister of State, Department of Health (Norman Lamb)
I thank the hon. Member for Luton South (Gavin Shuker) for securing this debate and for speaking in a reasonable tone about issues of enormous concern to some of his constituents. I very much noted the fact that they have told him that they have experienced good care. They regard the care home as their home. In a way, that demonstrates the conflict that sometimes arises, in that there is a general trend towards more people wanting to live in their own communities with support, as the hon. Gentleman rightly said. He described his sense that he would want to remain in his own home were he to be disabled, but at the same time there are those who regard a care home as their home and they have no desire to change that. It is right to recognise that that conflict exists, and it creates a dilemma.
The hon. Gentleman suggested that, in a way, Scope was closing the home because of Government policy. Government policy, as enshrined in the Care Act 2014, is to put people in charge—to focus on well-being, which is the central theme of the Care Act. As far as possible, it should be the individual who determines where they want to be. I have spoken to Richard Hawkes, the chief executive of Scope. Scope is very clear that this is its decision: it wants to do it and is doing so for what it regards as a good purpose. However, the Government’s focus is simply on the individual—on ensuring that, as far as possible, we enable people to make the decision that is right for them, recognising, however, the conflict that can arise.
Care homes often look after some very frail people, but also individuals with quite complex needs. It is understandable and reasonable that, should there be a possibility of a care home closing, residents and their families will be extremely concerned about the future, particularly with the upheaval of having to move. It will inevitably be an unsettling and potentially stressful time. The decision to close a care home voluntarily is taken by the owner or operator—either the local council, where that remains the case, or, if it is an independent home, the proprietor, whether the home is in the private or the voluntary sector. Of the approximately 17,000 care and nursing homes in England these days, over 90% are in the independent sector—that has been the case for many years—and are owned and operated by private companies or charitable and voluntary sector organisations such as Scope.
Homes may close for a variety of reasons, including lack of financial viability and/or insufficient demand for places, retirement of the owners, the sale of premises for alternative use and even the de-registration of unsuitable or unsafe services as a result of the Care Quality Commission’s intervention. In the case of Scope, the organisation is looking to redesign the services it provides to support people. It is important that people who need care and support are accommodated in appropriate settings that are based, critically, on their choice as far as possible. It is clearly not desirable if someone has to move from a care home where they are settled and happy and where their needs are being met.
Local authorities have a responsibility, through good commissioning strategies, to ensure a healthy local care home sector. Through the Care Act 2014, which will come into force next April, we are giving local authorities a core duty to promote their local care market, with a particular focus on ensuring diversity, quality and sustainability. Importantly, they should ensure that sufficient high-quality services are available to meet the needs of individuals in their local area. However, although local authorities should make all reasonable efforts to ensure that good care homes remain viable and stay open, there will be situations where homes have to close or where the proprietors choose to close them. We have to face this. What is most important is that any decision to close a home should be handled sensitively and appropriately. It is essential that person-centred care planning identifies the best possible alternative for each individual. Adequate time should be allowed for the process, so that residents and their relatives can be properly involved and be given plenty of time to make decisions and arrangements in a way that minimises stress.
I must emphasise that, should a home have to close, local authorities have a statutory duty to arrange suitable alternative accommodation for those residents who are assessed as being in need of residential care, so it should never be the case that someone who needs residential care will not be provided with it. I fully appreciate, however, that that does not reassure someone who regards a particular building and set of care workers as their home and their home environment.
I am aware that some providers of residential care for disabled people—including the charity for disabled people, Scope—are reviewing their residential services and are consulting users of services and their families. I appreciate, as I have said, that this can be an extraordinarily worrying time and a stressful situation both for the people in those homes and for their families. Parents of adult disabled people are often themselves quite elderly, which can cause additional stress. The hon. Gentleman touched on that when he talked about his constituent. I would encourage the residents and their families fully to engage with the consultation process and ensure that their views are taken into account.
Scope has given an assurance to the Department of Health that it is committed to ensuring that all users of its services who may be affected are properly consulted and supported. It has promised to provide any individual who needs it with advocacy so that every resident of its homes can understand what the proposals mean for them and can make it clear what they want for the future. Richard Hawkes told me that Scope has even provided care workers to come down to Parliament to support people who were lobbying their MPs against the closures. It says that it has tried to be as reasonable as possible. This process will not, Scope says, be rushed or hurried. It has informed the Department that the consultation will take place over a period of three years.
Scope runs many other care homes that will remain open. There is a particular focus on the larger care homes, but there are also many smaller care homes that it intends to keep open—eight of them, as I think the hon. Gentleman mentioned. Scope appreciates that many residents are happy in its homes, but has to face the fact that there is a lessening demand for large, traditional residential care services.
Richard Hawkes, as chief executive, made the point to me that more people are taking on personal budgets—a concept substantially and rightly developed under the previous Government and one that is continued by this Government and now legislated for in the Care Act 2014. The concept was designed to put the individual in charge, so that they can determine how the money available for their care is spent to meet their particular priorities. As people take on personal budgets, according to Richard Hawkes, they are increasingly voting with their feet and choosing not to go into larger care homes, which often have long corridors, shared bathrooms and so forth. They are increasingly choosing to remain in supported living if possible with a package of care built around their individual needs. Scope is reviewing its services now, so that decisions can be made and, if need be, homes closed in a controlled, planned manner before vacancy levels make them unviable.
Richard Hawkes also told me about an experience that Scope has been through in Southampton. It proposed to close a care home, leading to the same totally legitimate anxieties and concerns. It went through the process and all the individuals in the home have been relocated in circumstances that suit those individuals, with their having a central say in where they are going to go. He tells me—I base my comments just on what he says—that all now appear to be happier with their new circumstances and are finding a new sense of freedom that they did not experience in the past. Although these changes to circumstances can be traumatic and difficult, the end-result, as demonstrated in the experience of Southampton, can sometimes be a good one for the individuals involved. I realise, though, that elderly parents in particular will sometimes find that quite hard to recognise.
It is worth taking a moment to look at the history of this issue. Many traditional, large residential care homes are quite old now. A number of Scope’s homes date back to the 1970s. They were developed in—and designed to suit the needs and demands of—a different era. By modern standards, they lack privacy, and they do not allow residents the degree of freedom, choice and control that we rightly expect and demand nowadays. As a result, many Scope homes are under-occupied. The increasing availability of new models and types of care, support and accommodation means that traditional large care homes are no longer the default or only option when it comes to providing care and support for people with disabilities.
Innovations and developments in supported living, and the various types of housing with care that are available these days, offer disabled people far more choice than they ever had in the past, and control over their lives. I am sure that, ultimately, we should all welcome that. Scope has informed us that, owing to the newer options that have become available, local authorities do not automatically make routine new placements in residential care, and it expects the number of empty places in its older homes to continue to rise. In the long term, it can only be a good thing that people have so many more choices when it comes to the care that is available to them, but, as I have said, I entirely appreciate that, as with any change, the process is not without its short-term challenges.
The Government want to give people more control over their health and social care services, and, therefore, over their lives. That is the central ambition of the Care Act. Personalisation means building support around individuals and providing more choice, control and flexibility in the way in which they receive care and support, regardless of the setting in which they receive it. There is no central policy, incidentally, that says care homes are bad: absolutely not. It is a question of what is right for the individual involved.
The Care Act provides a new legislative focus on personalisation, increasing opportunities for greater choice, control and independence, so that people can choose the services that are best suited to meet their care and support needs. The Act provides that adults who are eligible for care and support must receive services that meet their individual needs. It also requires that they must be involved in care planning. Some, of course, will need and benefit from residential care. There will always be an important job for care homes to do. However, for others a different model of care may now be more appropriate to their needs, and, most importantly, to their aspirations and desire to lead the sort of independent life that all the rest of us take for granted.
We are committed to ensuring that people who wish and are able to live in their communities are given the support that they need in order to do so. Everyone, especially younger adults—including those with a learning disability—should have the opportunity to make informed choices about where and with whom they live, and to have greater choice and control over their lives and support to help them to lead a fulfilling life of their own.
Question put and agreed to.