Home Care Workers

Alison McGovern Excerpts

Wednesday 6th March 2013 Westminster Hall

[Alison McGovern (Wirral South) (Lab)]

I begin by congratulating my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. There could not be a more important subject on which to have a Westminster Hall debate. I also thank the hon. Member for St Ives (Andrew George), who made a very important contribution. To add more thanks, the recent CQC and Unison reports have been incredibly helpful; for those of us who have been thinking about care for some time, the two reports have crystallised and explained, in a well researched way, the substantial challenge that we face.

If I may make a slightly parochial Merseyside remark, this is an extremely important issue for us, especially in Wirral, where we have an ageing population, which, I must say, we are very glad about. We are glad and proud that our grandparents and parents are living longer, but with that pride comes responsibility. That is why the challenge that we face is very important. I would like to thank my constituents, who have been very good in coming to several public meetings with me on the subject of care. I have asked them to help me think about that issue, because I know that many of them face this challenge. They have willingly given up their time to inform me about their concerns, and I am incredibly grateful.

I have also been lucky in the Wirral because home care staff have met me and given me the benefit of their experience, along with council officers and councillors. I recognise that the problem is shared across all those groups. We are going to fix the problem together, and we are here today to ask the Minister whether he will join us in helping to do that.

[Mr Gregory Campbell (East Londonderry) (DUP)]

On the point she just mentioned, does the hon. Lady agree that one of the pleasing aspects of this issue is the number of active senior citizens in all our constituencies who want, in a voluntary capacity, to involve themselves in the debate to try and lift the standards and ensure that we give the proper care to people in their own homes?

[Alison McGovern]

I could not agree more. Only last Friday, I was with Heswall Soroptimists, a very committed group of women who volunteer in our community, and who raised various issues about care. That is only one example of committed groups of citizens who are keen to be involved in finding a solution.

It is important that we make the moral case for change. Too often, people in need of care in their homes are hidden from our society, and people who need support, by their nature, can find significant barriers to their participation in democracy. Therefore, it is extremely important that politicians take the time to speak up for them. I have been meeting regularly with Wirral officers to try and work through some of those issues, and specifically, to discuss whether there is a way that we can improve the quality of care in our borough.

On that note, I flag to the Minister that such conversations are made much more difficult by the funding settlement that local government has received. The fact that local government has taken the biggest cuts from Whitehall has certainly impeded my ability, locally in the Wirral, to get change. I ask the Minister to note that point, and next time that he has conversations with Cabinet Ministers and the Treasury, to remind them of local government’s role in care and of the important challenge that we are trying to meet.

In discussions with Wirral council officers, we have also been trying to consider how to tackle the problem of information that has already been flagged. For people who are trying to procure care, it is difficult to know what quality standards they can expect and what the market looks like. I sympathise greatly with the points made by my right hon. Friend the Member for Oxford East about the role of markets in what is, I would argue, a bit of the economy that does not necessarily lend itself well to markets. I hope that hon. Members will forgive me if I sound like a bit of an economics geek when I say that, in any case, markets do not work well when participants have insufficient information. I believe that if we cannot solve that problem, the current system will never work.

I will move on to talk about two aspects of home care that have repeatedly been shown to be very important to my constituents. As I mentioned, we have had several public meetings in the Wirral to discuss these issues, and we have tried to bring together both those who work in care and those who receive care so that we can see the problems from either side of the coin. Those two aspects are 15-minute appointments and zero-hours contracts. Those two issues typify the insecurity at work and low investment in skills that home care workers face.

First, on 15-minute appointments, it might have been mentioned that the recent Unison report found that 46% of staff felt that they had to rush visits—that is nearly half the workers going into the homes of people who are very important and need help. The result is the feedback that I receive that due care and attention cannot be given to people. I am talking about basic matters of respect, such as addressing the person concerned as they would wish to be addressed.

Let me give an example from my own constituency. A care worker was in a couple’s home to make some food for them, but said that they were able to do that for only one member of the couple—the husband or wife—because that was all that they had been allocated time for. Most people expect to be able to sit down to a meal with their partner. That is a basic thing that we all expect to be able to do in our lives. Fifteen-minute appointments may or may not have been the cause of the problem in that case, but if 15-minute appointments mean that the normal standards that we would all expect to be upheld have to be disregarded, that is not a system that will work well.

I will read out a quote from one of the care workers to whom Unison spoke:

“When the person you go to needs more care or has incontinence you are only allocated 15 minutes for a meal and have to leave them. I haven’t left a client like that and would go over my time (although not paid for it), but it does mean you are running late for other calls.”

I cannot imagine what it must be like for someone to turn up at a person’s home and find, if they are incontinent, that the worst has happened. They are supposed to be there only to make them a sandwich or whatever and they must decide between being late for the next person, which will cause stress, or, frankly, rushing around doing things that they know they will not be paid for, which will cause them stress. At the same time, they are trying to make that individual feel better about what has happened. What skills and talents does someone need to make that situation go well? We should first admire the people who do this job, but also question what in the system is causing such a breakdown.

One aspect of this subject that I have highlighted as a result of listening to my constituents is that too much of the way in which our system works is task-orientated, not person-orientated. Dignity is extremely important. Increasingly, people have recognised that the way in which we treat others in society is ever more important. When we are asking people to do a list of tasks—no more and no less—rather than think about the individual and try to help them with whatever their needs are, we will not fix the problem. Individuals will feel bad about the care that they receive rather than feeling that it is a help to them. Another care worker quoted in the Unison report expressed that very clearly:

“I never seem to have enough time for the human contact and care that these people deserve.”

That is a lesson to us all.

Secondly, on zero-hours contracts, my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) and I have recently commenced a survey that is designed to listen to people across all industries who have experienced being asked to do or have taken on zero-hours contracts. Of course, for people who want a bit of work but do not need it to be regular—students or others—zero-hours contracts may not be such a problem. However, I think we all recognise in this Chamber the problems with that flexibility and insecurity in a world in which people are trying to provide routine, predictability and attention to detail for some quite vulnerable people. I think we would all question the appropriateness of zero-hours contracts.

There are two problems with zero-hours contracts that we need to consider. The first is inconsistent care. My constituents tell me that they would like to know who the person is who will be turning up and they would like visits to be predictable and regular, not least because of respect and dignity issues, such as knowing the little details. Often, people who need care face communication barriers. Understanding in detail how a person communicates is extremely important, so consistency of care could not be more important. How do zero-hours contracts support consistency of care?

The second issue is stress. Insecurity at work causes stress, and in a world in which we are asking people, as I mentioned in my example, to turn up and help vulnerable people, we need them to feel confident and secure and to have enough skills to be able to tackle whatever problems are there. Recent research has shown the impact of stress and insecurity for those working in care on the manner of treatment received by the people for whom they are caring. That is an important message to us all as politicians. What responsibility can we take for creating more security at work for those who care for vulnerable people?

Comments have already been made about the pay levels in the sector. They are clearly low. Low pay plus zero-hours contracts mean that we will have people of relatively low skill. I mean “low skill” in the technical sense; I would argue that people who work in care are extremely skilled and extremely able practically, given what they have to deal with. However, investment in skills will clearly not happen where there is low pay and an insecure labour market.

Having described the problem, I will conclude by describing what I believe might be part of the solution. First, working in home care needs to be seen as an aspirational job. There is no reason why someone should not work in care and aspire to management, to moving up in their career. We need to find pathways through the career chain so that we can make this a genuinely aspirational job. A significant number of our young people are out of work. We need to demonstrate to them that home care work is valued in society and that if they pursue such a career, they will be invested in and respected as members of our society. We need to make that absolutely clear.

I again thank my right hon. Friend the Member for Oxford East for securing the debate. There could not be a more important subject than this. I hope that the Minister will respond positively and explain what we can do to bring some change to the sector.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Turner.

I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this incredibly important debate. As was pointed out by the shadow Minister, the hon. Member for Leicester West (Liz Kendall), the subject is too often neglected. It is literally hidden behind closed doors, and it does not get the attention it deserves. I also thank my hon. Friend the Member for St Ives (Andrew George), and the hon. Members for Wirral South (Alison McGovern), for Strangford (Jim Shannon)—he drew attention to the brilliant work done by Crossroads in many parts of the country—and for Nottingham South (Lilian Greenwood), who spoke from direct personal experience.

I totally agree with the shadow Minister that the health and care system has not kept pace with the demands and challenges of an ageing society, and that we need a fundamental re-engineering of how we deliver care. I have a passionate belief in the need to shift towards an integrated care model, in which we shape services around the needs of the individual, rather than those of the institution, which is a shift that must happen.

Before I go into details, let me say that I applaud Unison for having undertaken the report that several hon. Members have mentioned. When its staff wrote to me about the report, I asked officials to meet them, and they will meet soon. I, too, asked to meet them, and I will discuss their concerns with them next month. I recently met some care workers, with another hon. Member, to hear directly from them, and I want to experience myself what goes on—often behind closed doors.

The right hon. Member for Oxford East mentioned whistleblowers, and I have a lot of sympathy with the points he made. Last January, the Government extended the Government-funded whistleblowing helpline to the whole of the care sector, so that any care worker can find out how to pursue their concerns. Of course, as employees, care workers have employment law protection, and we should encourage them all to use their rights.

The Government want to do all we can to ensure that standards of care remain as high as possible, and indeed improve. That is the challenge we all face. People who receive home care and their families should be able to expect the highest quality of care every time. I am aware of the many examples of poor care. The right hon. Gentleman and other hon. Members drew our attention to some pretty shocking case studies and to the fact that someone can have up to 13 different care workers over a relatively short space of time. As the hon. Member for Leicester West said, it is completely unacceptable that a person has to receive quite intimate care from someone whom they have never met before. Moreover, the idea of a zero-hours contract is, in most circumstances, completely incompatible with a model of high quality care, in which the individual really gets to know their care worker.

The CQC report “Not just a number” highlighted some serious concerns, which we must take action to address. The responsibility for bringing about improvement rests with all the key players, including the providers, the councils and the regulator. The Government too must take their share of the responsibility here. The trick is to erase the bad, keep the good and improve services across the board.

The care and support White Paper sets out our intentions to improve the standard of social care. We will do that primarily by investing in people—by focusing attention on the staff who provide care in the first place. I want to join the right hon. Gentleman and other hon. Members in paying tribute to care workers, the vast majority of whom do really excellent work, often in difficult circumstances. They work under real pressures because of the way in which care is commissioned over very short spaces of time. We are seeing a race to the bottom, and we must move away from that. It puts care workers under impossible pressure and it does not provide good quality care.

Another matter I feel strongly about, and to which I referred in my response to the Winterbourne View scandal, is that there must be much more effective corporate accountability. Some companies are making very good money out of home care, so accountability must go with that profit making. It is unacceptable that home care providers sometimes allow negligent care to take place under their watch, and they must be held to account for it. Poor care, private or public, should be condemned wherever it exists. We must not have the idea that poor care exists only in the private sector. It was intolerable that hundreds of people died in Mid-Staffordshire hospital, an NHS hospital, as a result of poor care, and it is equally unacceptable when it happens under the watch of a private provider.

It is impossible to speak about improving standards without also talking about human capital. Care workers who feel valued and encouraged will perform better; it is as simple as that. The more attention the Government pay to the skills, training and personal development of the work force, the better are our chances of improving standards. After all, it is the care workers, not us in Parliament, who ultimately provide the care. We must increase the capacity and the capability of the social care work force, give people better information about care providers and improve the performance of the regulator, the Care Quality Commission. All those things will make social care a more attractive place for people to work and, most importantly, improve the quality of services.

We will shortly introduce new minimum standards to improve training for care staff to make sure that all employees have the foundations for excellence. My focus must be on training and standards, and ensuring that they apply across the board. I am dubious about the idea of creating a new regulator or of using the Nursing and Midwifery Council, which has not had a great record, to regulate some 1.5 million people. The money that is available should perhaps go to the front-line workers, rather than on creating new bureaucratic structures. I will give way to the hon. Lady, and ask her to be very quick if she does not mind.

[Alison McGovern]

I will be speedy. I have listened carefully to what the Minister has said about the causes of the problem. He does not seem to have mentioned funding pressures on local government. Will he respond to that point, because it is a massive constraint on improvements in the sector?

[Norman Lamb]

I will directly address that point. The analysis of the independent King’s Fund said that provided councils apply the money that the Government have allocated to care and undertake proper efficiency savings, which the previous Labour Government recognised had to happen across health and care, they should be able to continue to provide the level of service that exists at present. We need to think more fundamentally about a much more integrated approach between health and care. We can save resources and improve care if we bring the systems much more closely together.

It was, I think, the hon. Member for Wirral South who made the point about looking at care as an aspirational role.

[Alison McGovern]

indicated assent.

[Norman Lamb]

I totally agree with her. If a worker can aspire to something better—perhaps a progression in their career—they will commit themselves very fully to the role. The idea of a vocational progression towards nursing, even if, at the end of the day, a degree is involved, should be opened up much more than it is at present. I completely agree with her on the points that she makes.

I share the concerns that hon. Members have raised about pay. There have been reports that some home care workers may be working for less than the minimum wage, which is an absolutely disgraceful situation for a vast number of reasons, not least because an illegally low wage will never produce excellent results and it is an exploitation of the worker that we must not tolerate. It is the responsibility of all employers, including home care providers, to pay staff at least the national minimum wage. The Government are working closely with the Low Pay Commission and local authorities to address that issue. I can assure all hon. Members that we will not accept anything less than 100% compliance with the regulations.

When I was a Minister in the Department for Business, Innovation and Skills, I wanted to change the rules to make it easier to name and shame employers who fail to pay the minimum wage. We must regard that as completely unacceptable practice, and any employer who indulges in it should be exposed; it is utterly intolerable.

NHS Commissioning Board

Alison McGovern Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

Competition should only ever be used to enhance the interests of the patient and to improve patient care; it is not an end in itself, and that must always be the case. These regulations will ensure that that is the case and that other vital factors such as co-operation and integration must be taken into account by CCGs in making their judgments.

[Alison McGovern (Wirral South) (Lab)]

This top-down reorganisation has, from day one, been a chaotic waste of time, money and effort. Now that the Minister has made a U-turn, will he make things clear, so that I can tell all the professionals and patients in the Wirral what his policy is? Will he say when he will bring to this House a statement of what the Government’s policy is on competition in the NHS?

[Norman Lamb]

I repeat that we will be publishing amended regulations within days and that the Government’s reforms are about putting the clinician centre stage in decisions about how money is spent, rather than unaccountable bureaucrats, as happened in primary care trusts up and down the country. The reforms are also about ensuring that the patient’s interests and patient care are always uppermost in the minds of everyone making decisions about the use of money in the NHS.

Backbench business

Alison McGovern Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes]

One of the messages that I have received from parents is that they already feel enormous guilt, in some instances completely unjustifiably. They feel shame for what is going on with their child, and as if they are somehow to blame. They are not, and I find that in the majority of cases, parents were the fastest to identify the condition. They instinctively knew that something was wrong with their child, even though they might not have been able to put their finger on what exactly it was. I have heard some terrible tales from parents, which I will come on to—I assure you, Mrs Osborne, I am getting towards the end—about the responsibility and burden placed on them. I have even heard about parents who have been told that it is their fault. It simply is not.

We do not fully understand what causes eating disorders; it is complicated. All the parents I have spoken to have done the most fantastic job in supporting their children. As one sufferer’s mother said to me on the phone just yesterday, there is nothing that she would not have sacrificed to get her daughter the help that she needed. Had the mother been able to buy private health care, she would have sold her house to do it, so desperate was she for her daughter to get well.

I know how long sufferers have had to wait to gain admission to April House—something that has been emphasised to me incredibly strongly—and the picture from around the country is that the average wait from diagnosis to treatment in a specialist unit can be as long as nine months. For sufferers, that is simply far too long. As we move from primary care trusts to clinical commissioning groups, it is imperative that awareness of the scale of the problem is uppermost in the minds of GPs, who will be responsible for commissioning the relevant services.

I have mentioned briefly one significant theme, but I would like to mention it again. It is a message that has come from the parents about the impact on families. The effects are many and varied, and certainly include huge feelings of guilt and despair, and lack of comprehension of why this has happened to their child, or why an individual might choose to deprive themselves of the necessary nutrition to lead a healthy life.

[Alison McGovern (Wirral South) (Lab)]

I apologise to the hon. Lady, who is making a brilliant case on behalf of the sufferers of eating disorders, for intervening on an excellent speech. Given the shame and guilt she has mentioned, which are big factors, does she agree that it is fantastic that constituents of mine have got in touch with me to ask me to attend this debate? All of us have constituents who have got in touch with us on this issue and have talked about their experiences. Their coming forward helps to dispel some of those feelings, and some of the myths and rumours surrounding these conditions. Will she congratulate them with me?

[Caroline Nokes]

I thank the hon. Lady for that intervention. One word that keeps being used is “stigma”. She is absolutely right to highlight the bravery of individuals, some of whom were perfectly happy to be named; when I told Katie Waters that I wanted to quote her, she was over the moon that I was going to quote her in Parliament. Others did not want to be named but still wanted to tell their story. They have all been phenomenally brave, including those in this place who have contacted me and talked about their personal stories.

I have had mothers contact me to tell me that when their child was diagnosed with an eating disorder, they were accused of abusing their child. The assumption was made that they must have harmed their child for her or him to have developed an eating disorder. I am not saying that that never happens, but from my experience, the parents and families of people with eating disorders have been caring, loving, supportive, desperate for knowledge and help, and in many cases prepared to sacrifice absolutely everything for their family member to be well again. I therefore pay tribute to charities such as Beat and ABC, which have recognised that this is not a condition of the individual, but affects entire families, wider networks, friends and colleagues.

Beat is working in partnership with Student Run Self Help, which runs a number of support groups in universities throughout the country. Both organisations have heard of a number of cases in which students have not been able to access treatment, or have been able to access only intermittent treatment, due to a lack of co-ordination and flexibility on the part of GPs and eating disorder treatment services at their university and in their home location. They have asked me specifically to highlight to the Minister the serious problem with 18-year-olds going off to university. We know that people are most likely to develop an eating disorder at 17, so that is a vulnerable age.

What sufferers need above all else is continuity and stability of treatment, which Beat originally thought could be achieved by enabling people to register with two GPs at one time. However, after consideration was given to who would have overall financial and clinical responsibility for the patient, discussion turned to the proposal that the home GP could have those responsibilities. This should encourage greater communication between the home GP and the GP with whom the student is registered as a temporary patient at university. In addition, it is likely to be argued that the student should be able to register with more than one eating disorders unit—one at home and one at university—so that they can receive the necessary care during both term time and the holidays.

I am conscious that other Members wish to speak and my contribution has been somewhat lengthy, so I shall conclude my remarks with a tribute to one of my constituents, whom I first met at April House this time last year. She has gone out of her way to keep in touch with updates about what she is doing to raise awareness of eating disorders. She has certainly improved my knowledge and understanding, and is shortly to take part in a charity sky-dive to raise funds for eating disorders awareness. What struck me about Becky was her willingness to open up about her battle with anorexia and some of the stark truths.

Hampshire is a fortunate county, with excellent schools and sixth-form colleges. Even in schools and colleges rated as excellent, however, eating disorders can flourish. Transition from school to college can be difficult for many, and at times of change, stress and pressure, eating disorders can frequently manifest themselves. Even where teachers and head teachers are good, concerned and caring, and where pastoral care is superb, young people can fall victim to these disorders. I hope that in some small way this debate has helped to raise awareness and understanding in this place. I sincerely thank all those in the Public Gallery for attending, and I thank colleagues for their contributions this afternoon.

Dementia

Alison McGovern Excerpts

Thursday 10th January 2013 Commons Chamber

[Hazel Blears]

Yes, there was. The all-party group had an interesting presentation from the Scottish Health Department. Diagnosis rates in Scotland are very high indeed, and we learned that the highly organised, managed and focused system there was driving up diagnosis. It is driven, to some extent, from the centre, and I know that that is not always popular these days, but the drive from the centre out to the GPs is really making a difference. I think that there is room for us to adopt a more driven process—it need not necessarily be more centralised—in which GPs are more accountable and in which they report back on rates of diagnosis. There is much more that we can do in that regard.

Diagnosis is a problem, but once a diagnosis has been made, the availability of support in the community becomes relevant. There are many problems in that area. Our inquiry revealed that many carers felt that nothing happened after the diagnosis, because there was no help or support available. In my area in Salford, we are lucky. We have one of the 10 national demonstration projects established under the national dementia strategy in 2009, and we are developing some really innovative services in the community. I should perhaps declare an interest: my mum attends the centre two days a week, and I sit on the strategic board that drives the process there. I have seen that when people are really committed to such projects, they can make a huge difference.

Our centre is the result of a partnership between the local authority and the Humphrey Booth charity, which has existed in Salford since the year 1600. It is a marvellous example of people working together. The centre is known as the Poppy centre, and its facilities include a dementia singing group, on a Wednesday, which attracts 150 people. That is an incredible resource. The centre also offers day centre services, art work, music, personal tailored care, a dementia café for when friends and family drop in, living history, hairdressing and hand massage. It is a wonderful place, staffed by brilliant people.

[Alison McGovern (Wirral South) (Lab)]

I apologise to my right hon. Friend and other Members because I cannot stay for the whole debate. The lesson I have learned from her expertise and from the evidence I have heard about Salford on this and other occasions is that we cannot think in the old way about how we help people with dementia; we have to be creative and provide the best range of services possible.

[Hazel Blears]

My hon. Friend is absolutely right. We are at the beginning of the kind of innovative care that she talks about. One thing we need to do is to get more young people and more young clinicians involved in this area, because that is how we will see innovation coming through.

We have a brilliant centre in Salford run by the manager Sue Skeer. There is also Sue Smyth and Nicola Fletcher, and users and carers are on our board. Margaret and Fred Pickering are an inspiration: Fred has dementia, Margaret is his carer and the whole of our practice is driven by users and carers at the centre. We are lucky, but many places have nothing like the Poppy day centre to support them.

We want to make Salford a dementia-friendly community and to make sure that transport, housing, leisure and local shops are all aware of the issues around dementia. My local university in Salford is setting up a dementia centre—a collaboration between the department of the built environment, including architects, and the department of social care. Design is being looked at really seriously. A marvellous Italian Professor Ricardo Codinhoto and a wonderful nurse, Natalie Yates-Bolton have inaugurated not just the design centre at Salford university, but now a European collaboration so that we will have an international design network on how we can make dementia-friendly communities work.

My question to the Minister on dementia-friendly communities, which we hope to be in Salford and which York, Plymouth and other places are pursuing, is: what resources have the Government committed to support the work of these communities, and how will it be sustained in the long term? We can push on, but we need a resource to make it happen. Yesterday, I met Duncan Selbie, the new director of Public Health England, who is going to make dementia a national priority for public health, so there really is commitment and energy behind all this. I want to hear from the Government what they can do to help.

Let me briefly cover my second theme—I have accepted two interventions—which is about the research challenge. I met the Wellcome Trust this week, and I was hugely encouraged by its willingness to put serious research funding into this area. It is looking not just at clinical research, which it might have done in the past, but at research on “living well with dementia”, recognising the importance of a holistic approach. I was impressed, too, when I met David Lynn and Dr John Williams. They acknowledged the difficulty of this area because there is so much that we still do not know about the brain. Nevertheless, despite the failure of the recent clinical trials, the data from them could prove very useful in taking us forward to the next steps, which we hope will help us find drugs that will at least slow down or delay the onset of Alzheimer’s. What everyone who has Alzheimer’s wants is a cure; they are desperate to get some progress here.

If we have a really big push on research, I feel that progress could be made. Our scientists are some of the best in the world in this area, yet for every six scientists working on cancer, only one works on dementia. Only 2.5% of the Government’s research budget goes to dementia, with 25% going to cancer. We should look at the progress made in cancer over the last 20 or 30 years; I do not want to wait another 25 or 30 years to make the same progress for the hundreds of thousands of people who are suffering from dementia now. The Government really must press on.

There are many people out there who want to help us. Just this week, the Daily Mail featured a long article about the possible benefits of coconut oil and the work done on that at Oxford. I have no idea whether that is likely to help people. It has helped some families, but we can see from that the absolute desperation people have to try to find something that can help the life of their loved one. Research is thus a huge challenge, as is help in the community.

I want to express some concerns about where we are at the moment. It is a time of great change in the health service. We are moving from primary care trusts to clinical commissioning groups, and it could be a time of instability. I am worried about the expertise—or lack of it—in the clinical commissioning groups when it comes to commissioning for something as complex as dementia. I want every CCG to have a lead for dementia, developing expertise and knowledge so that they know how to get the best from the money available. I would like to hear the Minister say that he wants to see a dementia lead in every CCG.

My final point is about the resources available to us. Over the last three years, my local authority has faced cuts of £876,000—30% of the adult social care budget. I know the Government will say that they have put £1 billion back in and that £1 billion has been lost, but when the budget is not ring-fenced, it can easily get spent on other issues. It is virtually impossible for councils to meet their targets without looking at the adult social care budget, which is 40% of their overall expenditure. That is why we can see day centres closing. They are an essential support network, providing a lifeline for carers, yet they are being cut. I am very worried indeed—not just about local authority cuts, but about buddying services provided by Age Concern. These voluntary and third-sector groups, so essential to people, are now quite fragile.

I am sure that the future funding of social care is going to be discussed. I make a plea: please may we have the cap at a level that helps the majority of families that need to be helped? If it is set at £75,000, I will be worried that those who really need the help will not receive it.

I think we are now at a point where progress can be made of the kind that has probably not been made for years. I really hope that we can press forward on a cross-party basis. We need a long-term settlement so that we can support people at what is probably the most difficult and frightening time of their lives.

I remember what it felt like to discover that my mum had dementia and that her future would be so different from the one that her and my dad planned together. We have been lucky in that we have been able to speak up and get help and support from the fantastic caring people at the Poppy centre, but it is hard for many people who might not have a strong voice or someone to advocate on their behalf. My mum instilled in me that sense of justice and fairness, which has driven me throughout my political life. I know that she would want me to continue to fight for all those who often find themselves bewildered and powerless, and to make sure that they are treated with care and dignity. We owe them all nothing less.

Care and Support

Alison McGovern Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. I know how important the work of Crossroads Care is in my constituency and others. The “Caring for our future” engagement over a number of months was a major contributory process to the White Paper. I believe we have accurately reflected in the White Paper the priorities set out then. This is not the end of the process. We have important and positive messages to take forward, and further work to do, not least on funding. I hope we can do that equally in close co-operation with the Care and Support Alliance and its members.

[Alison McGovern (Wirral South) (Lab)]

Given the scale of the care crisis in Wirral, I have listened to my constituents at a number of public meetings. They tell me that their priority is for loved ones to live at home with dignity, but local authority cuts make that harder, and—I am sorry—the NHS reorganisation is just a distraction. Contracting by the minute, which the Secretary of State mentioned, is far from the only problem. How will he tackle other problems in the care industry, such as older people being disrespectfully told what time to go to bed and get up?

NHS Care of Older People

Alison McGovern Excerpts

Thursday 27th October 2011 Westminster Hall

[Alison McGovern (Wirral South) (Lab)]

The hon. Lady’s final point before she reached her conclusions and recommendations made some quite clear criticisms of the values in society. Will she add to that list how she would like the values in society to improve?

[Margot James]

I welcome that intervention because whenever one is preparing for a debate such as this, one is conscious of how much more there is to say than one has time for. I was not intending to draw too many conclusions on what needs to change in society. I was concentrating on what needs to change in the domain that we are discussing, but perhaps the hon. Lady would care to call for a debate on the topic to which she has referred. I am sure that we could fill an afternoon with such a discussion and I should be delighted to take part.

[Margot James]

I thank my hon. Friend. That is a very good point. The integration of health and social care should, with the weight of joint commissioning behind it, make quite a difference. My speech has concentrated on care in hospitals, but I hope that other hon. Members will bring out issues to do with care at home and other aspects of what the NHS delivers.

I shall go through my list of recommendations briefly. On nutrition, the Age UK report, “Still Hungry to Be Heard”, advocated that ward staff needed to be “food-aware”. Training should include nutrition and the importance of assistance with meals when needed. I agree with these recommendations. Older people should be assessed for signs of malnourishment on admission, during their stay and on discharge. Hospitals should introduce protected mealtimes. Where they are using a red tray system, which involves a red tray being given to patients who require assistance with eating, staff should be trained in how to use it. It sounds as though that system works well where it is used properly.

[Alison McGovern]

I thank the hon. Lady for her generosity in giving way to me again. Does she question, as I do, the red tray system, in that if nurses and nursing staff understand the needs of a person, surely they should understand what their nutritional assistance needs are without the use of a red tray? Surely they should know patients well enough already. Is that not a question that we should ask?

[Margot James]

I thank the hon. Lady for her excellent point. In an ideal world, I would strongly agree with her. I agree that what she has suggested is to be desired. The trouble with relying on that is that the throughput of patients through wards these days is quite fast, the rostering system for nurses is very complicated and the continuity of care is certainly not as good as it used to be. Many nurses work intensively for a week and then have a substantial amount of time not working. Therefore the personal relationship, which is so desirable, has been compromised to the extent that we can no longer rely on it to ensure that patients’ nutritional needs are met. That is why I believe that the red tray system is useful. However, I am very concerned that people could easily think, “Oh well, that sorts the problem out,” and not feel that they need to relate to the patient in the way that the hon. Lady suggests.

I come now to accountability. I realise that this is not something that the Government can mandate, but chief executives should come on to the wards regularly—every day that they are in work. Nurses used to be accountable to a matron, who would turn up unannounced to check on standards. We must replicate that discipline again, and I recommend starting at the top.

Managers need to ensure that budgets are used wisely to support front-line staff and that front-line staff are not distracted by other, non-patient-care “priorities”. I looked at nurse blogs when I was preparing my speech and I sympathised with one nurse who said that nurses are

“at the beck and call of so many departments who wish to give work away and have no qualms in ‘getting the nurses to do it’. Loan stores, training, HR, to mention a few who seem to have forgotten that their role is to support us—not the other way around.”

I have sympathy with busy nurses who are pulled in all directions.

--- Later in debate ---

[Alison McGovern (Wirral South) (Lab)]

I congratulate the hon. Member for Stourbridge (Margot James) on securing the debate and thank the Backbench Business Committee for timetabling it. There are few issues that mean more to me or make me more angry than the poor treatment of older people, especially by our NHS. Therefore, it is highly important that we focus on that today.

I shall begin where other hon. Members might not have had time to go—by questioning our values. The hon. Member for Stourbridge listed societal problems as being one of the causes of indignity in hospitals and, when I intervened to ask her about that, she said that she did not have enough time to go into the subject. I hope I can assist her by taking us on that journey.

I am afraid that I shall start by disagreeing with the hon. Lady. I find it hard to believe that there is a lack of moral value or preference in society. Part of the problem is that those values are not made explicit often enough. We have talked much about dignity today. That word is often used, but rarely explored. I question and doubt the point made by the hon. Member for Truro and Falmouth (Sarah Newton) about older people being treated differently in other countries. If that is the case, it is incumbent upon us as politicians to make our values absolutely clear. In many ways, the national health service is, for Britain, an expression of our moral choices and preferences. Whether or not we talk about the NHS in those terms, that is what it is.

Let us begin by asking what we mean by “dignity.” It means inherently respecting the other person because of their humanity. In practice, that means demonstrating they are listened to, cared for and thought of, no matter who they are or what their personal circumstances are. Let me quote from the CQC report to give an example of what I mean and why it is so important that we make that absolutely explicit. In the report’s overview by Dame Jo Williams, she mentioned that they found cases where they believed that staff stripped patients of their dignity. She says:

“People were spoken over, and not spoken to…left without call bells, ignored for hours on end, or not given assistance to do the basics of life.”

When we talk about dignity, that is what we really mean. I find it hard to believe that we live in a Britain where most people would walk past, look the other way or not consider the needs of somebody who is extremely vulnerable and stripped of the basic necessities of life. The vast majority of people in our country would consider that situation to be utterly intolerable.

The question is: what is going on in the health service that leads us to see cases in our surgeries and examples among our families where people are bereft of their dignity? Given that we set such high moral value by the appropriate respect given to people because of their inherent dignity, what is going on in the health service that allows such a situation to occur? I accept other hon. Members’ points about the level of frequency and the commitment of staff by and large, and I was also most taken by the remarks of my hon. Friend the Member for Nottingham South (Lilian Greenwood), who is no longer in her place, about the best practice demonstrated to her. Given that we know what the right answer is, we need to consider what happens when there is a failure.

[Dr Coffey]

I strongly endorse what the hon. Lady is saying. What is even more extraordinary is how there are such different experiences within a single hospital. That is why local leadership is absolutely critical to getting this right.

[Alison McGovern]

I thank the hon. Lady, who spoke so well and so bravely earlier, for her intervention. I will come on to describe the differences within hospitals—a point at the heart of the debate.

Last year, the Wirral University Teaching Hospital Trust experienced some of the worst staff survey results in England. They were awful. The percentage of people who would recommend our local hospital to a member of their family was disturbingly low. I know I speak for other hon. Members in the area when I say that we are extremely concerned about this. The trust has a plan of action to try and put this right and there are many examples of the best quality of care being given to my constituents. However, some wards have been very poor. What we have observed locally relates exactly to the point raised by the hon. Member for Suffolk Coastal (Dr Coffey). Some wards are very good and some are extremely poor, and the CQC report also found that. Some of the places of most concern also had very good practice, so this is a problem.

We ought to ask the following questions about staff in the NHS, and I think that they should ask the same questions of themselves. The first question relates to the point that I started with: do they have the right values? Do they make the right moral choices? Do they have the right preferences? By and large, I think our answer would be yes. I do not believe that people in this country somehow just do not care—I think that that is wrong. The second question is: are NHS staff empowered to make choices in line with those values—the basic right to dignity and sense of humanity that we want them to? Are they empowered? Finally, in line with the points that have just been made, are they accountable if that does not happen? That is a crucial point.

The Front Line Care report is an important report written under the previous Government about the future of nursing. There is, perhaps, a missed opportunity. It covers, in detail, many of the questions that we have about nursing care. My mother was a nurse. Her line on nursing is that a nurse’s job is whatever the patient needs. That coheres entirely with both the Front Line Care report and the CQC report, which points out the problem alluded to by other hon. Members. Dame Jo Williams states that care seems to be:

“focusing on the unit of work, rather than the person who needs to be looked after.”

We need staff who are empowered to provide person-led care that looks at the needs of each person, and delivers for them what they need in the health service.

There is, of course, the question of targets. The Government have moved towards dropping some of the waiting list targets that were in place under the previous Government. Is this the kind of thing we can have targets for? I am not sure. However, I know that we know good quality when we see it. If the model of staffing for the dignified and respectful care of people is right, then that will drive up the quality of experience they receive. Leaving aside whether we have targets, quality of experience can definitely be monitored. There are some difficulties relating to monitoring older people, not least people who die in hospital. It can be very difficult to ask for feedback about the death of a loved one, but we need to find a way of asking. A good death is at the heart of what it means to be a dignified person. I encourage all hospitals to think carefully about how they ask for feedback from the relatives of a patient who has died. Even in the case of an older person with dementia, how do we get feedback on how the NHS has treated them?

As politicians, we need to back nursing staff and doctors. At the beginning of my speech, I tried to be very clear about the values that we espouse and I hope that they are shared across the Chamber. Those values give people absolute faith about what is expected. We can be clearer about the standards of care that we expect. I have concerns about systems, such as the red tray one, which rely on a tick-box culture, rather than saying, “Here is the standard that we expect people to live up to and it is your responsibility to do so”. How people in different wards meet those standards would be different, but they must meet them.

I would set the following test for the NHS. I believe in the NHS not merely through custom and practice, but as an article of my political faith. It is a fundamental expression of our values that everybody should be looked after if, through no fault of their own, they become unwell. Everybody should be taken care of. That means that if one person is not taken care of in the NHS—whether they are related to us, or nothing to do with us—in the way that we would expect for a member of our family, then that is not good enough. We should articulate that value. I hope—and know, in my case—that local leaders of hospitals share the belief that we should care for people in the NHS as though they were members of our family and give them the dignity to which they have an absolute moral right. We need to articulate those values and then make people empowered and accountable to living up to them in the NHS.

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I thank the Backbench Business Committee for allowing us to have the debate. In particular, I thank the hon. Member for Stourbridge (Margot James) for securing it. I also want to thank all other hon. Members who have spoken and given passionate, heartfelt and thoughtful contributions.

Hon. Members from all parts of the Chamber have spoken with one voice. It is completely unacceptable for any older person to receive the appalling standard of care that we have read about in the CQC report and in the ombudsman’s report. We have seen that appalling standard of care in our own constituencies. My hon. Friend the Member for Bolton West (Julie Hilling) has seen it in her own family. Although we may not have seen as poor a standard of care as she did, I am sure that many of us have been concerned about the care given to our own families. I would like to consider some potential causes of those poor standards of care, and talk about possible measures to tackle them and to ensure that every service matches the best standards.

It is important to look closely and carefully at this question and to avoid thinking that one issue, one group of staff or one set of problems is to blame. While there are some straightforward, practical steps that could be taken immediately, there will not be one simple quick fix that will solve the whole issue. There are deeper and more complex issues that are far harder to address. I will talk about five areas: staff levels and resources; staff training, which many hon. Members have spoken about; culture and leadership; the regulation of the NHS; and deeper issues that are very difficult to address.

Several hon. Members, particularly at the beginning of the debate, raised the issue of staffing levels and resources. If we talk to individual members of staff or organisations such as the Royal College of Nursing, they say that the issue is of concern. Staff to patient ratios were referred to by the hon. Member for Stourbridge and the hon. Member for St Ives (Andrew George). Peter Carter, who runs the RCN, gave me a stark example. The figures are rough and not perfect, but he said that paediatric and children’s wards have one nurse for every four patients, while in the wards that specialise in care for older people the ratio is around one nurse for every 10 patients. Elderly, dependent patients have different needs from sick young children, but in many ways they are just as challenging, so we need to look at that, particularly because, with an ageing population and some of the problems in social care, more sick elderly patients are ending up in hospitals, many with not only dementia but two or three other health problems. That co-morbidity issue will be important as we see hospitals with big financial challenges, which we will over the next couple of years.

On staff training, we often hear commentators or senior people in the NHS, frequently medics, who question whether moving nursing towards being a degree profession has been an entirely good thing. It is vital to get the right balance between academic and practical elements in nurse training. Degree courses have been around for many years—40, I think. As many hon. Members have said, we see differences between and even within hospitals that are using nurses with the same qualifications, often from the same universities, and some have their problems and some do not. We need to look at the balance, but we should not think that that is the entire cause of the problem. A lot is down to the culture created in wards, which I will say more about in a moment.

Concerns have been expressed by many hon. Members today, the media and NHS staff about health care assistants. Health care assistants in wards provide more and more of the care, some of which is intimate, such as feeding older people or helping those with continence problems, but it is a positive development. As other hon. Members have said, our staff have the right values, and that is partly about the training they get. I think the hon. Member for Stourbridge said that health care assistants do not get any training and are not regulated, but they do, or should, get training from their employer, the trusts. Such training can be patchy, and we need to look at that.

In 2003, I called for the regulation of health care assistants—as many people did, way before me—in a project I did called “The Future Healthcare Worker.” If nurses are to take on some of the more clinical roles, and health care assistants more care, we need to look at that issue. I had hoped for more progress on that under the previous Government. It would be interesting to hear from the Minister the current Government’s views on regulation. There are all sorts of issues around time and cost—for employers and individual staff—but it is something we need to look at.

Culture and leadership are woolly words, but in practice we know when we see good culture and good leadership. My hon. Friend the Member for Wirral South (Alison McGovern) made this point. What is it on the ward that matters above all? Yes, it is about how long it takes to be treated, whether operations are a success or whether medicine is taken on time, but it is also, crucially, about the experience of the patient, whether they and their families feel that they have been given enough information and the time to think about it. When the information is given can be important. We have all been in situations where the doctor has said something quite shocking and we were not prepared for it. What matters is the simple things such as whether the patients are covered up when they go to the toilet and cleaned effectively afterwards.

There are places where the patient’s experience is at the top of the agenda, not only of the individual ward but of the hospital as a whole. Simple and straightforward surveys, developed by organisations such as the Picker Institute, can help individual organisations and services to get that across.

Another thing about culture is a bit more tricky and concerns how we build a team and being open to questioning. In a team, staff should value each other’s different experiences. That might not be the case with some of the old-fashioned hierarchies in a hospital—doctor, nurse, care assistant—where they do not dare question one another. Teams need to value each other’s skills and experiences but also be open to questioning.

[Alison McGovern]

One of the best examples of quality of care that I have seen recently was in one of my local hospitals, when I was shown around a ward in part by the cleaner, because she was deemed to be so important to the good functioning of that ward.

[Liz Kendall]

That is absolutely right. It is not that everyone has the same skills and experience, but that all those different skills and experience are important. In a proper culture of learning, mistakes can be admitted, because we all want to learn from them to ensure that they do not happen again. We need to see not only the different health professionals as part of the team, but users and families too. Peter Carter of the RCN raised the issue of families being involved, and it was sad that all over the papers he was reported as saying, “Come in and care—it is up to you to care for members of your own family.” What we need, though, is for families to be part of the process, particularly if their relatives are elderly patients suffering from dementia. Family members know them best. We might not be able to hear what they are saying but their family will know how they react, and whether they like or dislike something.

Such a culture and such leadership need to be in evidence not only on the ward, but on the board—a point made by the hon. Member for Stourbridge. As the boss, the board should want to know what is happening on the ward and its members should be getting the surveys and patient feedback. As with Members of Parliament, hopefully, what they will most want to know is what individual constituents think of them. Accountability is vital, from the top down. Also, in particular for old people who might not have family members nearby, the idea of volunteers who can be advocates and part of the process is important.

On regulation and the Care Quality Commission, I am concerned about the issue. More could be done immediately. The CQC has an important role to play, but I want to be clear that responsibility for the quality of services lies with the providers and not with the regulator. However, people want to have confidence that, if the CQC says that somewhere is okay, it is okay and, if it is not okay, that the CQC will go back and ensure that it is sorted out. I am concerned that, almost six months after the initial inspections, the CQC has not been back to a third of the hospitals it said in its report were failing to respect and involve older people, and it has not been back to two thirds of the hospitals that were failing to meet nutritional needs. I have written to the CQC, which has not written back, but it said on the phone that it had received written reassurances. That is not good enough. It should be going back to those hospitals. I am keen to hear from the Minister whether he could take action to ensure that we know which hospitals have not had a follow-up and what the timetable for action is.

There are clear national guidelines for people who work for public bodies such as the council or the NHS. There are guidelines on raising the alert and referring a person immediately—within one day—if it is thought that they are vulnerable or at risk of neglect or abuse. I have asked the CQC whether it referred people, or whether it required the hospitals to do that. If someone has seen children at risk of neglect or abuse, action would need to be taken or they could face the legal consequences. I am concerned about that matter.

I have spoken longer than I intended. I want to finish by addressing what I call “deeper issues”: our model of health care, the nature of medicine and the way we as a society treat older people. When our NHS was established, our population had very different health problems. People needed episodes of care for acute conditions that could be treated and increasingly cured. Our health services were based on the model of individual district general hospitals. However, we have health problems now that are related to people living longer with long-term and chronic conditions. Improving health is no longer solely about needing episodes of acute care that seek to cure people. It is about increasingly helping people to manage their long-term health problem, and, when they are very old or suffering from dementia, helping them to live to the end of their days as comfortably as possible.

Our model of health care has not kept pace with changing needs. One third of hospital admissions are for people over 65, but, because on average they stay in hospital twice as long, two thirds of hospital beds have an older person in them. Hospitals are not the place to care for older people, but hospitals are where we care for them. We must change that situation, which means shifting services out of hospitals and into the community. We need to focus more on prevention and joining up with social care.

There is a big challenge for medicine. We have talked a lot about nurses, but not about doctors’ mentality. They are trained to cure. There is a big challenge for doctors as well as nurses as our health needs change. In too many places, doctors are still at the top of the hierarchy. They are the ones who help to determine the shape of care. It is important to look at their changing role, too.

I want to talk about how we as a society treat older people. I hope we will have a proper debate about that one day. I want to say two things. First—I think other hon. Members have mentioned this—we are not used to seeing people get so old. It is quite a recent thing to see people living for such a long time, often in pain, and it is very painful for families, particularly if they see people whom they love suffering with dementia. Society shuts older people away too often. We say, “You’re just getting old” or we prefer that they are not seen and not heard. In other countries, it is not like that. Older people feel more part of the community and they are perhaps more visible than in this country. I can give a simple example. Care homes in Spain do not have opening hours—they are simply open—and people see them as part of the community.

The issue is about how our services cope with an ageing population and how we treat older people. If someone is very old and slowly dying, including from something such as dementia, which is awful to see, we need to find a new way to deal with that.

Care (Older People)

Alison McGovern Excerpts

Tuesday 6th September 2011 Westminster Hall

[Alison McGovern (Wirral South) (Lab)]

I congratulate all hon. Members who have spoken so far, especially the hon. Member for Chatham and Aylesford (Tracey Crouch). I feel sure that her grandmother would be incredibly proud of her today. Her contribution was important and she made many points that I wholeheartedly support.

I want to follow on from the comments of the hon. Member for Newton Abbot (Anne Marie Morris), who articulated part of the problem very well. Although we have focused on Dilnot, the review and funding, I argue alongside her that we cannot talk about money without talking about what people get for that money. What people are prepared to pay surely depends on the quality of care that they are going to get.

[Rehman Chishti]

The hon. Lady makes a point about resources. A crucial issue linked to resources is that of the principle and presumption of early intervention and prevention in improving the quality of care for the elderly.

[Alison McGovern]

I agree. In a moment, I will talk about some of the problems that local authorities are currently facing. They have had bigger cuts than any part of Government in Whitehall. Although I wholeheartedly agree with what the hon. Gentleman said, it is a challenge to all of us to support local authorities in that prevention role.

The hon. Member for Newton Abbot rightly made the point that quality matters above all else. Some of the examples given by her and others were compelling in terms of the moral requirement on us all to stand up for the dignity of older people. I firmly believe that, when we hear examples such as the one just given, we know what is happening is wrong. I have heard examples from my constituents: for example, older people are told that a “breakfast” visit to get them up can take place any time between 6 am and 11.30 am, regardless of their personal preference. That is not good enough and is an offence to somebody who prior to needing care was independent and perfectly capable of looking after themselves. We all know that instinctively.

The question is: how do we get from where we are to where we would like to be? I want briefly to make two points on the subject. First, I shall mention enforcement and some of the professional development issues. Leading on from that, I shall talk about the market for care provision and why there is an interesting and difficult problem that the Government will have to tackle regarding the market for providing care. I agree with many of the points made by the hon. Member for Newton Abbot about some of the anomalies surrounding enforcement. I repeat that local authorities are having to struggle with the fact that, if they were a Government Department, they would be experiencing the biggest cuts in Whitehall. That makes the job of having responsibility for the care of older people, which is a fixed cost, very difficult.

[Margot James]

Does the hon. Lady agree that, when we consider expenditure, part of the problem is that, over the past 10 years, the increase in local authority budgets for adult and social care has been minimal compared with the increase in many other local authority budgets, particularly that for children and younger people’s services, to name but one? With adult and social care, we are starting from a base that is already very low, which is one of the problems and is why local authorities are struggling so much.

--- Later in debate ---

[Alison McGovern]

I do not know the statistics on that, so I am hesitant to comment. If the hon. Lady says that that is the situation, of course, I believe her. However, I do not know off the top of my head whether that is the case comparatively. I will make some comparisons with children’s services because there are some interesting parallels. If, as she mentions, the budget for children’s services has increased, I can only think that that is a good thing given the importance of child protection and youth services. I live in hope that we can move towards having better funding for older people’s services in the near future.

I return to the point I was making on enforcement. We have all had cases—since I was elected, I have had many cases—of people coming to surgeries who feel that the care provided is not sufficient. There must be a clear, easy process to follow for relatives or those concerned about a poor standard of care. At the moment, the system is confused. I will not repeat what has already been said, but that is my conclusion. If someone feels that the quality of care they have received is poor, the process they have to go through is not easy.

Some of the issues raised by constituents at my surgery have stemmed from the absence of professional development for those providing care. I have seen extremely good quality examples of both residential accommodation for older people and care provided in people’s homes but, by and large, the work force who provide that care are underpaid and neglected. It has to be said that that work force are mainly women who often have not received much workplace training over many years and are some of the lowest paid people in our society. Frankly, it does not do much for the dignity of older people that the job of looking after them is one of the lowest paid and least respected in our society. It is about time that we put that right. We should make it clear that looking after older people and protecting the dignity of our society is an important job. We ought to pay those people a decent wage and give them the training and support that they deserve.

The example of e-monitoring has been mentioned. In my surgery, I have been given examples of that. People are given time to look after people but not enough time to travel between appointments, and they are for ever catching up after themselves. By and large, the whole system is set up to make a profit for the company concerned, rather than to think first about the quality of service for the person receiving care.

[Mrs Anne Main in the Chair]

On the profit issue, I am not an unreconstructed left-winger. [Interruption.] To the chagrin of some, I am not one who thinks that the profit motive has no place at all in public services. However, there is a structural issue here. We have a large amount of competition for the provision of care. Price competition, in an industry where greater profit cannot be extracted through the use of technology—this is a person-to-person service with a one-to-one relationship with the person, so we cannot invest in technology to make more profit—means that wages are the only expenditure that can be driven down. In an environment where the work of care is seen as low, wages have been driven down. There has to be a response from the Government on the structure of the industry, which effectively means that wages have been pushed down lower and lower, and people’s skills and time are not being invested in.

I draw an analogy with the child care industry. In the 1980s and early 1990s we had a similar situation. Frankly, those involved in child care were seen as the lowest of the low and were paid as little as humanly possible to look after children. Those days are over now. By and large, those who look after children are now paid a bit better and are likely to have qualifications. Can we not set ourselves the challenge of better wages and a better skill level for those working in care for older people? That would meet the aspirations of the hon. Members who have spoken so far and would do a great deal to improve the quality of care. That would help us to deal with some of the funding issues. People would feel that what they paid for was worth having and worth investing in. Hopefully, it would also meet the challenge set to me earlier and ensure that the case is made to local authorities to pay for quality.

In conclusion, I agree with the comments that have been made so far. There has to be attention to quality and to standards, and an ability to uphold those standards. There is a problem, however, in the market for care that is forcing a driving down of the quality, and it could be dealt with.

--- Later in debate ---

[Gareth Johnson (Dartford) (Con)]

I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing the debate. She feels passionately about the subject and made a robust and fair-minded speech.

Care and services for older people are of increasing importance, and I agree with the sentiments already expressed about how we must deal with the issue sooner rather than later. It is a growing mushroom that must be dealt with fairly soon because the population in this country is getting older, which is placing strains on our systems. That is a good and positive thing—too often we hear about longevity in a negative way, but it is a marvellous tribute to medical science that we have people living longer than they previously did—but greater reliance is placed on our care home provision and local authorities have to adapt to the changes in pressure placed on them as a consequence. I have disagreed publicly with my local authority, Kent county council, on decisions it has made about care home provision in my constituency of Dartford.

I accept that the future lies in a public-private partnership in care provision throughout the country. The Government face a dilemma: they cannot afford indefinite free care home provision and they do not want to penalise those who have saved for their retirement. Free care home provision for all without tax rises is completely unaffordable—I agree with my hon. Friend the Member for Banbury (Tony Baldry) about that. Such rises, especially in the current climate, would have a huge negative impact on the finances of this country. Equally, we should not be punishing prudence and forcing the elderly to sell their homes to pay for care. Prudence should be rewarded by the state, not punished.

Health and safety legislation has often added to the cost of care provision. The apparent necessity for all rooms in a care home to have en suite facilities was used as part of a reason to close care homes in my constituency, yet residents in those care homes would say that what they want is their home preserved and not the health and safety considerations met. I recently visited Emily Court care home in Wilmington in my constituency. The residents echoed the sentiments I have heard in every care home I have ever gone to: they like the facilities, but what is most important to them is that it is their home. That drives the affinity they have for the place.

What has staggered me since the upheaval in my area with the closure of care homes is how easy it is in this country to close them. I find it incredible that no real security of tenure exists for residents in a care home. Travellers have some rights over land they settle on—that is obviously an argument for a different time—and squatters have rights over empty properties that they occupy, yet residents in care homes can be moved almost on a whim. That might need further investigation, because the consultation exercises before any care home closes concentrate a bit too much on the bricks and mortar involved and not enough on the people.

[Alison McGovern]

The hon. Gentleman says what a bugbear health and safety legislation was and then mentioned the lack of security of tenure for residents. I find it difficult to know whether he thinks we need more or less regulation, legislation or sub-legislative guidance. What mechanism does he think is best to improve some of the standards?

[Gareth Johnson]

The two issues are separate. When Southern Cross went bankrupt, for example, it blamed in part the increase in health and safety legislation, some of which was sensible and some completely unnecessary. Ensuring that people who reside at care homes have some rights over the land that they are living on is a separate matter. I do not see that as placing increased burdens on those running the care homes; it simply gives the individual residents the same rights that we would have if we leased a flat. Those living in residential care homes, who are perhaps among the most vulnerable in society, should surely have that extra protection. The challenge for the Government is to find a solution that is both affordable and fair—affordable, so that the Government can cope with the ageing population and the increasing demand on care homes, and fair, so that the elderly are not forced to sell their homes and lose out because of their earlier, sensible financial decisions.

Southern Cross Care Homes

Alison McGovern Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I believe that the hon. Gentleman has been in the House for a considerable time. He will know that the secret that he appears to be sharing with the House, and with others who are following our proceedings, is not something totally new. He knows that care homes close already, and he knows that, as a consequence, people do face such terrible circumstances. That is why the Government, working with ADASS, have ensured that the necessary arrangements and good practice advice are in place, which is something that his party did not do.

[Alison McGovern (Wirral South) (Lab)]

Residents of Bebington and the rest of the Wirral are extremely concerned about the Southern Cross experience. Will the Minister say more about the specific lessons that we need to learn from it, given the Prime Minister’s announcement yesterday about the wider opening up of public service delivery?

[Paul Burstow]

As I said to my hon. Friend the Member for St Ives (Andrew George), 77% of adult social care is already in the private sector, and as we said in “A vision for adult social care”, we want a more vibrant, diverse market which includes voluntary sector providers. We want to examine the role of regulation, to ensure that it assists with the management of that market and, fundamentally, to ensure that it protects the rights and best interests of those who use these services.

Reform of Social Care

Alison McGovern Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend for his question. This is very much about ensuring that, at the same time as engaging on the palliative care report, we build pilots that will enable us to see how the proposals would work in a number of places across the country. I know that some areas of the country are ready and willing to do that. The essence of what we are doing is to be increasingly clear about what quality services for those at the end of their lives look like, and to be sure that we can integrate those services by developing a system of per-patient funding. That would enable the providers to work together within the funding framework, without the current constraints and demarcations, and without the silo system that currently divides palliative care and end-of-life care services in a way that makes the system immensely confusing and difficult for people at the end of their lives. This is a real opportunity that has been fashioned by Tom Hughes-Hallett and Alan Craft’s report.

[Alison McGovern (Wirral South) (Lab)]

Funding for care is clearly a hugely important issue, but so is the quality of the care that older people receive. The parliamentary ombudsman and even the Financial Times have reported the need for greater respect and dignity for those receiving care. When will the Secretary of State return to the House and inform us in detail of the standards of care that older people can expect?

[Mr Lansley]

The hon. Lady will know that we are continuously seeking to improve the standards of care that older people receive, and, in so doing, we sometimes have to tackle what are clearly serious abuses. In the wake of the Winterbourne View events, for example, we will bring forward a report to Parliament on standards and the means by which they are to be met. With regard to hospital care, it was I who asked the Care Quality Commission to undertake specific unannounced nurse-led inspections to look at dignity and nutrition. We will work continuously to ensure that we deliver the standards of care that people have a right to expect.

NHS Future Forum

Alison McGovern Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I understand the point that my hon. Friend is making. We need—not least in a further emphasis on safety and some of the other measures that we as a Government, including my colleagues at the Ministry of Justice, have said we would bring forward—to try to offset a rising tide of litigation and cost associated with clinical negligence cases in the NHS. My hon. Friend is kind to me about working hard. I never imagined I would not do so, but if I have worked hard over the past eight weeks, it is nothing compared to the leaders of the NHS Future Forum who, in the space of just eight weeks, produced excellent work which will be of enduring significance.

[Alison McGovern (Wirral South) (Lab)]

Last year, the NHS in Wirral tried to respond quickly to the Secretary of State’s top-down reorganisation and has since spent months in uncertainty and stress. Will the Secretary of State apologise now to staff and patients on the Wirral for all the unnecessary problems he has caused them and all the money he has wasted?

[Mr Lansley]

I met many of the previous practice-based commissioning groups in the Wirral and south Merseyside, who came together to tell me how enthusiastic they were about the possibilities for designing clinical services more effectively in future. They are doing that. They want to get on with it and the Future Forum is right: we need to give them the opportunity to get on with that now.