Care Bill [Lords]

Debate between Emma Lewell-Buck and Robert Buckland

Monday 10th March 2014 Commons Chamber

[Mr Robert Buckland (South Swindon) (Con)]

My amendments 27 and 28 are on safeguarding. Clause 42 contains a raft of measures that will go some way to enhancing the powers and role of the authorities in dealing with disturbing and worrying cases of abuse or neglect, which we hear about all too often when it comes to the care of vulnerable adults.

Amendment 27 relates to the definition of abuse in clause 42(3), which rightly makes reference to financial abuse. We are all aware of the rising phenomenon of financial abuse, where older people and those with learning difficulties have been preyed on, sometimes by their own family, for financial gain. My worry is that, while a distinct reference to financial abuse is welcome, there is a danger of creating an imbalance that will make other forms of abuse less relevant or important.

Statistics from the Health and Social Care Information Centre on the number of safeguarding referrals in the last year for which records are available show that the most common causes or types of abuse are physical abuse and neglect. My concern is that they do not appear in the Bill. It would perhaps be better to have an amendment, along the lines of the one I have tabled, that acknowledges different types of abuse and refers the matter to guidance that could be carefully and comprehensively drafted, so that practitioners can be safe in the knowledge that one type of abuse does not take precedence over another. This is an issue that has been raised in the other place and in Committee here. The Government have said they are concerned that defining abuse further might restrict the scope of a local authority’s duty to inquire, but my concern, and the concern of organisations such as Mencap, is that not having a reference to other forms of abuse might lead to an undue focus on financial abuse only, to the detriment of others.

Amendment 28 would place a duty on relevant partners, such as those providing care and support, to notify the local authority if they believe an adult is at risk of abuse. It is clear that local authorities cannot be expected to identify all types of abuse themselves, or to rely on the good will of other people or agencies. If relevant partners, including providers of care, had a duty to report that adults were at risk of abuse, that would make their responsibilities clear, and would help to secure greater transparency. I, and others, fear that leaving the matter to guidance would pose a risk that the duty would not be taken seriously enough. A legal duty for relevant partners has already been introduced in Wales, and the amendment seeks to mirror that.

We are familiar with the existing framework relating to adult safeguarding boards and the joint agency working that takes place, but concerns that arise day in, day out are not always reported, and, sadly, there is also under-reporting of concerns from hospitals. While there are many examples of local excellence in the development of safeguarding procedures, I fear, as do others, that there will be too much of a patchwork and not enough of a national framework. It is essential for us to know, wherever we live, that the standards of reporting and obligations placed on agencies and other partners to make that all-important report about abuse are consistent. Because adults are often much more isolated than children and young people who are surrounded by a framework, a duty to report when an adult is at risk could be considered to be more crucial.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I shall speak briefly about new clauses 17 and 18 and amendments 31 to 33, which stand in my name.

New clauses 17 and 18 go to the heart of the social care profession. They say a great deal about how much we value the care of vulnerable and older people. New clause 17 would reveal the full extent of poor employment practices in the care sector, including zero-hours contracts and failure to pay the national minimum wage. Good social care thrives on the provision of well-trained, motivated staff who can develop proper relationships with the people whom they visit, but we know that that does not happen. According to the Social Care Workforce Research Unit, more than 150,000 people in the care work force earn less than the national minimum wage. Poor pay not only affects employee morale, but makes it difficult to attract skilled staff and encourages high staff turnover. None of that is good for service users, who need to have confidence and trust in the people who visit them.

The Government promised to get tough on employers who do not pay the national minimum wage, but so far only five employers have been “named and shamed”. Not one of them was in the care sector, which is worrying given how widespread we know the problem to be. New clause 17 would give a clear picture of the state of the sector, and would create a foundation for possible action.

New clause 18 would create a requirement for local authorities to consider how the employment practices of providers they commission might affect the quality of care. The aim is to build checks into the system so that standards are not allowed to slip. Training is a particular concern: more than 40% of respondents to a Unison survey reported that they had not been given specialised training to deal with the specific needs of clients with conditions such as dementia. Nearly a quarter reported that they were required to carry out medical procedures or give medicine to clients when they had not been trained to do so. More worryingly, a care worker who spoke to me recently told me that it was standard practice in the agency to leave tablets for clients by their bedsides to save the cost of another visit later in the evening to ensure that the client had taken his or her medication. That means, essentially, that hundreds of vulnerable, confused people who are not in control of their own care are left to control their own medicine.

The issue of 15-minute care visits has rightly attracted considerable attention, not just because they often make the practicalities of care impossible, but because they eliminate almost any chance for a relationship to develop between carer and client. An under-reported crisis among older people is growing isolation, and the carer may be the only person to whom many of them speak on most days. That has real, measurable impacts on people’s well-being, and is made worse by those flying visits. New clause 18 would force authorities to take such factors into account when commissioning services.

A care worker on a zero-hours contract told me that it was common for 15 or 30- minute visits to be scheduled back to back, which gave him time to do only the bare minimum. He had no time to speak to his clients, or to go the extra mile to keep them comfortable. He often drops in on them in his spare time just to ensure that they are okay. On one occasion, he arrived at a client’s home to find that the man had fallen and needed to go to hospital. The man asked whether the care worker—a constituent of mine—could go with him, and my constituent rang his employers to see whether that was possible. He was told that it was not. It is extremely worrying to see cases in which social care has lost that basic element of compassion. Employers must be required to build some kind of flexibility into their practices.

My own experience in adult social care has convinced me that a general duty of well-being is simply not enough.