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Mr Dominic Grieve (Beaconsfield) (Con)
I beg to move,
That this House has considered CCTV for communal areas of care homes.
It is a great pleasure to move this motion under your chairmanship, Sir David. I was pleased to be successful in the ballot, as the debate gives me an opportunity to raise with the House and the Minister my concerns about what more could be done to improve safety and security in our care homes. I hope it may also provide an opportunity to have in a more informal setting a sensible discussion about how we can take this forward.
There will be no Members of Parliament, I suspect, who do not have care homes for the elderly in their constituencies; in many cases, there will also be residential homes for vulnerable and disabled adults and children. The latest statistics available show that there are over 400,000 registered care home beds in the United Kingdom. With an ageing population, that number is growing, and those in care homes for the elderly are suffering from increasingly complex forms of physical and mental disability, particularly dementia. Some will exhibit challenging and distressing forms of behaviour. Looking after them properly is a demanding task—one that requires emotional skills that are not necessarily inherent in all of us. It is estimated that there will be 1 million people with dementia in the United Kingdom by 2021, unless medical science changes dramatically in its prevention or delay.
Care homes are not hospitals. The Minister and her Department will be aware that staffing in care homes ranges from highly medically qualified staff through to staff who are unqualified but have all the right life skills, and those who have little or no vocational interest in the work, which can involve long hours at relatively low pay. We should not be surprised, therefore, that the expansion in the number of care homes has been accompanied by a constant pattern of stories concerning instances of neglect and abuse. Such instances may represent a relatively small percentage of the overall population, but they are not insignificant. They also undermine public trust to an astonishing extent. One might argue that the public’s perception is too negative, but it cannot be ignored. A 2016 poll of a public sample group showed that 52% believed that abuse of residents was a regular event in care homes.
Although that level of anxiety may be excessive, I do not think it is entirely unreasonable given the evidence from the Care Quality Commission, which reported in October 2017 that every day more than 100 vulnerable and elderly people suffered serious injuries in care homes, and that reports of serious injuries had risen 40% over five years. That may be because there is more reporting—one has to factor that in—but it is a statistic that I am sure the Minister and anybody who looks at the report is concerned about. Serious injury notifications rose from 26,779 in 2012 to 38,676 in 2016. The CQC’s chief inspector of adult care said:
“People living in care homes and their families want to be reassured that those in charge are doing everything they can to support their health and wellbeing, including making sure their services are as safe as possible.”
In furtherance of that, the CQC requires notification of serious injuries, so that people may learn from and minimise the risk of such injuries and the quality of care can be constantly improved. In bad cases, it may also bring prosecutions, with the sanction of substantial fines if negligent actions are found to have occurred, and in some cases care homes have been closed down. The Minister and her Department need to ask themselves whether all that is sufficient to meet these problems.
I hope the Minister has seen the recent academic research conducted under the aegis of University College London’s department of old age psychiatry, led by Claudia Cooper, which consisted of an extensive survey of 1,544 staff in 92 care homes. The report made quite troubling reading: while most staff reported positive care behaviours, some, under the cloak of anonymity, were perfectly prepared to report practices that were not. Over 50% reported carrying out or observing potentially abusive or neglectful behaviours at least sometimes in the previous three months that they had been working in a care home. Some abuse of residents was reported as happening sometimes in 91 out of the 92 care homes that took part in the survey. Neglect was the most frequently reported instance. Making a resident wait for care was reported in 26% of homes; avoiding a resident with challenging behaviours was reported in 25% of homes; giving a resident insufficient time for food was reported in 19% of homes, and taking insufficient care when moving a resident was reported in 11% of homes. Perhaps most worrying, physical and verbal abuse was reported in 54% of homes.
Unsurprisingly, there was a clear correlation between abusive and neglectful behaviour and homes with higher rates of staff turnover and poor morale. A long series of studies have shown that carer stress, likely to lead to neglect or abuse of residents, is associated with low job satisfaction, long hours, low pay, physical demands, staff shortages, and minimal education and training—that will not be a surprise to any of us. Interestingly, contrary to the hypothesis the research started with, numbers or ratios of staff to residents, the environmental quality of the home and the severity of the neuropsychiatric symptoms in residents were not associated with a higher incidence of abuse. A common picture emerges: the risks are the product of poor management, low levels of training and low levels of staff motivation.
That brings me to what more might be done about this and whether the use of CCTV in the common parts of care homes, both as a deterrent to abuse and an aid to improving care performance might prove to be valuable. I was first approached about this issue several years ago by my constituent, Ms Jayne Connery. Ms Connery’s mother had been a resident as a dementia sufferer in a care home just outside my constituency—a care home that I know—where she suffered abuse through rough handling, which came to light only when a whistleblower among the staff informed Ms Connery of what had occurred. On being questioned by the police, the member of staff concerned stated that her behaviour was facilitated by the absence of any realistic safety monitoring of staff behaviour. Subsequent inquiry, before Ms Connery moved her mother elsewhere, also suggested that the lack of proper systems at the home led to, for example, unauthorised strangers being invited into the home late at night by staff. When Ms Connery raised that concern with the management, she was told that there was no proof of that having happened.
As the abuse and the illicit visits by strangers to the home took place in communal areas, Ms Connery was persuaded of the desirability of making the monitoring of common parts of care homes obligatory. She was also influenced by the fact that many cases of abuse had been proved—there are stories in the newspapers several days a week—as a result of relatives setting up hidden cameras when they had strong suspicions that abuse was taking place, and then being able to find the evidence of what was going on, even though the management denied that anything untoward was occurring. That has since led Ms Connery to set up an organisation—Care Campaign for the Vulnerable—with a mission to promote and introduce CCTV in the common parts of care homes.
When Ms Connery first contacted me, I was impressed by her determination and motivation, but I have to admit—perhaps it was the lawyer in me—to not being certain that her proposal was necessarily the best way to tackle the problem. I had a lawyer’s concern about the extent to which placing CCTV cameras in care homes might infringe privacy. Several rounds of correspondence between me and the Department and the Secretary of State followed, in which I gently pressed the Department to respond to the details of Ms Connery’s campaign, but while I am not suggesting that there was a lack of interest, it is right to say that the Department’s responses have been rather non-committal.
In July last year, the then Secretary of State, my right hon. Friend the Member for South West Surrey (Mr Hunt), wrote:
“I appreciate Ms Connery’s concerns… We agree that poor care, abuse and neglect are completely unacceptable. Everyone should receive high quality care, delivered by well trained, properly managed and compassionate staff. We are committed to making this a reality.
The Department believes that the use of CCTV and other forms of covert surveillance should not be routine, but should be considered on a case by case basis. The Department does not object to the use of CCTV in individual care homes, or by the families of residents, provided it is done in consultation with and with the permission of those residents and their families.”
Of course, I agree with that point. He continued:
“We want to make sure that people are held to account for the quality of care they provide, so we are introducing measures to ensure that company directors who consent or turn a blind eye to poor care will personally be liable for prosecution. In the future, they, and the provider organisations, could face unlimited fines if found guilty.
The Care Quality Commission is the independent regulator of all health and adult care providers in England. All providers of regulated activities, including the NHS and independent providers, must register with the CQC and meet a set of requirements governing the safety and quality of services. These requirements include areas such as cleanliness and infection control, the management of medicines, safety, the availability and suitability of equipment, respecting and involving service users and ensuring that there are sufficient numbers of suitably qualified skilled and experienced people employed by providers.”
The rest of the letter dealt with trying to raise staffing standards through the introduction of the care certificate for employees in the sector.
No one reading that letter could have any reason to disagree with its sentiments—I certainly do not—but it seems to miss the point that Ms Connery had been pressing, that CCTV in common parts could be a useful tool to achieve several important ends. First, it offers reassurance to residents and their families that any incidents that take place in communal areas can be recorded, and that if something occurs in that setting it will be possible to ascertain the facts. It is worth bearing in mind that in the last five years, the CQC has been coping with more than 100,000 allegations of abuse or instances of negligence leading to safeguarding referrals, at a significant cost in terms of manpower. In many cases, the inevitable outcome is that the causes of an incident remain unresolved, which is as unsatisfactory for the provision of care as it may be wholly unfair to the staff involved. Someone caring for an elderly and vulnerable person, who may have brittle bones, for example, cannot completely remove the risk of accidents if they are also trying to involve that person more generally in the life of the home. As I sometimes point out to people, there may well from time to time be accidents that are nobody’s fault, even if one wishes to try to learn from what happened.
Secondly, the presence of CCTV in common parts will act as a deterrent to people who might enter the care home for an unlawful and unauthorised purpose, which regrettably is not unknown. Some years ago in my constituency, I had an appalling case of a serious sexual assault on a disabled resident by a stranger who had gained access to a care home for the severely disabled as an apparent visitor. Nobody had challenged them.
Thirdly, the correct use of CCTV provides an opportunity for managers in care homes to keep problems under review and to help staff to learn from errors in delivering care that may have occurred in the course of their work. CCTV is sometimes seen as a spy, but that is not the intention here. The point is not just to catch people who may be doing something wrong, but to have systems in place that enable standards to be improved, which can facilitate the improvements that the CQC and the Secretary of State seek, as he set out in his letter.
Before being elected to the House, I was a lawyer practising mainly in the wide-ranging area of health and safety law. My experience was that people have to talk the talk and walk the walk, so I wanted examples, rather than just ideas, of the use of CCTV being beneficial and bringing about innovatory change. What swayed my opinion more than anything was the great deal of evidence that Ms Connery provided that responsible care homes are increasingly installing CCTV and are convinced of its usefulness. I have two examples that may be helpful.
Zest Care Homes, based at Yarm in Cleveland, is a long-established care home provider with several care homes. It was concerned that, despite best intentions and robust operational policies and auditing of services, it still had poor performance issues. It concluded that the principal problem was that, regardless of the training and induction of staff, there was a trend by staff to take shortcuts when carrying out their work and assisting residents. Accordingly, Zest Care Homes consulted all the relevant stakeholders and moved to an overt CCTV consent-based system that, interestingly, covered not only communal areas but, by agreement, bedrooms as well. I should add that it met the European convention on human rights standards of proportionality on privacy. Footage was viewed by professionally trained monitors from a separate company, which had been set up for that purpose and acted independently of the parent company providing the care, and which had a requirement to produce monthly reports based on two hours of sampling per day. The footage was not continuous but could be triggered by certain events, such as people going in and out of a room, moving around, or delivering certain sorts of care.
After installation, Zest Care Homes stated:
“We have noted very material culture changes such as how staff now position themselves when talking to residents, the practise of using mobile phones when talking to residents, the presentation of food etc, to more major issues such as the delivery of personal care, management of incontinence and manual handling consistency. Very significant events such as resident on resident violence, staff attempting to sleep overnight at times, drug near misses as staff are distracted when administering medications, staff rudeness, family abuse of residents etc. All have been noted because of the CP system and addressed immediately without any delay.
One real positive is the reduction of unexplained injury events and a reduction in unexplained safeguarded referrals. The CP system has assisted with preventing accidents as focussed training followed monitor notification of repetitive poor or casual practices. Families are very positive about system use...It is our view that whilst the regulator (CQC) operates under a very robust framework and has a challenging inspection regime, its findings are nevertheless a ‘snapshot’ in time. We believe that daily monitoring is much more effective and focus on care practises and the actual delivery of care should have priority over the presentation of care documentation as to whether care quality at any site is of good enough standard.
Providers have an interest in knowing that information. CP acts as a critical friend...shortcomings are no longer ‘perceived’ as images either confirm issues indeed are present, or they are not.”
Other reputable providers, such as the Priory Group, have adopted similar independent monitoring systems.
The second provider that I will use as an example is the Marbrook Centre in Cambridgeshire. It is slightly different, because it is a specialist provider of neurological care and rehabilitation. It stresses an awareness that CCTV can have drawbacks, as it can lead to staff watching screens rather than interacting with those for whom they care. Of course, if we go back to Zest for a moment, the whole point is that it is not the staff who are monitoring the screens; that is done somewhere else, so it is not such a distraction. However, the Marbrook Centre sees that drawback as wholly outweighed by the benefits that I have already cited. It says,
“the senior management team can access it randomly to watch snapshots of life at the home. This probably amounts to less than an hour of live footage a week being seen. As part of our audit and quality procedures we do randomly select perhaps three or four different shifts a month to look at retrospectively. We look at how our staff are interacting with residents and if staff at night are fully awake and attentive?...It is also used without hesitation when we have a suspected incident, accident or complaint which needs further investigation.”
I hope these examples will help the Minister understand why I think CCTV should be promoted in care homes.
Beyond that, the question arises whether, at some point in the future, CCTV should be made compulsory in the common parts of homes to which residents have access. From a legal point of view, this raises no privacy issues of any complexity, because many common parts of buildings have CCTV, including parts of the Houses of Parliament. As long as people are notified of the CCTV, there is not an issue, and it would provide a powerful tool for helping to prevent abuse and improve standards. It is clear that care homes with high standards are already adopting this form of technology widely.
I am aware that the Government will be concerned that any such change would impose a new cost burden on care homes, and I recognise that that is an important issue. As many of us know, care homes operate on very low profit margins, particularly in areas of high cost, and some are finding it increasingly difficult to provide the service—certainly at the rate that local authorities are able to pay, unless they can compensate for it by getting in privately paying and privately funded residents. I assure the Minister that I am mindful of the problems that she grapples with when she sits down at her desk in the morning. These are real issues that cannot be readily solved.
None the less, I believe that, in view of the likely cost of the technology and its widespread availability, providing an adequate lead-in time ought to enable the cost to be absorbed without a crisis. Even if the Government cannot move to that point, active encouragement and using Government systems to point out the widely evident benefits of using a CCTV system would be a powerful tool that would help the Government to improve good-quality care of the elderly and vulnerable, and ensure it is not inhibited by a failure to implement good practice. History shows that people may not be persuaded to move forward without being given a bit of a shove.
I am conscious that I have taken up the 25 minutes that I said I would speak for, Sir David, and I try to keep within my time limits, although I think I may be 11 seconds over. I look forward to hearing the Minister’s response in due course, having heard from other hon. Members present, and I very much hope that she will be in a position to provide a positive message to those who are taking an active interest in this matter.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
I just want to add a few comments to the excellent speech given by the right hon. and learned Member for Beaconsfield (Mr Grieve) and to offer him my support. Similar to the story that he has just related, a constituent of mine, Tony Stowell, came to see me after having problems with his mother, who had fallen in a care home and broken her hip. Since then, he has been incredibly concerned.
We talk a lot about CCTV offering reassurance. At one point in my previous life, I worked in a children’s nursery. One thing the nursery offered was CCTV cameras in all of the different areas. Anyone who has ever dropped a small child off at nursery or on the first day back at school knows that their child is in floods of tears when they are about to leave them. They go home feeling dreadful that they have abandoned their child and feeling that their child is going to cry all day, only to ring the school or the nursery and hear them say, “Oh, your child had a wonderful time. They stopped crying the minute you left.” By offering CCTV, the nursery was able to say to parents, “Sit down and have a look at your child. The minute you walked out of the door, they wiped their eyes and were off playing and having a great time.” It gave people peace of mind and reassurance, which is what is missing from care homes.
As the right hon. and learned Gentleman said, it is not that we think everybody in care homes is going to be abusing the elderly or treating them badly, but if a person has an elderly relative with dementia who cannot clearly communicate how they are feeling or what is happening to them, having that reassurance—being able to look at footage and think, “Actually, they are okay. They are not really unhappy”—offers that desperately needed peace of mind.
I have written to the Minister and would like clarification on the reply I received. It said:
“As the majority of care homes are in the independent sector, the Department of Health and Social Care does not have powers to enforce the installation of CCTV. This would require a change in the law, which falls within the remit of the Ministry of Justice.”
I am a bit confused as to where this issue lies: does it lie with both Departments or with one of them? Clarity on that would be helpful.
More than 20,000 care homes care for more than 300,000 people. Two thirds of the people in our care homes are in their 80s and only 1% of our care homes are rated outstanding. Surely Members of Parliament and the Government should do everything possible to raise standards. I believe that offering CCTV would not only help to raise standards in care homes but offer reassurance, and I look forward to the Minister’s reply.
Glyn Davies (Montgomeryshire) (Con)
I apologise that I will not be able to stay for the winding-up speeches, much as I would like to. I will have to depend on tomorrow’s Hansard to read the Minister’s response, which I am very much looking forward to. I have another meeting that I simply cannot avoid.
In the past, I spent some time working with a care home in an advisory capacity, helping them to deliver the effective and safe service that we all want. I was particularly involved with the development of an advocacy service for residents of care homes, and also a lay visitor scheme, which is hugely important. We are all aiming for the same result, as is today’s debate. We all want compassionate and effective care in our residential care homes that develops confidence for the people in them as well as a safe environment.
I congratulate my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) not only on securing this debate but on his comprehensive speech. I unashamedly inform him that I shall take some of what he has said today and claim it as my own in future speeches. He put a very comprehensive case and I agree with all of it, so there is no point in my repeating any of it except to say how much I agree.
I have two issues in mind. One is CCTV in communal areas, for which the case is strong, particularly in terms of protection and the promotion of welfare for residents, and also for issues such as the identification of personal property, which is often helped by CCTV. It promotes a general air of confidence. However, everyone must sign up to it. That is key. Everybody operating under CCTV knows perfectly well that it is there, which in itself develops a much higher standard and awareness of the way in which everyone should operate. There is a danger of a loss of trust if everybody is not aware. An absence of trust and a feeling that there is surveillance that people do not know about can cause great damage.
Cost is a concern. In my constituency of Montgomeryshire, there is huge pressure on residential care homes, although the adoption of the minimum wage has made a big difference. Quite a few care homes will not survive because, although the local authority pays a certain rate, access to private care is not how it would be in a more affluent part of the country, so there is a big dependence on local authority provision. However, the fees simply do not cover the cost. We must be aware of that so that we do not impose anything on care homes that reduces the number of care places available.
The issue of surveillance in private rooms is much more complex and controversial, but the reality is that it will happen more and more. There have been high-profile cases in which individual families have undertaken their own surveillance. I think that will increase because there have been high-profile incidents that highlighted poor care—others will undertake their own surveillance. The issue is how we manage it and the circumstances in which we consider it appropriate in private rooms. My instinct has always been that there should never be surveillance unless everybody within its view knows about it. That would lead to confidence and not cause damage.
Everybody wants safe and effective care in our care homes. I share the view of my right hon. and learned Friend the Member for Beaconsfield that introducing CCTV as a compulsory measure in all care homes at some stage would be a positive step in helping to achieve that.
Patricia Gibson (North Ayrshire and Arran) (SNP)
I thank the right hon. and learned Member for Beaconsfield (Mr Grieve) for securing this debate and for the considered way in which he set out his powerful case. Increasingly in recent years allegations of abuse in care homes have been the subject of television documentaries and newspaper reports, as the right hon. and learned Gentleman pointed out. They have even given rise to parliamentary petitions.
We heard today the case for the installation of CCTV cameras in communal areas in care homes. It is easy to see how cameras could help to prevent the abuse of vulnerable and elderly people. We have certainly seen in the past how hidden surveillance has exposed disturbing and serious abuse of very vulnerable people, much of it long standing, such as in, to name one example, the Winterbourne View hospital, as the hon. Member for Montgomeryshire (Glyn Davies) pointed out. As the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) said, we do not want to let the shocking examples of poor care that have been publicised to allow us to forget that some care homes, perhaps the vast majority, provide excellent care to some of the most vulnerable members of our communities across the United Kingdom.
Some of the information set out for us today by the right hon. and learned Member for Beaconsfield is truly shocking, but we can all agree that there is a balance to be struck between protecting the vulnerable in care homes and protecting their privacy. There can be no doubt that CCTV can be helpful in some circumstances. The Mental Welfare Commission for Scotland stated:
“There are serious human rights considerations in relation to the use of hidden surveillance, but we do not argue that it should never happen.”
The right hon. and learned Gentleman pointed out that if CCTV is to be introduced purely in communal areas, the arguments about invasion of privacy become less urgent. If those receiving care have the capacity to consent to being filmed, they must also have the right to refuse, as suggested by the hon. Member for Montgomeryshire. No one should be placed under surveillance without their agreement, but if there is concern that a vulnerable person is being mistreated or abused in some way, the local authority can consider other adult protection measures.
Regardless of how well intentioned, there can be no denying that the use of CCTV inevitably intrudes upon a person’s privacy, even if it is restricted to communal areas. We also have to be mindful that care homes are people’s homes, and people need to feel safe, secure and supported in their home.
As for the suggestion that CCTV cameras in communal areas should become the norm, which might well be the case, I cannot help feeling that it is a sad indictment of our society when, across the board, staff as well as residents are subjected to monitoring. Some might say that that would afford additional protection to staff as they go about their duties as well as to residents, but it would be sad if such monitoring were to become the norm, although I accept the argument from the hon. Member for Kingston upon Hull West and Hessle about reassuring relatives who are concerned about their elderly loved one.
The reason we are debating this subject is the alarming cases of abuse of vulnerable and elderly people that have been exposed through secret filming. We must take those examples extremely seriously, but it is important that we do not allow ourselves to believe that they provide a template for what happens everywhere and for how all staff behave. My mother-in-law, a former Glasgow City councillor, has dementia and is cared for in an excellent care home—Haylie House in Largs. Its first-class staff are cheerful and good-natured, and the care provided is second to none. When we put our vulnerable and elderly relatives into care homes, often with great reluctance, we need to be able to trust the staff. That is an essential part of the care process. We cannot allow the reports of abuse to allow us to forget the good work in the vast majority of our care homes.
It would be wise at this juncture to take cognisance of the view of Age UK that we must take care that CCTV might provide false assurances in addition to potentially compromising the privacy of residents in care homes. The chief executive of Age UK, Caroline Abrahams, has warned:
“With all the media stories about abuse and neglect in care homes it can be tempting to see installing security cameras as ‘the answer’, but Age UK very much doubts this is the case.”
Mr Grieve
I entirely endorse that. CCTV cannot be a substitute for good quality care. The examples I gave showed that, in areas where there is an attempt at delivering really good quality care, CCTV has served to improve it, but clearly if a care home simply relied on CCTV as a failsafe, that might be even worse than the current position.
Patricia Gibson
I absolutely agree. I will move on to address the right hon. and learned Gentleman’s point about high-quality care, but will first finish the point I was making.
Cameras offer some protection to vulnerable and elderly people in care homes—I do not think anyone would dispute that—but they cannot be everywhere on the premises, so their impact will necessarily be limited. It is important that relatives of elderly residents and those who work in care homes and seek to improve them do not see CCTV as promising more protection than it can deliver in reality.
It is important to remember that abuse and neglect can be subtle and disguised. Cameras might pick up such subtlety and studied disguise but they might not. To go back to the point I made earlier about trust between residents, staff and the families of residents, if care homes do not operate on trust they are truly lost. It is essential that care homes command the trust of residents and their families, whether or not cameras are in place.
The hon. Member for Kingston upon Hull West and Hessle talked about raising the standards in care homes. We can all agree on that and it is why we are here. Returning to the point that the right hon. and learned Member for Beaconsfield made, we all understand that care homes find it increasingly difficult to recruit and retain suitable staff. We need more effort and more support for care homes, because that is the most positive way forward.
The sad fact is that our elderly relatives are in care homes because they need good-quality and very patient support in their senior years, but too often those providing that support are underpaid and undervalued by wider society. Those who do the extremely challenging job of looking after our elderly relatives need more recognition for the demanding and challenging work they do. I am sure we all agree on that. The right hon. and learned Gentleman set out the challenges in staff morale, which demand our attention.
We agree that caring for people with dementia every single day can be extremely challenging, and those who do it well deserve to be applauded. CCTV may well have a place, but it is not and cannot be—I do not think anybody is suggesting it is—the answer to the important question of how we better support and care for our older people in their twilight years, with the best possible and most highly motivated support staff, who are suitably and appropriately valued by society. If we can achieve that, we will have done a huge amount to improve our care homes and the care experience of older people.
Julie Cooper (Burnley) (Lab)
It is a pleasure to serve under your chairmanship, Sir David. I am grateful for the opportunity to respond to the debate, and to the right hon. and learned Member for Beaconsfield (Mr Grieve) for bringing this important subject before the House. I feel strongly about it, and I bring some personal experience over many years of sourcing care for grandparents and, most recently, for my own mother. I have seen examples of poor care in nursing homes and care homes, as well as examples of absolutely fantastic care in both. I pay tribute to the carers who have the skills, patience and dedication to do what must be one of the most important jobs, and probably the least valued by our society. We all should take note of that and value such people.
It should be a priority for any civilised nation to promote and ensure the safety and wellbeing of its citizens, and the provision of high-quality care in a safe environment for elderly and vulnerable people should be a given, and something that we can take for granted. Elderly people are the group I have the most experience with in this area, but I expect that it is pertinent to people in other groups who find that they need to move into a care home.
When someone is no longer able to live independently in their own home it is a big deal—for the person themselves and for their close family. Admitting that they, or a family member, cannot cope independently, giving up their home and moving away from familiar surroundings can be extremely traumatic and quite frightening. Having made the decision, everyone involved needs to be reassured that the care home is a safe and genuinely caring facility, adequately staffed by well-qualified, well-supported and well-supervised carers and nurses.
Sadly, that is not always the case, and there are well-publicised examples of poor care, neglect and, in some instances, wilful abuse. It is a shocking state of affairs that is totally unacceptable. There is, rightly and properly, a lot of agreement in today’s debate. We all agree that a single case of abuse or neglect is one too many, and I base all my comments on that point of view.
The combined findings of Care Quality Commission inspections and staff surveys seem to indicate that poor standards of care, delayed care and neglect are widespread, while instances of deliberate abuse are relatively rare. I have seen many cases of neglect and poor levels of care. I have not seen any outright, wilful abuse, but that is not to take away from the fact that it exists. The question for us today is whether the installation of CCTV in communal areas of care homes would eradicate such problems or lead to improvements. The right hon. and learned Member for Beaconsfield and other Members made a powerful case for the contribution that CCTV could make in some instances, but it is perhaps a bit of a search for a quick fix. This is a complex area with no quick fixes, and false reassurances, as has been mentioned, are a worry.
We are talking about introducing CCTV in communal areas, but the majority of care is delivered in private bedrooms, bathrooms and treatment rooms. Introducing overt surveillance into communal areas would only shift any poor practice to areas not covered by cameras. We therefore run the risk, as I said a moment ago, of providing false reassurances to family members.
More broadly, we all live in a world where CCTV is a part of everyday life. In every shop and on every high street, where we go and what we do is recorded—except, that is, in our homes. When we sit down in our lounge, family communal areas or dining room we have privacy. Is anyone suggesting that the routine recording of elderly residents while they sit in their lounge or eat in the dining room should be a requirement in every home in the land? Who among us would like to be filmed while we snooze in front of the TV or sit down to eat? If we are talking about the dignity of the residents in such homes, is that really what we want to see routinely?
Mr Grieve
I appreciate the hon. Lady’s point. Equally, perhaps one has to bear in mind that if we move out of the total privacy of a room in which we sit alone, we are observed by other people. That is part of our lives. There is a strange irony in the fact that we are perfectly happy to say, “This is wonderful—the meal time is so well supervised by staff,” but if it is supervised remotely through CCTV, or if there is CCTV available to check whether something has gone wrong, we are troubled by it.
Of course, so much depends on the absolute effectiveness of maintaining the necessary safeguard that material is kept within private circulation. However, provided we have that, I confess that I find it slightly difficult to differentiate between a camera providing some degree of assurance that everything is all right and a person physically sitting there, to which nobody would have any objection.
Julie Cooper
I hear what the right hon and learned Gentleman says. There are no right or wrong answers here; it is about creating a balance. I would point out that not all residents in care homes have dementia. Many of them do not and have a very strong awareness of their environment. They would see this as an infringement of their dignity—a dignity that they are fighting to hold on to for the remainder of their life. I take the point, but I do not think the issue is straightforward.
A point was made about CCTV in this building. We accept it, but we do not live here. We accept it in our lives, but if we are to make care homes a genuine substitute home for vulnerable people, we have to bear such points in mind. CCTV may have a role in specific circumstances, for example where a concern has been identified, but it ought to be a last resort, implemented only with the knowledge and full consent of residents, families, staff and professional representatives, because this affects everybody, and observing would definitely affect the relationships in the home.
Acknowledging that it is unlikely that incidents of abuse and poor standards of care would be prevented by installing CCTV cameras in communal areas does not mean that serious problems can be ignored. Abuse of people in care homes, and/or poor care, shames us all. ln many ways, the issue of CCTV is more of a red herring than a solution. I accept that it may have a role in some areas, and there may be justification for using it in some limited ways. However, there is widespread agreement from a range of well-respected organisations that the blanket imposition of CCTV is not the answer.
As the hon. Member for North Ayrshire and Arran (Patricia Gibson) has pointed out, Caroline Abrahams from Age UK said that it is more important
“to raise the quality of care in care homes across the board and ensure that all older people, their families and staff are involved...and are able to raise any concerns, confident that their feedback will be acted on.”
That is not always the case at the moment.
Dr Peter Carter, former chief executive of the Royal College of Nursing has said that the answer to better care is better recruitment, training and managerial supervision of staff; that would be a better way to deal with this. I agree.
The CQC said:
“We would be concerned by an over-reliance on surveillance to deliver key elements of care, and it can never be a substitute for trained and well supported staff.”
I agree with that too, and I know that other hon. Members do too—there is so much agreement in this place on this subject, which is quite unusual. I am sure that the right hon. and learned Member for Beaconsfield has initiated this debate in good faith, but if we are really serious about ensuring the highest standards of care in care homes, which I believe he and other Members here are, he will join me in urging the Minister to consider reversing some of the funding cuts to social care.
It is a sad fact, but a fact nevertheless, that in response to Government funding cuts local authorities have reduced spending on social care by £6.3 billion since 2010. The cuts are now having a huge impact on care quality—a quarter of all adult care services have the lowest safety ratings, 30% of nursing homes in England require improvement or are inadequate and a growing number of private care homes are handing back their contracts, citing insufficient funds. Many more are teetering on the brink of financial collapse, faced with no alternative but to reduce staff numbers and, inevitably, standards of care.
We have not talked much about the funding implications of CCTV. Given that the sector is short of funds to start with, I am not sure who exactly would pay for CCTV installation and the ongoing monitoring, if it were to become mandatory; if it were to have any value at all, that would be expensive.
Before this debate, the Department of Health and Social Care said:
“Closed circuit television should not be...a substitute for proper recruitment procedures, training, management and support of care staff, or for ensuring that numbers of staff on duty are sufficient”.
I agree, but proper recruitment, training and adequate numbers of care staff have an associated cost, which it appears the Government are not prepared to meet. Quality care for the elderly and vulnerable cannot be delivered on a shoestring by poorly paid and overstretched carers. Our old people, our parents and grandparents deserve better. I look to the Minister to bring forward the promised Green Paper, to embrace the points made in this debate and to ensure that we have the kind of social care and care for our elderly that we can all be proud of.
The Minister for Care (Caroline Dinenage)
It is a pleasure to serve under your chairmanship, Sir David. I congratulate my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) on securing the debate. I welcome his well-thought-out and measured contribution to this incredibly important agenda. At its heart is a focus on our shared interest in safety and quality of care for those in residential settings. I thank other hon. Members who have contributed. Consensus has broken out widely in the Chamber, which is not entirely usual and is to be warmly welcomed.
I begin as other hon. Members have by paying tribute to those who work in adult social care. They do a brilliant job often in quite difficult and demanding circumstances, and sometimes with very frail and vulnerable people. Social care professionals work with great compassion and resilience and the vast majority of them treat those they care for with enormous dignity and respect.
Central to the effectiveness of care and support services that enable living well is the quality of those services. Everybody wants the very best care for their loved ones, but we do not know for sure what takes place when we leave a residential care home, which is understandably a concern to many people.
I listened to my right hon. and learned Friend’s arguments with interest. He makes them in his customary reasonable, compelling and persuasive manner. I agree that there are cases in which CCTV could be seen to be of benefit. The question we need to answer today is whether, in the Government’s pursuit of quality care, mandatory CCTV cameras are the answer.
Currently, there is no obligation on care homes to install CCTV cameras, but are they able to provide reassurance that care assistants and other staff are looking after our relatives in the way that we would wish? I do not think there is a single answer to making sure that abuse is eliminated and care is delivered in the best way possible. Some providers may reap significant benefits from using surveillance. Certainly, campaigners such as my right hon. and learned Friend’s constituent, Ms Connery, have collected great examples of it working very well to safeguard vulnerable residents. I can see how surveillance systems can be used as part of the appropriate deprivation of an individual’s liberty. With appropriate safeguarding, CCTV could be used to monitor and identify whether a person living with dementia is attempting to leave a care home, for example.
Mr Grieve
I am grateful for the spirit in which the Minister is responding to the debate. As we have examples of what appears to be good practice—it is possible that one is being misled by the examples, which we have to bear in mind—I would be interested to know whether the Government, as well as the CQC, are assessing those companies that are voluntarily using CCTV in common parts and their results so that we can be better informed as to its success or otherwise.
Caroline Dinenage
We have not done that to date, but we would be very happy to see the valuable evidence that my right hon. and learned Friend says people have been collecting.
The hon. Members for Burnley (Julie Cooper) and for North Ayrshire and Arran (Patricia Gibson) raised the concern that CCTV has the potential to be intrusive in people’s lives, not only for those who live in such homes but for their friends and families, the staff and people who come to visit. As they both said probably more articulately than I can, we have to keep at the back of our mind at all times that these are people’s homes. Given the huge rise in the amount of care that is delivered in individual homes rather than in residential settings, there is also the concerning question of whether there would be pressure to install cameras in the homes of people who receive domiciliary care if CCTV is made compulsory for care homes, which would be a step into a whole new world.
I move on to this part of my speech with some trepidation, given that I am speaking to a former Attorney General. There are complications with the legal aspects of his proposal. I am not a learned Member of Parliament by any stretch of the imagination, but there could be an administrative and financial burden on care homes, many of which are small businesses with very few administrative staff. In 2014, the Care Quality Commission published “Using Surveillance: Information for providers of health and social care on using surveillance to monitor services”. It was aimed at the public, inspectors and providers who are considering or already using surveillance systems. That guidance will be refreshed later this year.
The legal framework requires that any use of surveillance in care services must be lawful, fair and proportionate, and for purposes that support the delivery of safe, effective, compassionate and high-quality care. Providers considering using surveillance, particularly covert surveillance, must bear in mind the potential impact on the bond of trust with people who use their service.
Mr Grieve
I have to make it absolutely clear that I was not suggesting covert surveillance. I have been quite plain about this. As I understand it, the homes that have introduced it have done so overtly; the common parts are covered by CCTV and anybody who comes into the home understands that. I am not recommending a form of covert surveillance. I can see how that could be open to considerable abuse and lots of difficulties, and I strongly urge the Minister and her Department to steer well clear of that legal minefield.
Caroline Dinenage
I thank my right hon. and learned Friend for that legal advice, which would probably have cost me a fortune in the outside world. I am grateful for that clarification. The provider should consult those affected on the use of surveillance wherever it is possible to do so. It would have to meet the cost not simply of the equipment and the monitoring of it if it is done by a third party, but of the training, staff time, legal advice and consultation activity. There is no point in having such a system unless it is monitored and routinely checked.
The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke compellingly about early years settings. I have experience of that, not just as the former early years Minister but as a mother who has been in exactly the situation that she mentioned. It certainly rings bells with me—leaving children screaming their heads off, and five minutes later being told they are all perfectly fine. As she says, that can be very comforting for parents. CCTV is not compulsory in early years settings either, but there are many similarities between the two sectors: they are both predominantly run by private companies. I hope that early years and residential care businesses see the benefits.
I have an apology to make to the hon. Lady. She asked about the letter that we sent, which suggested it might have to be up to the Ministry of Justice to change the law. That was incorrect, and we have subsequently sent her a letter clarifying that. I apologise.
Ultimately, CCTV can have benefits, but it simply cannot be a substitute for well-supported, well-trained staff and excellent management. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure
“the services they commission are safe, effective and of high quality”.
We also expect those providing the service, local authorities and the Care Quality Commission to take swift action where anyone alleges poor care, neglect or abuse. We have backed that up with more than £9 billion of investment in the sector in the past three years,[Official Report, 11 October 2018, Vol. 647, c. 4MC.] which equates to an 8% increase in funding. That incredible amount of money highlights the challenge we face in the sector.
Julie Cooper
Does the Minister not accept that, as a result of cuts to local authority funding, there has been a reduction equivalent to £6.3 billion of spending in the sector?
Caroline Dinenage
I accept that there were cuts to local government funding during the time of the recession that we all endured. That was incredibly regrettable, but was one of those very difficult decisions that Governments have to take.[Official Report, 11 October 2018, Vol. 647, c. 4MC.] In the last three years, we have increased funding by £9.4 billion, which equates to an 8% increase. It demonstrates the challenge of this ageing population—people are living longer with much more complex needs, and many vulnerable people need an enormous amount of support and care. It is an enormous amount of money, and yet we still see the sector facing great challenges and stress, which is why we have a Green Paper coming out later this year. We hope it will help address the sustainability of the adult social care sector. Successive Governments have wrestled with this incredibly challenging issue, and we need to find a long-term solution.
We expect serious allegations of abuse and neglect to be thoroughly investigated and prosecutions to be brought where that is warranted. The abuse of people who depend on care services is completely unacceptable and we are determined to stamp it out. That is why we introduced the new wilful neglect offence, which came into force in April 2015. The hon. Member for North Ayrshire and Arran said that we must get the very best quality of staff into this demanding and challenging profession. I could not agree with her more. We have made changes to help services recruit people with the right values and skills, and introduced a care certificate for frontline staff to ensure older and vulnerable people receive the high-quality care they deserve.
The Department for Health and Social Care has commissioned and funded Skills for Health, Skills for Care and Health Education England to develop a dementia core skills education and training framework, which is very important to me. There is also a fit-and-proper-person test to hold directors to account for care. Let us not forget that 82% of adult social care providers are rated as good or outstanding as of August 2018, according the Care Quality Commission. That is a testament to the many hundreds of thousands of hard-working and committed professionals working in care, to whom we owe a debt of gratitude. Surely the best way of building on that is not to say to them, “We’re watching you in case you do the job wrong,” but rather to say, “How can we support you to do the job better? How can we invest in skills training, continuous professional development, great management and more staff on better wages?”
Mr Grieve
I come back to my point: in the course of their life, a person might carry out a job under supervision—I used to as a pupil barrister—when somebody might watch what they are doing and tell them what they are doing wrong. One of the difficulties in some care homes is that that is not necessarily happening. I urge the Minister simply to factor in that the chain care homes that I cited were using CCTV not to pick up, punish and sack staff, but to improve the quality of the care. That is one of the things that impressed me the most about it.
Caroline Dinenage
My right. hon and learned Friend has made that point incredibly powerfully and I do not dispute for one second that there is value in that form of monitoring. Certain responsible employers might see that value and benefit from it. I still do not think that there is any substitute whatever for top-quality management carrying out that sort of monitoring and surveillance themselves, when done properly.
The Care Act 2014 places a duty on local authorities to promote their local market to ensure that all service users have a choice of high-quality services available. In 2015-16, nearly two thirds of service users reported that they were extremely or very satisfied with their care and support, which was consistent with the previous year and is testament to the work carried out at local level to deliver quality services. We cannot rest on our laurels: if two thirds of service users reported that they were extremely or very satisfied, a third did not. That is why the Department for Health and Social Care is working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.
The compulsory use of CCTV cameras in the communal areas of care homes would require a change in the law, and it is not clear that that blanket approach would be proportionate or respect the needs and wishes of everyone who lives in a care home. There are undoubtedly cases in which better monitoring of staff would produce benefits, but without fuller evidence, the decision to install CCTV should remain one for the care home provider. I have been encouraged by the stories told by my right hon. and learned Friend about companies that found that installing CCTV brought tangible benefits. I encourage other providers to look at those kinds of examples if they are contemplating installing CCTV, and would certainly support them if they wished to do so.
The Government are absolutely committed to providing high-quality adult social care for service users, families, carers and everyone working in the sector, but at this stage we do not intend to make installing CCTV in care homes mandatory.
Mr Grieve
I am most grateful to the Minister for the time and trouble she has taken, and to other hon. Members who participated in the debate, my hon. Friend the Member for Montgomeryshire (Glyn Davies) in particular.
The points that have been made are all valid. I emphasise that I am not putting this proposal forward as a panacea—there are no panaceas. One of the things that we should have learnt a long time ago—I hope most hon. Members know this—is that perfecting humanity is impossible. All we can do is to strive to improve what we do. The point I would like to emphasise is that, despite the fact that many care homes strive to be good, systematic patterns of failings are clearly creeping into the area.
That happens in many other areas of human activity but, for the reasons I gave at the start of the debate, I do not think that the failings picked up in care homes should be in any way surprising.
Looking after people who have complex physical and in some cases mental health-related issues is a very difficult thing to do. It will stretch and test human beings, especially their tolerance levels. I know from past experience in other fields that any deterioration in how human beings behave towards each other, whether that is neglect or abuse, usually comes not as a one-off but as part of a pattern of inability to manage the stresses and strains that people are under and then to respond to them appropriately.
I have a younger son who has just come out of Sandhurst. When he left Sandhurst, during a lunch to celebrate his passing out, he said to me, “The funny thing is, I went into Sandhurst far more confident about my capacity to be an officer and a leader than when I came out,” to which one of the instructor officers replied, “That is exactly what we intended.” It was intended to point out the areas where they were going to be put under pressure and would have to find the right discipline to respond. That is the fundamental problem.
Ultimately, the Minister is right: it is about management. If there is good management, whether that be in prisons, hospitals or care homes, or political parties for that matter, those places are likely to work better than without good management. The question is, “What are the tools which we can use to try to enhance that?” Of course, CCTV is not a panacea—it could be misused and just become mechanical. Admittedly, the examples I have given are only examples. There may be others I do not know about in which CCTV has been used and is not working well—I have not come across any because I can only pick up the bits of evidence I am given, which is why I have suggested to the Minister that doing an evaluation might be quite useful. The Government are in a much better position, as is the CQC, to see whether the results are sufficiently positive. Even if CCTV is not made compulsory, it should be more positively encouraged because it is such a good tool. The best examples I have heard about suggest that it works rather well.
Far from CCTV leading to terrible stories about sacking inadequate or brutal staff, it simply means that staff end up happier and deliver a much better service to residents in care homes, relatives are much more reassured and, if there is a problem, it can be dealt with more effectively. That is what I am talking about. It is not a binary choice that I am putting forward—we have far too many of those in this place.
If this debate has served any useful purpose, I hope it has highlighted that in CCTV we have a positive tool that can be used effectively. I encourage the Minister and her Department, which has lots of problems to contend with, to look at this carefully. Despite the drawbacks that were rightly highlighted—I understand privacy, an issue which can trouble me very much as well—when we look at the nature of the sort of homes we are talking about, there is a place for CCTV. If it is encouraged, I think it might prove very useful in raising the standard, which is exactly what the Minister wants to do. I am here to encourage her in that direction in any way I can.
Question put and agreed to.
Resolved,
That this House has considered CCTV for communal areas of care homes.