Care Services: Older People

Debate between Earl Howe and Baroness Neuberger

Wednesday 22nd June 2011 Lords Chamber

[Baroness Neuberger]

To ask Her Majesty’s Government, in the light of the Equality and Human Rights Commission’s interim report on the care of older people in their own homes, what plans they have to ensure appropriate care that respects dignity.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, dignity and respect are the cornerstones of good quality care. The Government have made the Care Quality Commission responsible for assuring quality of care. It is the responsibility of local authorities to specify and commission care and providers to deliver it. The Government’s planned reforms for health and social care, with an emphasis on better commissioning, should increase our ability to drive up standards in services and result in improvements in quality of care.

[Baroness Neuberger]

My Lords, I thank my noble friend the Minister for his reply. However, is he aware that a large proportion of the responses to the interim report from the Equality and Human Rights Commission have come from the care workers themselves who feel that in present circumstances they are simply unable to provide care that provides dignity to the older people in their care? Can he assure this House that in those reforms that are going forward, measures will be taken to make sure that local authorities must commission services that allow real dignity, which probably means rather longer passages of care for the people concerned?

[Earl Howe]

My noble friend makes some extremely important points and I agree with the thrust of them. As she said, these are interim findings. We all look forward to the finished report later in the year, which will no doubt contain deeper analysis than we have had access to so far. There can be no place for poor quality care in care services. We should all welcome an inquiry of this kind because it clearly will expose poor practice and will point the way towards some clear messages that we must bear in mind in the context of the Health and Social Care Bill. In that context, we are seeking to achieve much more joined-up commissioning so that we have health and social care working together towards quality outcomes.

Baroness Greengross: My Lords, does the Minister agree that a reprioritising of funding towards the care of people in their own homes is essential? Would he also agree that in training both commissioners and care workers a human rights approach is a very useful tool when caring for vulnerable older and disabled people in their own homes? I declare an interest as a commissioner on the Equality and Human Rights Commission.

Earl Howe: I certainly agree with the noble Baroness that being looked after in one’s own home is the preferred option for most elderly people. That is where we have to focus our attention and, over time, increasingly our resources to deliver good quality care in that context. She makes a very good point about training. Regarding the essential qualities of a good care worker, you cannot train anyone in a kind and compassionate attitude, which is probably the foremost requirement for anyone in that field. I take her point about human rights. My department is already speaking to the Equality and Human Rights Commission and has entered into a voluntary agreement with it to help us embed equality right across health and social care and to enable the commission and stakeholders to evaluate the progress we have made.

Baroness Wheeler: My Lords, I, too, welcome the work being undertaken by the EHRC on this vital issue. We know that there are substantial problems with commissioning and standards of care delivery. For example, many local agency contracts do not provide staff with travelling time between visits, which greatly adds to the pressures on them. Stories of older people even being catheterised to avoid the costs of an extra visit are not unheard of. However, as a carer, I stress that in my own locality, care agency arrangements work very well, to a high standard and as part of an integrated care package. How will the Minister ensure that future commissioning makes this experience the norm, bearing in mind that 81 per cent of publicly funded home care today is provided by the independent sector?

Earl Howe: The noble Baroness again makes some extremely good points. At the moment we have an architecture that, first, should ensure that basic standards of quality are maintained. We have that through the Care Quality Commission, whose job it is to register domiciliary care agencies and to ensure that they have systems in place to quality-assure themselves. That must be the starting point: agencies must make sure that they are delivering the service for which they have been commissioned. Secondly, it is also a matter of ensuring that we have visibility where problems arise and that service users are encouraged to believe that they can speak up for themselves, that whistleblowing is possible, and that anyone else who observes poor quality care should feel free to speak up and to know whom to tell when they see bad care happening.

Baroness Campbell of Surbiton: My Lords, over four-fifths of local authority-funded home care is delivered by the private and voluntary sectors. In light of this, will the Government use the opportunity of the current Health and Social Care Bill to clarify that private and voluntary sector agencies providing home care services on behalf of local authorities are performing public functions under the Human Rights Act?

Earl Howe: I am sure that the noble Baroness, with her experience, can tell me a lot of what I do not know about what is built into the contracts that local authorities take out with private, independent and voluntary sector organisations. I would be surprised if the human rights obligations she refers to are not built into those contracts. It is clear that everyone has a basic human right to be treated properly wherever type of care is being delivered. The key here is to ensure that service users are aware of their rights. As I said earlier, my department is extremely keen to embed equalities and human rights in everything that it is responsible for.

Baroness Jolly: My Lords, will the Minister tell the House what proportion of domiciliary care providers are owned by private equity companies?

Earl Howe: I am afraid that I do not have that figure in my brief. I am not sure whether my department will either but if I can find it out I will let her know, gladly.