Social Care Services

David Anderson 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.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

It is a pleasure to be serving under your chairmanship, Mr Brady. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate, which is timely not just because of the demonstrations that we saw outside this place last week, but because we are in the pause before the Health and Social Care Bill comes back to Parliament. This debate is also a matter of great personal passion. In 1989, thanks to the behaviour of a previous Tory Government, I lost my job in the coal industry and had to take up a job in care. Although I ended up in that sector almost by mistake, it was one of the best things that ever happened to me. I met some fantastic people who were dedicated to taking care of the frail and vulnerable people in the city that my hon. Friend represents. Sadly, in the early 1990s, a lot of that care, commitment and dedication was lost. A series of cuts from the national Government decimated the care services across the whole country, and we see the same happening today.

I hope that the Health and Social Care Bill will be withdrawn in its entirety. Despite what they say, it is clear that the Government are leading us to a privatised NHS. The experience of social care should show us what happens when we put services out to the private sector. We are told that the White Paper has been delayed. There may be some last-minute qualms from the Government about how far they can go against public and professional opinion. I am surprised that the pause has happened now, because public and professional opinion has always been against this Bill, even when it was first announced. Perhaps that opinion took a while to sink into the minds of the Government; it certainly did not immediately sink into the minds of the Liberal Democrat members. It clearly has now, and thank God for that. I hope that the Minister, along with his colleagues in his party, will work with other people across society to ensure that the Bill does not go any further and that we do not see the same damage to the health service that we have seen to the social care services.

Research carried out by Unison suggests that, if recent trends continue, the last council-run residential care homes will have closed in 15 years’ time and there will be no local authority-employed home care staff left by 2020. That is part and parcel of this Government’s drive not just to boost the private sector but to deconstruct public sector provision and give councils less and less responsibility. The anti-public sector phalanx in the Cabinet will, I am sure, be happy to see that happen and it will celebrate the disappearance of council-run services. It will argue that the private sector always performs better, despite the fact that that has not been shown to be the case.

[Alex Cunningham]

My hon. Friend is talking specifically about local authority provision of care homes. Is it not more important that we invest in extra care facilities and that we work with elderly people so that they can live in their own homes, because that is what the vast majority of them want to do?

[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.

[Anne Marie Morris]

I thank the hon. Gentleman for being so generous in giving way. The statistics are interesting, but care homes in my constituency of Newton Abbot complain that more visits are being made. I spoke to the CQC just this week and it said that it was making on-site visits to every home within its purview in the south-west. There might be a regional difference, but in the south-west, where there are a huge number of elderly people, the number of visits is going up, not down.

[Mr Anderson]

I thank the hon. Lady for that. More inspections are good: we want inspections that work; otherwise, we will get into the problems that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) mentioned.

Staff and service users fear that there is an over-reliance on provider self-assessment and secondary sources rather than direct inspections. There are fewer indicators and data sources for adult social care providers than there are for NHS providers, yet the methodology is common. Alongside a “lighter touch” approach from the regulator, local authorities are cutting quality assurance departments, which, as Community Care showed, means fewer local checks on the quality and safety of care being provided.

Some of the changes that the unions and workers at the CQC would like to see, which I agree require serious and urgent consideration, include reinstating and strengthening the requirements on the types of incidents and issues that must be reported to the regulator. These should again include medication errors, significant injuries, accident and emergency admissions, safeguarding referrals, matters where staff are subject to disciplinary action or dismissal and unusually high staff turnover. Those are all indicators of things that might be going wrong, but they are not being recorded as they should be. A minimum frequency should be set for how often a service is visited.

I have no doubt that the hon. Member for Newton Abbot (Anne Marie Morris) is correct about the experience in the south-west, but it should be replicated across the country because it would give people greater confidence that things were being done properly. There should be a greater range of tools so that service users and employees can make their concerns known to people who can affect outcomes. We want to encourage people who want to blow the whistle where necessary, and give people whose relatives are in care confidence that, if they make a genuine complaint, the care will not be reduced.

I hope the Minister will look at my points, provide answers on the failures of private adult social care providers and say whether anything can be done to make the CQC more representative. For years, adult social services have been regarded as the Cinderella service, which is a disgrace. People are in care not because they want to be but because they have to be, so I hope we will work together to try to make adult social care something this country can be proud of.

--- Later in debate ---

[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.

[Mr Anderson]

I agree with the Minister entirely. I also agree that the previous Government did by no means get things right for 13 years, which is also true of other previous Governments. My worry is that we are being railroaded by a cuts-led agenda. In the past, we at least had a safety net of council provision, but that will no longer exist. Therefore, when organisations such as Southern Cross go belly up, there will be no one to pick up the pieces.