Social Care Services

Catherine McKinnell Excerpts

Tuesday 17th May 2011 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is a pleasure, Mr Brady, to serve under your chairmanship. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this morning’s debate, which concerns an incredibly challenging and complex matter.

I am concerned that few Government Members are here today, so I congratulate the hon. Member for Newton Abbot (Anne Marie Morris) on attending. That makes me think that we are not all in this together, and it seems that only Opposition Members wish to represent their constituents on this matter.

I wish to contribute to this debate specifically on the standard of care being provided to vulnerable elderly people. I recently participated in a series of hard-hitting reports by Tyne Tees Television’s “North East Tonight” programme. Tyne Tees’s findings on the standard of care provided in some care homes in the north-east were distressing and disturbing, and I am pleased to have the opportunity today—again, I thank my hon. Friend for securing the debate—to highlight some of those concerns and present them directly to the Minister.

I must point out that there are some fantastic care homes in the north-east and that they have some dedicated staff and carers. However, the “North East Tonight” reports were timely, being broadcast in the same week that a paper by Newcastle university’s institute for ageing and health predicted a care home crisis unless there is major investment in the care system to support the rapidly increasing number of elderly people.

In 2010, there were 2.6 million people aged over 80, but by 2030 that figure is expected almost to double to 4.8 million, with one in five needing regular care. The Newcastle university paper predicted that there will be an 82% increase in the number of care home places needed—that is 630,000 extra places between now and 2030 just to cope with the demands of an increasingly older population.

In its investigations, Tyne Tees uncovered reports of former care-home workers who were forced to leave their jobs. Those workers were given bad references, which make future employment in the sector difficult, because they had blown the whistle on the unacceptably poor standards of care. That included lifting the lid on cases of dangerously poor hygiene, of residents not being fed properly, of a lack of interaction between staff and residents and of a total lack of stimulus for the people living there. The investigation also uncovered cases of appalling neglect of vulnerable care-home residents—according to relatives, it was often because there were simply insufficient staff on duty to ensure that their loved ones’ needs could be properly taken care of.

Tyne Tees also reported that many relatives were afraid of reporting concerns about the quality of care being provided, because they thought that it might put their loved ones in greater danger. It is understandably difficult to complain about the poor standard of care being provided for a relative when, in the first instance, the complaint has to be made to the people who are providing it.

Tyne Tees invited me to view its findings. What immediately struck me, as a mother of young children, was the contrast between the standard of care provided to young children in child care settings and the standard of care provided to vulnerable elderly people in care homes. If Tyne Tees had uncovered similar cases of neglect and fear of whistleblowing in nurseries in the north-east, I am sure that there would have been a national outrage, and rightly so, yet the treatment of older people is too often shamefully brushed under the carpet.

The Tyne Tees series of reports received unprecedented feedback through e-mails and Facebook comments, and people wrote to Tyne Tees to back up its findings and report similar concerns. That shows the level of concern across the north-east—and, I am sure, across the country—about the situation.

I recently had to intervene in support of a family seeking help for Jessie Wiseman, an elderly constituent. She is 91 and blind, and she was found living in squalor after ambulance workers paid a routine visit to her property. Despite concerns having been raised by her GP and her son about Jessie’s deteriorating condition, social care workers failed or act and she rapidly declined. That is why I welcome the recommendations in the recently published Law Commission report to introduce a set of statutory principles, a statutory basis for adult safeguarding boards and a duty on councils to assess carers and investigate adult safeguarding cases.

[Mr David Anderson (Blaydon) (Lab)]

Is it not the case that the failings in adult care have gone on for a long time, because, unlike child care, it has never had a statutory basis? In arguing for such a basis to be put in place, we may find that the Government say that this is just more red tape and bureaucracy.

[Catherine McKinnell]

I agree that that is a great concern, which is why the Minister must take on board the deep concerns that are being expressed today. In any event, reforming the law will still not be enough.

I am pleased that, as a result of the Tyne Tees investigation, the Care Quality Commission has agreed to review its reports and to conduct unannounced assessments on the homes in question. However, I am concerned that it appears to have required a television programme to spur the Care Quality Commission into action. By placing their loved ones in residential care, people are putting huge amounts of trust in a service. They rightly expect that the Care Quality Commission is adequately monitoring, regulating and inspecting all care homes on a frequent basis.

[Anne Marie Morris]

The hon. Lady has made some extraordinarily good points, and the Care Quality Commission certainly needs more help to do an effective job. Now that we have an outcome-based set of performance criteria, homes need to be given guidance on how to comply with them. In my meetings with the Care Quality Commission, it says that it no longer gives advice, which means that it is an uphill battle for any home to ensure that it provides the quality of care that is needed and that it complies with the new criteria.

[Catherine McKinnell]

I agree that the Care Quality Commission should take a proactive approach to improving the quality of care in our adult services.

Another worrying statistic is that on-site inspections in care homes have fallen by 70% since the Care Quality Commission was introduced in October 2010. That must worry anyone who lives in a care home or who has a loved one in a care home.

Will the Minister consider the following issues because they are crucial to the future provision of social care services? What further steps can the Government take to ensure a much greater level of protection and safeguarding for vulnerable elderly people in residential care? What measures will he take to ensure that the culture of fear that was spoken about by people participating in the Tyne Tees reports is broken down, so that care workers, relatives and residents feel confident and safe in raising concerns about the standard of care? What steps is he taking to improve the status, pay and training of care home staff, who are doing an incredibly difficult and important job? How will he ensure that the swingeing cuts to local authority budgets over the coming years do not detrimentally impact further on the quality of social care being provided to elderly people, particularly at a time of ever-increasing demand?

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[Mr Anderson]

I agree with my hon. Friend. My own personal experience was in a purpose-built site that did just that. We took in people for a week at a time for respite and we also provided day care, but the individuals all lived in their own homes. Although that was cost-intensive in labour terms, the quality of care was good. We took care of not just the individual but the needs of the family, and we built very close working relationships with them. If we want to have quality care in this country, we must bite the bullet and accept the fact that we have to pay for it. The previous Government accepted that if we wanted quality health care, we had to increase the public payment into it.

[Catherine McKinnell]

In my contribution, I highlighted the worrying case in my constituency of Jessie Wiseman whose care at home was contracted out to a private care provider. Some 15 visits took place over eight weeks before she was discovered in an appalling state. However, the local authority took no responsibility for it. This story feeds into the debate on the worrying trends that can take place when services of this nature are put out to the private sector.

[Mr Anderson]

The privatisation of home care services in this country has been a complete failure and a nightmare. I have represented home care workers for many years and have seen the service deteriorate. We had a dedicated work force who had a set list of clients whom they went to see day in, day out. They built a relationship with that person and their family. When those jobs were contracted out, it was said, “We will send worker A on this day and worker B on that day.” The home care worker lost that direct link with not just the family but the wider team within the authority. That team would work together and take a holistic view and work better for the person concerned. It is clear that services are being contracted out to save money. If we save money, services will not be as good.

It is clear that we will see problems being stored up if we lose public sector capacity in home care services. At the moment, some 31,000 residents are being taken care of by Southern Cross Healthcare. Their homes now hang in the balance as a result of reckless business practices and local commissioning, which has allowed the organisation to become so dominant in the market. Southern Cross and Four Seasons—the big two in residential care—have operated casino-style finances, and both are now teetering on the brink of collapse. A toxic cloud, formed by irresponsible borrowing, weakening demand, council cuts, the slump in care home property values and the collapse of favourable credit facilities, now hangs over the heads of frail elderly people and their families at a time of insecurity and when they need real security.

How has it come to this? How has RBS, a state-owned bank, become the biggest shareholder in Four Seasons in exchange for writing off debts of £300 million? Would taxpayers’ money not be better spent directly on care homes run by democratically accountable councils, rather than being tied up in byzantine financing arrangements?

Across the social care market, research by Community Care suggests that one in five providers expect to go out of business in the next financial year. The regulator describes the home care market as a cottage industry of small, often barely viable providers alongside a few giants such as Care UK, whose chairman kindly provided £21,000 to fund the personal office of the Secretary of State for Health—perhaps that is one reason Care UK is doing so well.

If Southern Cross, Four Seasons or indeed local providers collapse, how will local authorities find new homes for people when they no longer run them? When home care providers default, as they often have and might in future, how will local authorities fill the gap if they have scrapped their own home care teams, which is happening up and down the country?

What about the quality? Care Quality Commission data show that privately provided care services are less likely to be rated “good” or “excellent” and five times more likely to be rated “poor”. I know that the Government do not like targets or standards, but when their own commission is saying such things its message should be listened to. Private providers consistently score lower on a range of indicators of quality and safety. When we look at the employment practices of some providers, we cannot be surprised that home care workers do not stay in their job. They are not paid for their travel time between visits, and they have to provide their own mobile phones and pay for their uniforms. They suffer from underpayments; they often have zero-hour contracts; and they sometimes have to pay towards the cost of administering their own time sheets. No wonder people do not see it as a job for the future or a career that it is worth investing their time and talents in. We need real regulation of employers to stamp out employment practices that have impacted so badly on home care users and, through them, on staff.

Where are we today? We have a Government who want more from staff for less; who want more work by fewer staff, because they are making 500,000 public sector workers unemployed; who want more pension contributions from less pay and for poorer pension provision; and who want people to spend more time at work by making, in particular, women work until they are 66 years old, with less time at home and in retirement.

What did we get last week? The Chancellor has a new red tape initiative. What is he going to do when people are losing their jobs? If there is a chance of redundancies being managed sensibly, what does he talk about? He wants more chances of people being sacked, with less chance of real support by limiting the time to consult. People will have more chance of being made redundant and less legal support to challenge decisions taken by their employer.

The CQC sees a vacuum in regulation and in the checking of safety and quality of care. The CQC’s risk-based approach is resulting in a dramatic drop in inspections. A freedom of information request by Community Care found a 70% drop in CQC site inspections in the past year alone, at a time when more people are in need of care.

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[Paul Burstow]

The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.

I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.

Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.

Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.

The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.

The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.

[Catherine McKinnell]

I want to reassert the point that, regardless of the changes put in place during the past 13 years under the previous Administration, we are moving into unprecedented territory in terms of the funding given to local authorities for supporting social care within the community. That is the context in which some of the changes that we are demanding and requesting today need to be considered.

[Paul Burstow]

I have rehearsed some of the findings from the ADASS survey, which shows that although the changes are tough, they are not as unprecedented as the past 13 years of experience would suggest.

The hon. Member for Blaydon talked about the mixed economy of provision in social care and lamented the passing of a time when a public service offer was the almost exclusive way in which social care was provided. He harked back to a golden age that has passed and that may never have truly existed. I am not certain whether I heard him describe a solution or route map that would get us back to the past that he hankers after. If he has one, perhaps he would share it on another occasion. He also talked about Southern Cross. As a Minister, I am, of course, only too well aware of the issues with which that company is currently grappling. Above all else, I am concerned to safeguard the interests of the residents who live in those homes. That should be on our minds whenever we talk about Southern Cross and its prospects. We need to ensure that we secure its future for its residents.