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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.