Care Homes (Regulation)

Julian Knight Excerpts

Wednesday 4th November 2015 Westminster Hall

[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.