Cities and Local Government Devolution Bill [Lords]
Peter Heaton-Jones Excerpts(10 years, 2 months ago)
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Mr Speaker
Order. The right hon. Member for New Forest East (Dr Lewis) has for some minutes now been poised rather like a sprinter, but he suffers from one disadvantage relative to the hon. Member for North Devon (Peter Heaton-Jones), whose constituency houses Exmoor, namely that the right hon. Gentleman beetled into the Chamber a little after the hon. Gentleman. We will reserve the right hon. Gentleman as a specialist delicacy and reach him in due course.
Peter Heaton-Jones
Thank you, Mr Speaker, and I have never felt disadvantaged by my right hon. Friend the Member for New Forest East (Dr Lewis).
As you correctly point out, Mr Speaker, one third of Exmoor national park is in North Devon, and a beautiful part of the world it is. Before I go on with my prepared remarks, which I admit are pretty much a verbal tourist brochure, let me say that I do not recognise a lot of what was said from the Opposition Front Bench about the new clause, particularly the comments about its being slipped in and about insufficient time being given to speak to national park authorities. I, in common with all my hon. Friends, I am sure, had no notice at all. I was first alerted to the wording of the new clause on Thursday afternoon, and since then I have had time to have a detailed email correspondence with the chairman of Exmoor national park, Councillor Andrea Davis, my office has spoken at great length to managers at National Parks UK and two hours ago I came off the phone from a lengthy conversation with the chief executive of Exmoor national park, Dr Nigel Stone. If I can do that, I am sure that with all the voluminous resources available to them, those on the Opposition Front Bench should surely have been able to make some cursory inquiries about what the new clause is all about. It appears that they failed to do so.
Having spoken to those people, I can say that it is the national park authorities and managers who want this to happen. Opposition Members do those national park managers a great disservice by alleging some of the things that they are. They imply that in asking for the new clause those managers will in some way use the powers for nefarious purposes. Nothing could be further from the truth. Opposition Members need to be careful about what they are alleging because in my experience national park managers have nothing but the best intentions for managing our national parks, particularly in Exmoor.
That leads me on to extolling the virtues of Exmoor and why new clause 7, in particular, will be so valuable. One third of the national park is in my constituency and it includes the beautiful, rugged coastline that not only provides opportunities for many leisure activities but is very important for our environment and ecosystem. In the conversations I have had with them, the chairman and chief executive of Exmoor national park have been absolutely adamant that Exmoor in particular would benefit from the measures included in the new clause. Let me give some specific examples of why they believe that it would be beneficial and why they welcome it.
First, there is great pressure on the provision of housing for local communities in Exmoor and other areas of North Devon. Until now, national park authority managers have been hamstrung in the conversations they have been able to have with developers to ensure arrangements for local, affordable housing. Nevertheless, the new clause is not a carte blanche to say that all development will be allowed, and, as the Minister rightly said, nothing in it will allow that to happen.
Care Homes (Regulation)
Peter Heaton-Jones Excerpts(10 years, 3 months ago)
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Peter Heaton-Jones (North Devon) (Con)
I beg to move,
That this House has considered regulation of care homes.
It is a pleasure to serve under your chairmanship this afternoon, Ms Vaz. The purpose of today’s debate is to highlight what I believe to be serious shortfalls in the current system for the regulation, inspection and investigation of private care homes and nursing homes. At the moment, I believe, quite simply, that we are letting people down—the people who are least able to speak up for themselves. They are the estimated 300,000 older people who currently live in around 17,000 registered care homes in England. Their average age is 85 and a significant proportion suffer from dementia. They are people largely without a voice and that, I believe, needs to change.
Two and a half years ago, some time before being elected to this place, I was contacted by a constituent in North Devon. He told me the very moving story of his mother, a former resident at a private care home, who had died in 2009. Her son believed then, and still believes to this day, that there are serious questions about the care that she received in the final months and weeks of her life.
In the following years, my constituent has pursued all the avenues open to him to have his mother’s case fully investigated. Invariably, though, he hit a brick wall, so he began to look beyond his individual case at the more general question of how care homes are regulated and complaints investigated. He came to the conclusion that the current system is simply not fit for purpose. It is a conclusion that I share, which is why I sought today’s debate.
Let me stress that this debate is not about my constituent’s individual, specific case. I do not seek to reopen it nor to raise any questions about the standard of care in that establishment today, six years on. Indeed, last night, I spoke to a senior director at the home’s parent company to give her that assurance, which she accepted. However, my constituent’s individual case is the starting point. That is how it must be, because at the heart of this issue are people, and we must always remember that when we talk about systems, institutions and processes. It is the people who matter, and at the moment, I believe that we are letting them down.
To seek evidence for that, we have to look no further than the website of the Care Quality Commission, the body that currently has responsibility for the regulation and inspection of care homes. Today, that website tells us that of the 700 care homes most recently inspected by the CQC, a staggering 44% have been rated as either “Requires improvement” or “Inadequate”. There is no reason to believe that those figures are unrepresentative of the sector as a whole, so that means that four in 10 of all establishments are not currently reaching the required standard. Surely the purpose of any system of inspection and regulation must be to drive up standards. Those figures alone, therefore, suggest that currently the system is simply not working.
Let us look at that system, because it has undergone some significant changes in the recent past, and indeed it still is undergoing change, even as we speak today. It seems to be a process, however, that in its fluidity is encountering considerable difficulty. We are in a flexible mode, I think it is fair to say, as far as the CQC’s arrangements are concerned.
In June 2013, the CQC issued a consultation called “A new start”, which proposed a whole new approach to inspection across all sectors, including care homes. That approach was confirmed in October two years ago, and the new provider handbook for residential care came into effect from 9 October last year. In April this year, the CQC introduced a special measures regime, as it was called, for failing services. However, it is clear that there are problems in the implementation of some of those new processes.
The CQC’s most recent publication, which was published as recently as 28 October, is called “Building on strong foundations”—I have a copy here, hot off the press. It sets out
“some of the choices it faces in responding to changes to how health and social care is delivered”.
Well, it must face some pretty tough choices, because it is pretty clear that what it seeks to do in changing its processes is not fully working.
Let me quote an article from The Guardian, which I admit is not one of my usual media choices. The columnist, Michele Hanson, wrote on 28 September this year:
“Do you fancy being a CQC inspector? You can. Anyone can. You don’t have to be a social care expert, just have a six-week induction course. And luckily, once you start inspecting, you don’t have to inspect everything. You can just inspect a couple of the Key Lines of Enquiry (KLOE), because they’re not all mandatory.”
The article goes on to say:
“You can leave out management of medication, or quality of life, or complaints, and you can inspect different KLOEs in different homes, which means you can’t compare”
what is good and what is not good. She concludes:
“Which is perhaps why our local care home, rated ‘excellent’ by CQC”
was exposed on the television a short time afterwards
“over the fearful abuse of one resident”.
Clearly, something is wrong with the system. What is the cause of that? It seems, as I said, that the CQC has encountered particular problems recruiting sufficient expert inspectors. In July this year, the National Audit Office found that just 9% of care homes have so far been assessed, because of a shortfall of 160 inspectors. Indeed, the February 2016 deadline to complete the work has now been pushed back to next October.
I have a great deal of respect for the many hard-working staff at care homes and at the CQC. Those at care homes in particular receive low wages for a job that I would never want to do. I also have some sympathy for the many care home providers who are having to cope with the ever-changing regulation regime. The goalposts are constantly moving, and it is costly for those care home providers to comply with the system. Care homes have to pay to be registered by the CQC, and, depending on how many residents they have, the cost can be anything from £276 to more than £13,000 a year. It is fairly obvious where those costs are going to be passed on to.
Let us make no mistake. In cases where something goes wrong, it is the care homes and the people who own and manage them who bear the ultimate responsibility for getting things right, but the regulatory framework that we—the state—impose has to help them, encourage them, and yes, force them to improve. At the moment, it does not.
Julian Knight (Solihull) (Con)
My hon. Friend is making a powerful case and is clearly a strong advocate for fairness and transparency in the care home sector. On whether providers are being managed in the right way by the CQC, is not the point that they have said to Department for Business, Innovation and Skills that they feel that they are being asked to provide paperwork and not care, and that there is sometimes duplication between the local authority and the CQC in how the sector is regulated?
Peter Heaton-Jones
My hon. Friend makes an extremely good point. This must be about the elderly people who are in the care homes. They must be the entire focus of those who work in, manage and own those care homes, not the bureaucracy and the paperwork.
Andrew Percy (Brigg and Goole) (Con)
I congratulate my hon. Friend on securing the debate, and it is a pleasure to serve under your chairmanship, Ms Vaz. You will remember that we looked at this issue in the Select Committee on Health in the last Session, as will the shadow Minister. We welcomed the new inspection regime, but I seem to remember that one criticism we had in discussions in the Committee related to the fact that we are dealing with often very elderly, very frail people who cannot speak for themselves, and one thing that the CQC could perhaps do better is engagement with families. That is not just after an inspection, when everything is all right. It needs to ensure that family members of those in care homes understand what the inspection regime is and how they can engage with it before, after and during the process. Although some of the changes have been positive and there is now perhaps better regulation in England, the people whom we ask to give feedback are often not able to speak for themselves, so we need to engage families much better.
Peter Heaton-Jones
My hon. Friend makes an extremely pertinent point, and I will talk about some challenges in the entire system when it comes to engaging with people. As he rightly says, people have difficulty in understanding the best way to engage with the system.
When things go wrong and a member of the public needs to raise a complaint against a care home, I am afraid the system becomes even less satisfactory. The CQC’s website says that it
“is unable to investigate individual complaints”
against providers. So how does someone complain if something goes wrong and they are worried about the care that is being given to an elderly relative in a care home? It is difficult. What can someone do if they fear that an elderly relative is being neglected, mistreated or not given the right healthcare, or if they fear that their relative’s life might even be in danger and the care home provider has dismissed the complaint or will not listen to it? The CQC has that said it will not handle individual complaints, so should they go the Parliamentary and Health Service Ombudsman? No, because the ombudsman says:
“By law, the Ombudsman cannot look into complaints about privately funded healthcare.”
If someone tries to go to the ombudsman they reach a brick wall. The CQC will not handle individual complaints and the ombudsman does not accept them. There is one possibility: an organisation called the Independent Healthcare Sector Complaints Adjudication Service. The ombudsman’s website states that “you may”—I stress “may”—
“have the option of going to the Independent Sector Complaints Adjudication Service…which represents some independent healthcare providers.”
If someone’s healthcare provider is not one of them, they are stuck.
The system is bewildering. It lacks accountability and transparency, and would leave most people confused and frustrated. How are people in care homes supposed to deal with that bewildering system? They may be vulnerable, old and frail and perhaps suffering from dementia. Their loved ones might put all their time and energy into caring for them, but how are they supposed to navigate the system? It needs to change.
What changes am I proposing to try to put right some of the issues I have highlighted? Despite the best efforts of the CQC—I say again that this is not a criticism of individuals at the CQC, much less those who work in care homes—I am afraid that, as currently manifested, it is simply not fit for purpose when it comes to the regulation, inspection and investigation of standards in care homes. Its focus recently has rightly been on NHS hospitals and providers. In light of the Mid Staffordshire scandal and the findings of the Francis report, that is hardly surprising—indeed, it is right—but the unintended consequence has been insufficient focus on the private care home sector.
In the short term, we must hold the CQC to account and insist on significant improvements now, because the situation needs to be addressed immediately. In the long term, it seems to me that the solution is to create a new, single, dedicated body whose sole responsibility is the registration, regulation and inspection of private care homes. Crucially, that body should also be the first point of contact for anyone wanting to raise a complaint about a specific establishment or the care of an individual patient. It would have the responsibility and necessary powers and resources to investigate those complaints thoroughly and rigorously, and in real time.
At the moment, if someone has an immediate concern about the care being given to an elderly relative and the care home either disagrees or denies that there is a problem, there is nothing to be done and nowhere to turn. That could be a matter of life and death. It needs to change, and it needs to change urgently. When things need to be taken further, we need a complaints system that is easier for the public to access and more transparent, and whose findings are accountable to Parliament in individual cases. The current complaints infrastructure is bewildering and is just not working.
My constituent to whom I referred at the start of my speech has lived with the problem for the past six years. Over that time, he has invested a great deal of work, research and thought in it. It has been his life, and it has undoubtedly been part of the grieving process for his mother. He has produced a document that is the product of a lot of work, and I have it here. It contains 24 very detailed points, questions, proposals and recommendations. He is frustrated that despite his best efforts and with a few notable exceptions, the issue has been largely ignored by the media and not given sufficient focus by politicians. That is something I want to put right today.
In the many hours my constituent and I have spent discussing the issue, we keep coming back to one thing. It is not about processes, systems or organisations, it is about people—people who do not have a voice in a system in which, let us remember, four in 10 care homes currently fail to reach a satisfactory standard on the CQC’s own measures. That means that people—vulnerable, sick and elderly people—are not being properly cared for. That cannot be right. We must do something about it. I believe we have a moral duty to do something about it, and that we must act now.
Post Office Horizon System
Peter Heaton-Jones Excerpts(10 years, 7 months ago)
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Andrew Bridgen
My hon. Friend makes a good point and he is right. Many people pleaded guilty on advice from lawyers or out of fear of losing their liberty in a lengthy and expensive court battle with the Post Office.
The House should know that the Horizon system has no adequate suspense account function, so it pushes the sub-postmaster who wants to balance his books when the books actually do not balance. This is false accounting and a criminal offence. However, I have seen correspondence that shows that the Post Office has advised sub-postmasters to keep any surplus balances that they discover at the close of business in their safe so that they can put them back when they have a shortage. That is also false accounting and is also a criminal offence.
A further flaw is the fact that issues of concern to the forensic accountants Second Sight, appointed by the Post Office at the request of the working group to assess independently the mediation cases, have been specifically excluded from mediation—for example, the absence or the ignorance on the part of the sub-postmaster of the contract they were under, and the failure of audits and investigation—despite the agreement of Post Office Ltd with Members of this House that the scheme would cover all these issues. This is resulting in what I believe to be 90% of the cases in dispute being excluded from the mediation scheme. This mediation has proven to be a shadow of what was agreed with Members.
I first became involved in this matter several years ago when my constituent Michael Rudkin brought his case to me. My constituent had 15 years’ experience as a postmaster and served as a senior member of the national executive. Indeed, he was chairman of the negotiating committee, the most senior post within the National Federation of SubPostmasters, responsible for national negotiations with Post Office Ltd and Royal Mail Group. In short, my constituent knew his job and the organisation inside out. He knew the organisation to the extent that on a visit to the Post Office headquarters in Bracknell, he was shown in error a room where operatives had remote access to the Horizon software and it was demonstrated to him how postmasters’ accounts could be altered remotely. The House should know that the Post Office has always maintained that it is not possible to alter accounts in a sub-post office remotely. However, it has recently admitted that this was not the truth.
In a debate in December I went into the details of Mr Rudkin’s case. To summarise, his post office branch had a loss in the accounts in excess of £44,000. He was absolved of any knowledge of this loss by Post Office Ltd but ordered to pay back the money at £1,000 per month from his salary. After he had paid back £13,000, Post Office Ltd started proceedings against Mr Rudkin’s wife for theft and false accounting. It also applied for a confiscation order to be placed on all his property and had his bank accounts frozen using the Proceeds of Crime Act 2002. This all occurred after my constituent had witnessed the operatives in Post Office headquarters demonstrating their remote access to the Horizon system.
My constituent has gone through the mediation scheme and his experience is that the professional advisers, Aver Ltd, Bill Cleghorn and Emma Porter, are very good. Second Sight has been extremely fair, professional and accurate in its analysis of both systemic and thematic issues within Post Office Ltd. However, the same cannot be said of the Post Office itself. I and my constituent have no faith in its ability to resolve the matter. It is said that justice delayed is justice denied, and this matter has simply dragged on for too long, with the Post Office seemingly looking for ever more reasons to delay the truth of the matter coming out.
Peter Heaton-Jones (North Devon) (Con)
In the past five days I have been alerted to a case in my constituency. Very briefly, the sub-postmistress emailed me to say:
“My post office has been audited today and has been closed due to financial discrepancies as a result, I believe, of the inadequacies of the Horizon system.”
That has left the village without a post office service, and obviously it is also putting an intolerable strain on my constituent. I would be grateful if my hon. Friend and the Minister considered the impact that that is having.
Andrew Bridgen
My hon. Friend is quite right. When we hear a Post Office spokesperson stating,
“I am really sorry if people have faced lifestyle problems as a result of their having been working in Post Office branches”,
we have to wonder whether the organisation is even aware of the misery it has caused. The fact that Post Office Ltd believes that honest, decent, hard-working people losing their homes, their businesses, their savings, their reputation and, worst of all, in some cases their liberty can be quantified as a “lifestyle change” only serves to show that the organisation is not fit to conduct an inquiry into the matter.
The Post Office mediation scheme has proven to be a sham, Second Sight has proven to be far too independent for the Post Office to stand, and the disdain that has been shown to Members of this House and to sub-postmasters is a disgrace.