Older Persons: Human Rights and Care

Baroness Cavendish of Little Venice Excerpts

Thursday 16th November 2017 Lords Chamber

[Baroness Cavendish of Little Venice (Non-Afl)]

My Lords, I thank the noble Lord, Lord Foulkes, for securing this very important debate with its enormous number of issues.

I do not feel I can follow that powerful argument by the noble Lord, Lord Lipsey, without addressing it, because he has an enormously important point to make. I shall make one suggestion, which I was going to make anyway, because this issue of intergenerational equity, and the triple lock that was referred to earlier, is becoming increasingly toxic in our political life and is dividing the generations. One way through it would be to look in the round at all the benefits that go to the over-65s. We need to take the pensions, the bus passes, the personal independence payments, the care allowances—a huge number of benefits go to certain people in that age group—and set them against the increasing lifetime costs that those people face, especially the group who develop multiple chronic illnesses quite early. I suspect that many of the 1.9 million that the noble Lord, Lord Lipsey, referred to may be in that category. They develop those illnesses at quite an early stage, they find it difficult to continue to work and they are stuck in what I agree is a completely different group. I just wanted to make that point.

I sat on the board of the Care Quality Commission for two years between 2013 and 2015. I assure the noble Lord, Lord Foulkes, that we inspected care homes, though perhaps not regularly enough. As other noble Lords have mentioned, the CQC has uncovered some absolutely terrible and shocking cases of abuse. That does not mean it is perfect, but at least there is now a mechanism. I was also the author of the independent review into the 1.3 million unregistered workers in health and social care. As the noble Lord, Lord Balfe, said, they are, on the whole, deserving of our respect. One thing I was trying to do in the report was raise their status and recognise what they do. This is far too often still referred to as “unskilled”, but is actually deeply, deeply skilled and requires enormous maturity. I am glad to say that the Government have implemented some of my recommendations on training and the care certificate. I encourage them to keep moving forward on the idea of there eventually being one workforce across health and social care.

Some excellent examples of progress are now being made, particularly in Manchester, in pooling budgets and services for the over-65s. One of the missing pieces, however, will be that single workforce, with a common skill set and training. Partly as a result of the multiple chronic illnesses I referred to earlier, there is now a blurring of the lines between the jobs of healthcare assistant, district nurse and domiciliary care worker. It is increasingly difficult for people in the domiciliary care space who are going into homes where medical needs are quite acute. I would encourage more work to be done on developing that sort of joint training. We might perhaps consider including in this some of the relatives and volunteers who do so much of the caring work. They might benefit from some of that basic training and gaining that status.

I have two more points to make, the first about continuity of care. This has not been mentioned and is often overlooked. It is particularly important for frail elderly people, whether they are in a hospital ward or at home. The constant turnover of people in home care is obviously a difficulty for the sector, which is partly to do with money. However, in hospitals a bit more work and consideration need to be given to nursing shifts where, for some unknown reason, the same people reappear in a different part of the hospital for their next shift. That would make a substantial difference to a lot of very confused elderly people who are disoriented and some of whom have dementia.

Lastly, I entirely agree with some of what was in the report about negative stereotypes. There has been a lot of research in the US showing that negative stereotypes about older people being a burden influence enormously the way they feel about themselves and actually accelerate the process of ageing. Those of us in the media need to take more responsibility for the way we sometimes describe people without thinking. This is not malicious—it is just the way people talk in society—but the more that those in this House can do to challenge specific examples of it, the better off we will all be.