Care Homes (Regulation)

Baroness Keeley Excerpts

Wednesday 4th November 2015 Westminster Hall

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

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

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

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

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

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

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

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

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

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

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