Care Homes (Regulation)

Wednesday 4th November 2015 Westminster Hall

16:30

[Peter Heaton-Jones (North Devon) (Con)]

I beg to move,

That this House has considered regulation of care homes.

It is a pleasure to serve under your chairmanship this afternoon, Ms Vaz. The purpose of today’s debate is to highlight what I believe to be serious shortfalls in the current system for the regulation, inspection and investigation of private care homes and nursing homes. At the moment, I believe, quite simply, that we are letting people down—the people who are least able to speak up for themselves. They are the estimated 300,000 older people who currently live in around 17,000 registered care homes in England. Their average age is 85 and a significant proportion suffer from dementia. They are people largely without a voice and that, I believe, needs to change.

Two and a half years ago, some time before being elected to this place, I was contacted by a constituent in North Devon. He told me the very moving story of his mother, a former resident at a private care home, who had died in 2009. Her son believed then, and still believes to this day, that there are serious questions about the care that she received in the final months and weeks of her life.

In the following years, my constituent has pursued all the avenues open to him to have his mother’s case fully investigated. Invariably, though, he hit a brick wall, so he began to look beyond his individual case at the more general question of how care homes are regulated and complaints investigated. He came to the conclusion that the current system is simply not fit for purpose. It is a conclusion that I share, which is why I sought today’s debate.

Let me stress that this debate is not about my constituent’s individual, specific case. I do not seek to reopen it nor to raise any questions about the standard of care in that establishment today, six years on. Indeed, last night, I spoke to a senior director at the home’s parent company to give her that assurance, which she accepted. However, my constituent’s individual case is the starting point. That is how it must be, because at the heart of this issue are people, and we must always remember that when we talk about systems, institutions and processes. It is the people who matter, and at the moment, I believe that we are letting them down.

To seek evidence for that, we have to look no further than the website of the Care Quality Commission, the body that currently has responsibility for the regulation and inspection of care homes. Today, that website tells us that of the 700 care homes most recently inspected by the CQC, a staggering 44% have been rated as either “Requires improvement” or “Inadequate”. There is no reason to believe that those figures are unrepresentative of the sector as a whole, so that means that four in 10 of all establishments are not currently reaching the required standard. Surely the purpose of any system of inspection and regulation must be to drive up standards. Those figures alone, therefore, suggest that currently the system is simply not working.

Let us look at that system, because it has undergone some significant changes in the recent past, and indeed it still is undergoing change, even as we speak today. It seems to be a process, however, that in its fluidity is encountering considerable difficulty. We are in a flexible mode, I think it is fair to say, as far as the CQC’s arrangements are concerned.

In June 2013, the CQC issued a consultation called “A new start”, which proposed a whole new approach to inspection across all sectors, including care homes. That approach was confirmed in October two years ago, and the new provider handbook for residential care came into effect from 9 October last year. In April this year, the CQC introduced a special measures regime, as it was called, for failing services. However, it is clear that there are problems in the implementation of some of those new processes.

The CQC’s most recent publication, which was published as recently as 28 October, is called “Building on strong foundations”—I have a copy here, hot off the press. It sets out

“some of the choices it faces in responding to changes to how health and social care is delivered”.

Well, it must face some pretty tough choices, because it is pretty clear that what it seeks to do in changing its processes is not fully working.

Let me quote an article from The Guardian, which I admit is not one of my usual media choices. The columnist, Michele Hanson, wrote on 28 September this year:

“Do you fancy being a CQC inspector? You can. Anyone can. You don’t have to be a social care expert, just have a six-week induction course. And luckily, once you start inspecting, you don’t have to inspect everything. You can just inspect a couple of the Key Lines of Enquiry (KLOE), because they’re not all mandatory.”

The article goes on to say:

“You can leave out management of medication, or quality of life, or complaints, and you can inspect different KLOEs in different homes, which means you can’t compare”

what is good and what is not good. She concludes:

“Which is perhaps why our local care home, rated ‘excellent’ by CQC”

was exposed on the television a short time afterwards

“over the fearful abuse of one resident”.

Clearly, something is wrong with the system. What is the cause of that? It seems, as I said, that the CQC has encountered particular problems recruiting sufficient expert inspectors. In July this year, the National Audit Office found that just 9% of care homes have so far been assessed, because of a shortfall of 160 inspectors. Indeed, the February 2016 deadline to complete the work has now been pushed back to next October.

I have a great deal of respect for the many hard-working staff at care homes and at the CQC. Those at care homes in particular receive low wages for a job that I would never want to do. I also have some sympathy for the many care home providers who are having to cope with the ever-changing regulation regime. The goalposts are constantly moving, and it is costly for those care home providers to comply with the system. Care homes have to pay to be registered by the CQC, and, depending on how many residents they have, the cost can be anything from £276 to more than £13,000 a year. It is fairly obvious where those costs are going to be passed on to.

Let us make no mistake. In cases where something goes wrong, it is the care homes and the people who own and manage them who bear the ultimate responsibility for getting things right, but the regulatory framework that we—the state—impose has to help them, encourage them, and yes, force them to improve. At the moment, it does not.

[Julian Knight (Solihull) (Con)]

My hon. Friend is making a powerful case and is clearly a strong advocate for fairness and transparency in the care home sector. On whether providers are being managed in the right way by the CQC, is not the point that they have said to Department for Business, Innovation and Skills that they feel that they are being asked to provide paperwork and not care, and that there is sometimes duplication between the local authority and the CQC in how the sector is regulated?

[Peter Heaton-Jones]

My hon. Friend makes an extremely good point. This must be about the elderly people who are in the care homes. They must be the entire focus of those who work in, manage and own those care homes, not the bureaucracy and the paperwork.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate my hon. Friend on securing the debate, and it is a pleasure to serve under your chairmanship, Ms Vaz. You will remember that we looked at this issue in the Select Committee on Health in the last Session, as will the shadow Minister. We welcomed the new inspection regime, but I seem to remember that one criticism we had in discussions in the Committee related to the fact that we are dealing with often very elderly, very frail people who cannot speak for themselves, and one thing that the CQC could perhaps do better is engagement with families. That is not just after an inspection, when everything is all right. It needs to ensure that family members of those in care homes understand what the inspection regime is and how they can engage with it before, after and during the process. Although some of the changes have been positive and there is now perhaps better regulation in England, the people whom we ask to give feedback are often not able to speak for themselves, so we need to engage families much better.

[Peter Heaton-Jones]

My hon. Friend makes an extremely pertinent point, and I will talk about some challenges in the entire system when it comes to engaging with people. As he rightly says, people have difficulty in understanding the best way to engage with the system.

When things go wrong and a member of the public needs to raise a complaint against a care home, I am afraid the system becomes even less satisfactory. The CQC’s website says that it

“is unable to investigate individual complaints”

against providers. So how does someone complain if something goes wrong and they are worried about the care that is being given to an elderly relative in a care home? It is difficult. What can someone do if they fear that an elderly relative is being neglected, mistreated or not given the right healthcare, or if they fear that their relative’s life might even be in danger and the care home provider has dismissed the complaint or will not listen to it? The CQC has that said it will not handle individual complaints, so should they go the Parliamentary and Health Service Ombudsman? No, because the ombudsman says:

“By law, the Ombudsman cannot look into complaints about privately funded healthcare.”

If someone tries to go to the ombudsman they reach a brick wall. The CQC will not handle individual complaints and the ombudsman does not accept them. There is one possibility: an organisation called the Independent Healthcare Sector Complaints Adjudication Service. The ombudsman’s website states that “you may”—I stress “may”—

“have the option of going to the Independent Sector Complaints Adjudication Service…which represents some independent healthcare providers.”

If someone’s healthcare provider is not one of them, they are stuck.

The system is bewildering. It lacks accountability and transparency, and would leave most people confused and frustrated. How are people in care homes supposed to deal with that bewildering system? They may be vulnerable, old and frail and perhaps suffering from dementia. Their loved ones might put all their time and energy into caring for them, but how are they supposed to navigate the system? It needs to change.

What changes am I proposing to try to put right some of the issues I have highlighted? Despite the best efforts of the CQC—I say again that this is not a criticism of individuals at the CQC, much less those who work in care homes—I am afraid that, as currently manifested, it is simply not fit for purpose when it comes to the regulation, inspection and investigation of standards in care homes. Its focus recently has rightly been on NHS hospitals and providers. In light of the Mid Staffordshire scandal and the findings of the Francis report, that is hardly surprising—indeed, it is right—but the unintended consequence has been insufficient focus on the private care home sector.

In the short term, we must hold the CQC to account and insist on significant improvements now, because the situation needs to be addressed immediately. In the long term, it seems to me that the solution is to create a new, single, dedicated body whose sole responsibility is the registration, regulation and inspection of private care homes. Crucially, that body should also be the first point of contact for anyone wanting to raise a complaint about a specific establishment or the care of an individual patient. It would have the responsibility and necessary powers and resources to investigate those complaints thoroughly and rigorously, and in real time.

At the moment, if someone has an immediate concern about the care being given to an elderly relative and the care home either disagrees or denies that there is a problem, there is nothing to be done and nowhere to turn. That could be a matter of life and death. It needs to change, and it needs to change urgently. When things need to be taken further, we need a complaints system that is easier for the public to access and more transparent, and whose findings are accountable to Parliament in individual cases. The current complaints infrastructure is bewildering and is just not working.

My constituent to whom I referred at the start of my speech has lived with the problem for the past six years. Over that time, he has invested a great deal of work, research and thought in it. It has been his life, and it has undoubtedly been part of the grieving process for his mother. He has produced a document that is the product of a lot of work, and I have it here. It contains 24 very detailed points, questions, proposals and recommendations. He is frustrated that despite his best efforts and with a few notable exceptions, the issue has been largely ignored by the media and not given sufficient focus by politicians. That is something I want to put right today.

In the many hours my constituent and I have spent discussing the issue, we keep coming back to one thing. It is not about processes, systems or organisations, it is about people—people who do not have a voice in a system in which, let us remember, four in 10 care homes currently fail to reach a satisfactory standard on the CQC’s own measures. That means that people—vulnerable, sick and elderly people—are not being properly cared for. That cannot be right. We must do something about it. I believe we have a moral duty to do something about it, and that we must act now.

16:46

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Ms Vaz. I congratulate the hon. Member for North Devon (Peter Heaton-Jones) on bringing this topic to Westminster Hall, setting the scene and explaining its importance from his personal experience and knowledge.

Care homes should and must provide care and services to some of the most vulnerable in society. I believe and the House believes that those who have worked hard and have contributed to society and the economy all their lives deserve appropriate care and dignity in their old age. We have the opportunity to be a voice for those who cannot be a voice for themselves. That is the issue the hon. Gentleman has brought to the House today. The people involved are often at the fringes of society and are of all ages. Many people in care homes do not have immediate family and that is another concern. We read stories in the press and we may be suspicious of them, but they illustrate the problem. There is no smoke without fire, so if there is a story in the press there must be at least some truth in the story.

Some people may be physically unable to look after themselves, including those who are elderly or have learning difficulties, dementia or Alzheimer’s. They deserve the very best care in care homes and their families need the assurance that they are well looked after. If someone has dementia, Alzheimer’s or a physical disability, they deserve the same treatment and care as others to ensure that their meals are correct and that they are given a wee bit of time, compassion and understanding, as the hon. Gentleman said. It is imperative to do all we can to protect those in care homes and to ensure that they receive the care and dignity they deserve.

I welcome the opportunity to question how the Government intend to improve regulation of the industry so that the people who are cared for are protected. I am always a bit suspicious of statistics—as the saying goes, there are lies, damned lies and statistics—but they are clear. Only 64% of care service providers in England are registered with the Care Quality Commission, so there is a question to be answered. I have great respect for the Minister’s understanding and I think the world of him, so I am sure that in his response we will hear the compassionate understanding that he feels personally and as a Minister. I look forward to that.

The Care Quality Commission monitors and regulates care organisations to ensure that they are continuing to meet national standards, and herein we encounter the first issue about regulating care homes. We need to press for much higher levels of registration if we are even to think about improving regulation. We cannot improve regulation if we do not have registration. I hope that we can make higher levels of registration a key part not just of this debate, but of the Government response. We cannot improve regulation if 36% of care service providers are not registered with the main body for monitoring and regulating the industry. Indeed, we should express immediate concern about whether those unregistered care providers are up to the national standard. I am not saying that they are not, but Government observation and monitoring is needed to ensure that they are.

Last year, following years of scandals, the Care Quality Commission announced that it would reinspect all care services and then rate them individually. We do not want to go into too much detail about the most horrible stories and incidents, but they do resonate with all of us as elected representatives. Care homes judged to be inadequate would be shut down and their directors banned from working in such positions again.

[Andrew Percy]

The hon. Gentleman is making a very important speech. He references the examples of abuse, mainly involving physical abuse, that we have heard about. Does he share my concern that in other care homes the problem is not physical abuse, but people not receiving proper nutrition? It is a national scandal that £13 billion of NHS money is spent every year dealing with poor nutrition, much of it in the elderly population. There are no doubt some very good nursing homes and care homes, but the quality of the food in homes often contributes to the decline of residents, and the CQC needs to get a handle on that as well.

[Jim Shannon]

I thank the hon. Gentleman for his intervention; he is right. I tried to make the point earlier about the food that residents eat and its nutritional value, and about the time that may need to be spent looking after someone and feeding them. I thank the hon. Gentleman for highlighting another very important issue.

The National Audit Office found that just 9% of services had been assessed as of July this year, despite the deadline for inspections being February next year—a deadline that has been pushed back. Obviously, the February deadline cannot now be met, because 91% of homes cannot be inspected in that time, but perhaps when the Minister responds we can get an idea of a new deadline in relation to the inspection regime.

However well intended the Care Quality Commission system is, there are clear failings in the current way of doing things, and today’s debate gives us the opportunity to discuss the way ahead in terms of improving the poor rate of inspection. The right hon. and hon. Members who are here will illustrate that very clearly. Concerns have been raised across the political spectrum, both in newspapers and by political representatives, and I hope that the solution to those concerns can also be found on a cross-party, bipartisan basis. After all, this matter concerns us all. It is not a matter of scoring points—it is never that with me anyway, but it certainly is not with anyone in this debate, because we all have the same focus and commitment to delivery of the same level of care and to ensuring that all homes reach a certain level.

We have had many issues in the past in Northern Ireland. I know that this is a devolved matter and the responsibility of someone else, but having the appropriate protection and regulation is so important to ensuring that abuses are not happening. The historical and the up-to-date abuse cases that we see in the papers need to become a thing of the past.

We can come together from both sides of the House, set the right course, address the issues and hopefully, through the Minister and the shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley), provide some direction in relation to the solutions. I hope that my contribution and the issues I raised have been noted by the Minister—indeed, I know that they have been—and that they will prove useful to eliciting a strategy and a response from Government to ensure that this matter is addressed correctly as a matter of urgency, as the hon. Member for North Devon said, and to the best of our ability.

[Several hon. Members rose—]

[Valerie Vaz (in the Chair)]

Order. I intend to start the winding-up speeches at 10 past 5.

16:54

[Anne Marie Morris (Newton Abbot) (Con)]

Thank you, Ms Vaz. I shall endeavour to speed through my comments. First, I commend my hon. Friend the Member for North Devon (Peter Heaton-Jones). We are both MPs from the south-west, and our constituencies have a significant number of elderly residents and therefore of care homes and nursing homes. The issue he raises is crucial, but perhaps I can take the opportunity to broaden the debate, because I believe that the problem is not as simple as just the CQC. Many of his points about the CQC were well put, but this is a broader challenge.

I shall start by explaining that nine statutory bodies—all independent and all accountable to Parliament—are overseen by the Professional Standards Authority for Health and Social Care, so it is a question of looking not just at the CQC, but at all those bodies together. You can appreciate, Ms Vaz, that nine bodies will inevitably have various sets of regulations, which will not necessarily be consistent and work well together. Indeed, the Professional Standards Authority report in 2015 made it clear that the regulatory framework was unfit for purpose.

However, this is not just about the regulatory framework; it is broader than that, too. Rules and regulations do not make people good. Regulation is about trying to ensure best practice and that those who default are made to sort the situation out. As my hon. Friend said, too much bureaucracy takes the care out of caring, and this is really about care. It should not be about bureaucracy —box-ticking. It should be about ensuring that elderly residents are properly respected and cared for.

The Professional Standards Authority has concluded—unsurprisingly, given its oversight of nine authorities—that less is actually more. It suggests that we need a new framework and that we should look at sharing objectives across all the regulators and sharing the theories of what works so that there is a consistent approach. Most importantly, we should rebuild the trust among the professionals, the public and the regulator, because at the moment there is an awful lot of mudslinging among the three and that is not helpful. What we need is a good system that works for our society. We also need proper risk assessment models to ensure that we are looking at the things that really matter and actually put residents at risk.

There are, inevitably and tragically, many cases that none of us want to be repeated. It almost goes without saying—my hon. Friend has already made it clear—that there are plenty of examples. Indeed, the statistics demonstrate that there is clearly something wrong. The report “The state of health care and adult social care in England 2014/15” showed that 60% of providers found to be inadequate were not improving, so there is clearly something not quite right. In Bedfordshire the Old Village School home managed to go from “good” to closure within six months; previously it had been excellent. There is clearly something at the root of this that is not just about regulation and bureaucracy, but is more fundamental.

Before I move to that broad picture, I have a couple more thoughts on the Care Quality Commission itself. I have met Andrea Sutcliffe on a number of occasions and I believe that she is cognisant of and takes seriously the concerns raised by my hon. Friend. However, there is a challenge, which is that the remit of the CQC was expanded to cover so much that in reality it is almost inconceivable that it could do the job properly, to the right standards, given how stretched it is. Indeed, in its own survey in 2014, 40% of CQC staff felt that they were not adequately trained. There is clearly a challenge—about regulation, about structure and about asking an organisation to do more than realistically it is capable of doing. If that is the case, we should not be surprised when things fall apart.

There was an interesting comment, however, from the National Audit Office. It said that the CQC does not know whether its model for predicting staff numbers is accurate enough. That, for me, goes to the heart of the matter. We can have as much regulation as we like, but if we do not have staffing right—if we do not have the right numbers or the budget to pay for them—inevitably, there will be huge problems.

I have looked at the care home reports for Teignbridge District Council in my constituency. The new regime and the five new tests came into play April this year, and the new tests are absolutely on point: the home must be safe, efficient, caring, responsive and well led. That is absolutely right. Twenty-one of the 70 care homes in the area have been inspected and 10 have been found to be good. I share my colleague’s concerns about the homes that were not found to be good, but I took to reading the reports to find out what they actually said. Although the reports covered 10 or 15 different areas, if I dug down to the root causes I found that they were really about staff and the adequacy of both numbers and training.

I meet people from my care homes regularly, every three months, and they tell me that if hon. Members do as I did, they will reach a similar conclusion—that it is a real challenge to find the managers needed to run the homes. Without those managers, the homes are found wanting but they have no ability to resolve the problem. There is a similar challenge in the shortage of nurses. Being a nurse in the care home sector is much more challenging, I think, than being a nurse in the NHS. Care home nurses often work on their own at night, whereas a nurse in an NHS hospital will be surrounded by lots of colleagues. In the care home sector, nurses often work with difficult individuals who have complex problems, often including dementia, with all its attendant behavioural complexities.

The feedback from those responsible for care homes in my constituency conveys much frustration. They understand the role of the CQC, but they feel deeply frustrated that they cannot always put right the things that are found to be wrong. That must be incredibly frustrating. They feel that there needs to be a new balance between scrutiny and support. Although they feel it is right that they are properly scrutinised, they also feel that there is a lack of support. I had the pleasure of talking to the Minister only yesterday, and he was at pains to tell me that the CQC was indeed endeavouring to provide such support. I said to him then, and I will repeat it today, “They don’t see it and they don’t feel it.”

In the old days, under the CQC’s predecessor, care homes received guidance as well as criticism. Because of the desire to separate the two, which I can understand conceptually, they now feel as though they are left on their own. I am proud of our Devon homes, because we have produced our own kitemark for dementia care, as a result of which the homes work together, peer review each other and provide their own training schemes. I think that that is a good way forward.

For me, the big question is: are we looking at everything that impacts the system that endeavours to provide care in care homes and nursing homes? I do not think that we are. There is a big piece missing—the commissioning. At the moment, we review and scrutinise the provision of care, but we do not scrutinise the commissioning done by local authorities and unitaries. If they do not get the commissioning right and ensure that the right providers are providing what is needed, the system will fall down. I have, for example, seen individuals placed in care homes who should be in nursing homes because they have needs that are well beyond the capabilities of a non-nursing care home. That is something that must be critically and urgently addressed.

I am also concerned that we should look in a fair and balanced way at what we are paying our providers. At the moment, commissioners are not in any way held to account for what they pay providers. There is no standard review of the pricing across the country. If pricing is worked out on an ad hoc basis, the amount of money that local authorities pay their providers will vary across the country. At the end of the day, however, although there will be minimal differences in some staffing costs, by and large the costs will not be as diverse as the pricing structure indicates. There needs to be a proper analysis of the prices paid and what we are getting for the money. Are we getting tin tacks, or are we getting platinum? Is the situation as diverse as I fear it is? As a civilised society, we need to determine what we should be giving our citizens, and we need to ensure that that is delivered consistently across the country. The failure to do so will give rise to safeguarding issues.

My final point on commissioning is that we should separate commissioning and provision. At the moment, a local authority can do both, so there is a potential conflict of interest. I am conscious of the fact that time is not in my favour and you would like me to move on, Ms Vaz. I have made most of the points that I wanted to make, so I will just say that dealing with that is a key issue. Regulation is only part of the problem. As the sun slowly comes out, we need to start to fix the roof, and this has to be a key part of that process. We need a proper system of care, not merely compliance. It needs to be properly funded, and staff need to be properly trained.

17:05

[Andrew Percy (Brigg and Goole) (Con)]

I will be very brief, because I have already made the points I wanted to make about nutrition, and about family involvement and engagement in the inspection process. I congratulate my hon. Friend the Member for North Devon (Peter Heaton-Jones) on securing this debate on a subject that has always bothered me in my other role, which members of the Health Committee have heard a lot about, as a volunteer first responder with the ambulance service in Yorkshire. In that role, I have spent a lot of time in care homes, and there is a real mix of standards.

There are two things worth raising with the Minister that bother me and that, I hope, broadly come within the scope of this debate. One is the quality and dignity of care for elderly patients in care homes. When they need to be taken to hospital, they are often, sadly, taken on their own. I remember watching a very elderly lady who was having a suspected stroke on a hospital trolley at Scunthorpe hospital. She was alone and obviously very distressed. The ambulance crew were doing the best that they could, but they were booking her in and all the rest of it. I remember looking at her and thinking, “I would not want that to happen to my grandma.” That happens too often.

The second point is about the need for an understanding of palliative and end-of-life care in care homes. That is an issue of training and standards. I have been called to care homes where I have had to try to resuscitate people who are clearly at the end of life in a very unpleasant situation. We must get better at that, because we know what inevitably happens to many people in care homes before they even get to nursing homes, so proper training must be given. In that respect, proper standards of care and the quality of training of people working in care homes are in desperate need of improvement. In some areas and some care homes, those things are very good. I have a wonderful care home in my constituency, which has a cinema and a hairdresser, and it is lovely to go into. It does not have some of the problems found in other care homes. People have to pay for that, however, and only those who can afford to do so get it. Too many people cannot afford that, so they do not access the same quality of care or staff training. I hope that the Minister can respond to those two brief points.

17:08

[Natalie McGarry (Glasgow East) (SNP)]

It is an honour to serve under your chairmanship, Ms Vaz. I congratulate the hon. Member for North Devon (Peter Heaton-Jones) on securing this important debate. Ensuring that our older people, and those of a younger demographic who have complex needs, have access to high-quality care is a vital role and duty of any Government, and I am pleased to have the opportunity to contribute to the debate. Across the political divide, and in all parts of the UK, our older people deserve comfort, dignity and decent care. Many important points have been raised, and I think we all agree that strong regulation must be in place to ensure that care facilities that provide vital support meet the highest possible standards. With an increasingly ageing population, that is a necessary consideration that transcends party politics. It is not for me—a Scottish National party MP for a Scottish constituency and a spokesperson for the party—to dictate English policy on a matter that is devolved to Scotland, but I hope that by sharing the approach we have taken in Scotland, I can help to inform the debate and show some examples of best practice.

Members have contributed thoughts and experiences from their constituencies. The hon. Member for North Devon made the important point that we are talking about people, not merely systems and processes. He was a powerful advocate for our agreeing to ensure quality care for everyone. The hon. Member for Strangford (Jim Shannon) constructively articulated the need for cross-party consensus and argued for compassion and care. The hon. Member for Brigg and Goole (Andrew Percy) made a pertinent point about nutrition and standards, and spoke of the requirement to engage families in the care process. He brought his own experience to the debate. The hon. Member for Newton Abbot (Anne Marie Morris) successfully broadened the debate beyond the regulatory framework and the CQC, and raised a key concern about pay in the sector.

The debate has underlined the need to get things right for people in care everywhere. That was the key point of emphasis in our approach in Scotland, where Scottish Ministers have developed national care standards to ensure that everyone in Scotland receives the same high quality of care, no matter where they live. By articulating clear standards underpinned by the principles of dignity, privacy, choice, safety, realising potential, and equality and diversity, we are able to explain what someone can expect from any care service they use. The standards are written from the point of view of the person using the service, and help people to raise concerns or complaints.

Although the national care standards have served Scotland well, and ensured that we have a clear and robust regulation regime, the Scottish Government have committed to undertaking a review and are consulting the public on updating those standards. The SNP believes that the rights of our older people to decent care and dignity in care homes are human rights, and that is at the heart of the Scottish Government’s consultation. The Care Inspectorate and Healthcare Improvement Scotland are asking everyone with an interest and involvement in health or social care—personal or professional—to take part in the consultation, which will help the standards evolve to meet the needs, rights and choices of people across Scotland. I especially urge anybody with experience of care homes to give their input to the process in Scotland, as the consultation closes on 10 December.

Standards of safety were addressed in Scotland’s care homes following the tragic fire at Rosepark care home in Uddingston in 2011. In March 2014, the Scottish Government put revised guidelines in place to ensure the utmost standards of safety and care, and they continue to progress their improvement agenda. Improving safety, care and regulatory standards in care homes is a key priority for Members of all parties. The Rosepark case and the Scottish Government’s response underscore the importance of learning lessons from failings.

We need an open and inclusive debate on standards in care homes that involves all parties and, most importantly, members of the public who use the services—a debate that carefully considers how we can improve the care experience for all. In the past 45 minutes, we have made at least some contribution to the wider debate. I thank the hon. Member for North Devon for securing the debate, and I look forward to what I am sure will be a proactive and constructive response from the Minister.

17:13

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you as our chair, Ms Vaz. I congratulate the hon. Member for North Devon (Peter Heaton-Jones) on securing this debate on an extremely important issue. I have read the document he referred to, which was sent to me by his constituent. I sympathise with his constituent and others who have lost their loved ones in similar circumstances; those are tormenting times for people. If any patient is failed by the NHS or a care provider, we must ask them serious questions about what went wrong. We must try to ensure that no patient or family member has to go through a similar situation. Often, what family members want is for nobody else to have to suffer in the way that they have.

The regulation of care and nursing homes is extremely important, particularly as more people are likely to rely on those homes given our growing elderly population. The hon. Gentleman mentioned the CQC and its recent reports and developments. It said in its “State of Care” report that

“there is room for improvement across the whole of the adult social care sector.”

That is a very damning conclusion for it to come to, having moved into social care and nursing care inspection. The hon. Gentleman referred to the statistics. Only around two thirds of social care provision was rated good or outstanding, and 7% of services were rated inadequate. It is of even more concern that fewer than half of nursing homes were rated good or outstanding; 10% received the lowest rating of inadequate. Out of 1,275 nursing homes that the CQC inspected, 127 homes were rated inadequate. That is very serious if we think about how many people are in those homes. Would any of us accept that standard for our grandparents, mothers, fathers, wives or husbands? Of course we would not. We would demand the highest standards for our family members, as the hon. Member for Strangford (Jim Shannon) mentioned.

The CQC found examples of extremely bad practice, including a nursing home with an overpowering smell of urine and with mould on the walls, and a care home that did not administer medication properly. Recent evidence to the Public Accounts Committee showed that improvements were needed to the CQC’s regulatory regime. However, the CQC now appears to be having to manage with fewer resources. I understand that it plans to pioneer a new approach of “co-regulation”, with providers sending in

“self-assessments of how they think they’re doing”,

which the CQC would then verify. When less than 50% of nursing homes are judged to be good or outstanding and 10% are rated inadequate, I find that very concerning. This is not the time to move to a system of self-assessment—a move that seems to be driven by a projected cut to the CQC’s resources. As the hon. Member for North Devon said, it already has serious staffing issues, with one third of its inspection positions vacant.

More needs to be done. We covered that well during the debate. I agree that more needs to be done to help families to raise cases of bad practice, so that lessons can be learned—a point that the hon. Member for Brigg and Goole (Andrew Percy) touched on when he talked about the CQC working better with families. Complaints about health and social care are dealt with by different services, which follow local complaints processes. The Parliamentary and Health Service Ombudsman looks at complaints about the NHS, the independent Health and Social Care Advisory Service undertakes investigations, and the Local Government Ombudsman investigates issues regarding local authorities and adult social care. It is clear that care is changing, but care in nursing homes always spanned all those areas.

Vulnerable older people being cared for in nursing homes can rely on a variety of health and social care professionals. In nursing homes, older people often have a number of medical and care needs, which are dealt with by different people, including care assistants, nurses, GPs, and through hospital treatment and care. We need to ensure that the regulation of the sector takes that into account. When there are failures by multiple organisations, all those involved must be held to account. That very thing—the changeover—makes it difficult. How can the regulatory framework for nursing homes be improved to deal with that overlap? We are now talking about the integration of health and social care in Greater Manchester and other areas of the country, but we need a regulatory and complaints system that works with what we have. We should be striving for a health and social care system in which all older people receive the care that they need. If that does not happen, we need clear procedures enabling people to have their issues investigated. It is not clear where family members can go if they become alarmed that care is not being provided adequately.

The social care system helps some of the most vulnerable people in our society. When they do not have a voice, we must ensure that they are heard. In this debate we have heard some worrying statistics about care not being provided as it should have been. We need to improve our regulatory and complaints system, so that we learn from cases such as that of the constituent of the hon. Member for North Devon. I am glad that there has been quite a bit of consensus in the debate about the need to improve standards of care and regulation. We look to the Minister to tell us how that improvement might happen.

17:19

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to serve under your chairmanship, Ms Vaz. You will not find a lack of consensus here today; I am glad to start off in that way.

I congratulate my hon. Friend the Member for North Devon (Peter Heaton-Jones) on securing this debate, which has been really good. Colleagues have made some very moving and pertinent points. I find myself in the position that Ministers find themselves in; understandably, I have responsibility for an inspection and regulatory regime that we are all working hard to ensure does its job of protecting people in the manner that we all described. Inevitably, however, the issues that arise are always the things that go wrong. The question is how to strike the balance between, on the one hand, giving an assurance about the chief inspector of the Care Quality Commission, and the assurance that our degree of concern about what happens in care homes is absolutely appropriate, and, on the other hand, in no way being complacent about the issues that colleagues spoke about, and about where the problems are. That is what I hope to address.

I am really appreciative of the contributions made. I will come to the contribution of my hon. Friend the Member for North Devon in a moment. The hon. Member for Strangford (Jim Shannon) spoke with his usual decency and compassion. He wants speedier action, and he recognised our non-partisan sense of interest in those who require care. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) made a number of interesting points, including about managers in care homes. When I have spoken to CQC officials and others, I have found that issue to be vital. If there is good management, it will be a good care home; if there is not, it will not be. The lack of registered managers is a genuine problem, and we are on to that. The issue of commissioning is also underplayed.

My hon. Friend the Member for Brigg and Goole (Andrew Percy) spoke movingly about the issue of loneliness and isolation. He talked about someone who was taken from a home in an emergency, needing urgent care, who found themselves on their own. That raises questions about the extent of care delivered to individuals in those circumstances, and I hope that anyone who heard that would question their procedures to ensure that it did not happen to anyone they were looking after.

This morning, I met Unison officials in the office and we had a word about training standards. We have to be absolutely certain that training is available for all who are active in care homes. As we know, there is the skills care certificate. However, I am led to believe that we cannot be sure that everyone is getting the training they need, and as a result of this conversation, I am really interested in finding out what more we can do to ensure that training is available for all.

[Andrew Percy]

One area of training where we really could help to take the pressure off the ambulance service is in relation to falls, which place a huge demand on our local health services. Paramedics often say to me that they feel those falls could be dealt with more appropriately by care home staff—or even avoided—if staff were trained properly.

[Alistair Burt]

I take my hon. Friend’s point, which confirms what I was saying about the need for training, and for appropriate treatment and rehabilitation to be available after falls. The role of occupational therapists should not be minimised after such incidents.

I am all too willing to hear from the hon. Member for Glasgow East (Natalie McGarry). The fact that this matter is devolved is of no interest; what is important is that we share best practice and best standards of care. I very much appreciate her contribution. The hon. Member for Worsley and Eccles South (Barbara Keeley) again challenged me on what we are doing, and really that is the meat of the remarks I prepared to give in response to the comments of my hon. Friend the Member for North Devon; I am grateful to him for sharing those with us before the debate.

Let me put one or two things on the record. The Government are committed to improving the quality of adult social care, and to ensuring that people receive high-quality and compassionate care. We have taken a number of firm steps in that regard, and that is partly because of the sort of issues raised today. However, we are in a relatively early phase of the use of the new powers given to the CQC, and in a sense this debate reflects the sort of baseline from which we all have to work.

My hon. Friend referred to the experiences of his constituent, whose mother died in a local care home, and he spoke powerfully about the frustration that his constituent experienced in raising concerns with the care home provider and other bodies, such as the CQC and the local clinical commissioning group. We offer our condolences to my hon. Friend’s constituent, and I share his frustration that the experiences of service users and their families have not always been central to the provision of care or the oversight of regulation. I know that my hon. Friend’s constituent has met senior staff at the CQC on more than one occasion, and I hope that those meetings were helpful to him. However, I appreciate that this debate is not an opportunity to reopen this case, which I know the CQC has investigated extremely thoroughly.

Picking up on some of the concerns expressed today, I want to reassure my hon. Friend that we have come a long way; we have made real improvements in the regulation of adult social care in quite a short time, but of course there is more to do. Our reforms to the CQC have been central to those improvements. The regulation of adult social care has three key roles: first, to identify poor practice and take action to protect service users from the risk of harm; secondly, to encourage improvement by identifying areas of weakness; and, thirdly, to highlight and share good practice and success. All these roles are built on the foundations of effective use of data and rigorous inspection. In that respect, the CQC has been transformed in recent years, not least by having been given new powers in 2014, which is obviously not all that long ago. Those powers need to be built on.

The CQC has put in place specialist inspection teams under the leadership of the chief inspector of adult social care. These teams include “experts by experience”—people who have personal experience of care—and inspections now take particular account of the views and experiences of the users of services and their families.

The great majority of CQC inspections are unannounced. In a very small number of cases, when there are good practical reasons for doing so, notice may be given, but in the vast majority of cases services are not tipped off or warned that an inspection team is on its way. Providers registered with the CQC are required to meet a new set of fundamental standards that govern the quality and safety of services. These standards only came into force on 1 April, but they are the standards of safety and quality that providers must always meet. The CQC has a range of enforcement powers that it can use against providers that breach these fundamental standards. These powers vary from issuing warning notices and fines and imposing conditions on a provider’s registration, to cancelling registration, which withdraws a service’s permission to operate, thus closing it.

The new fundamental standards include two important new registration requirements. The first—the duty of candour—requires providers to be open with service users about all aspects of their care, and to inform them when there are failures in their care. The second—a “fit and proper person” requirement for directors—ensures that accountability for poor care can be traced all the way to the boardroom if necessary.

The CQC’s model does not just assess whether providers are meeting the fundamental standards. The CQC asks five key questions of each service: is it safe? Is it caring? Is it effective? Is it responsive? Is it well led? All inspections deliver a rating for each of these five key questions on a scale running from “inadequate”, through “requires improvement” and “good”, to “outstanding”. Inspections also result in an overall rating for each location.

There was much talk about what has been found so far in relation to those ratings, with a small number of providers deemed to be “outstanding” and more providers deemed to be “good”. However, a number of providers were deemed to “require improvement” or be “inadequate”. In starting its inspection process, the CQC looked first at those providers that might have more difficulties than others. The CQC is aware of what is going on, and it started its inspections at the end of the scale where it expected to find difficulties. That was designed not to force closures, but to recognise where improvement and support, which my hon. Friend the Member for Newton Abbot mentioned, is so important. In 40% of those cases, improvement has been made; on a subsequent inspection, things were found to have improved. However, that still leaves a percentage of those providers having not improved, and I think it is those providers that have been highlighted today.

Having met Andrea Sutcliffe, I am quite confident that her determination is exactly the same as that of everyone in this room. However, it is clear that there are so many places to cover that we have to be certain of ensuring that the standards that we have spoken of, and that the CQC is working to, will be delivered by all providers. Those are standards in training, management and ensuring effective monitoring.

My hon. Friend the Member for North Devon used the phrase, “There’s nowhere to go”, in relation to someone having concern about an individual. I would not want that to be the message; I would not want anyone to feel that they had nowhere to go if they felt that someone was at risk of being, or was being, ill-treated in a care home. That is not the case. The truth is that if someone has such a fear, they can contact the CQC, which will act if it agrees that a person’s safety or wellbeing is at risk, and if need be the CQC will contact the police. I would not want anyone to think that if they knew of someone in a care home being ill-treated, there was nothing they could do as of this moment. They can and should do something.

However, it is also clear from the nature of the debate that if the CQC’s most recent report has set a baseline, there are things that we need to do and improve. The sort of information available to us through our constituents, and the sort of interest that specialists such as those here have taken, will give me good guidance on how to ensure those improvements are seen through.

17:30

Motion lapsed, and sitting adjourned without Question put (Standing Order No.10(14)).