Care Homes: CCTV

Julie Cooper Excerpts

Wednesday 5th September 2018 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David. I am grateful for the opportunity to respond to the debate, and to the right hon. and learned Member for Beaconsfield (Mr Grieve) for bringing this important subject before the House. I feel strongly about it, and I bring some personal experience over many years of sourcing care for grandparents and, most recently, for my own mother. I have seen examples of poor care in nursing homes and care homes, as well as examples of absolutely fantastic care in both. I pay tribute to the carers who have the skills, patience and dedication to do what must be one of the most important jobs, and probably the least valued by our society. We all should take note of that and value such people.

It should be a priority for any civilised nation to promote and ensure the safety and wellbeing of its citizens, and the provision of high-quality care in a safe environment for elderly and vulnerable people should be a given, and something that we can take for granted. Elderly people are the group I have the most experience with in this area, but I expect that it is pertinent to people in other groups who find that they need to move into a care home.

When someone is no longer able to live independently in their own home it is a big deal—for the person themselves and for their close family. Admitting that they, or a family member, cannot cope independently, giving up their home and moving away from familiar surroundings can be extremely traumatic and quite frightening. Having made the decision, everyone involved needs to be reassured that the care home is a safe and genuinely caring facility, adequately staffed by well-qualified, well-supported and well-supervised carers and nurses.

Sadly, that is not always the case, and there are well-publicised examples of poor care, neglect and, in some instances, wilful abuse. It is a shocking state of affairs that is totally unacceptable. There is, rightly and properly, a lot of agreement in today’s debate. We all agree that a single case of abuse or neglect is one too many, and I base all my comments on that point of view.

The combined findings of Care Quality Commission inspections and staff surveys seem to indicate that poor standards of care, delayed care and neglect are widespread, while instances of deliberate abuse are relatively rare. I have seen many cases of neglect and poor levels of care. I have not seen any outright, wilful abuse, but that is not to take away from the fact that it exists. The question for us today is whether the installation of CCTV in communal areas of care homes would eradicate such problems or lead to improvements. The right hon. and learned Member for Beaconsfield and other Members made a powerful case for the contribution that CCTV could make in some instances, but it is perhaps a bit of a search for a quick fix. This is a complex area with no quick fixes, and false reassurances, as has been mentioned, are a worry.

We are talking about introducing CCTV in communal areas, but the majority of care is delivered in private bedrooms, bathrooms and treatment rooms. Introducing overt surveillance into communal areas would only shift any poor practice to areas not covered by cameras. We therefore run the risk, as I said a moment ago, of providing false reassurances to family members.

More broadly, we all live in a world where CCTV is a part of everyday life. In every shop and on every high street, where we go and what we do is recorded—except, that is, in our homes. When we sit down in our lounge, family communal areas or dining room we have privacy. Is anyone suggesting that the routine recording of elderly residents while they sit in their lounge or eat in the dining room should be a requirement in every home in the land? Who among us would like to be filmed while we snooze in front of the TV or sit down to eat? If we are talking about the dignity of the residents in such homes, is that really what we want to see routinely?

[Mr Grieve]

I appreciate the hon. Lady’s point. Equally, perhaps one has to bear in mind that if we move out of the total privacy of a room in which we sit alone, we are observed by other people. That is part of our lives. There is a strange irony in the fact that we are perfectly happy to say, “This is wonderful—the meal time is so well supervised by staff,” but if it is supervised remotely through CCTV, or if there is CCTV available to check whether something has gone wrong, we are troubled by it.

Of course, so much depends on the absolute effectiveness of maintaining the necessary safeguard that material is kept within private circulation. However, provided we have that, I confess that I find it slightly difficult to differentiate between a camera providing some degree of assurance that everything is all right and a person physically sitting there, to which nobody would have any objection.

[Julie Cooper]

I hear what the right hon and learned Gentleman says. There are no right or wrong answers here; it is about creating a balance. I would point out that not all residents in care homes have dementia. Many of them do not and have a very strong awareness of their environment. They would see this as an infringement of their dignity—a dignity that they are fighting to hold on to for the remainder of their life. I take the point, but I do not think the issue is straightforward.

A point was made about CCTV in this building. We accept it, but we do not live here. We accept it in our lives, but if we are to make care homes a genuine substitute home for vulnerable people, we have to bear such points in mind. CCTV may have a role in specific circumstances, for example where a concern has been identified, but it ought to be a last resort, implemented only with the knowledge and full consent of residents, families, staff and professional representatives, because this affects everybody, and observing would definitely affect the relationships in the home.

Acknowledging that it is unlikely that incidents of abuse and poor standards of care would be prevented by installing CCTV cameras in communal areas does not mean that serious problems can be ignored. Abuse of people in care homes, and/or poor care, shames us all. ln many ways, the issue of CCTV is more of a red herring than a solution. I accept that it may have a role in some areas, and there may be justification for using it in some limited ways. However, there is widespread agreement from a range of well-respected organisations that the blanket imposition of CCTV is not the answer.

As the hon. Member for North Ayrshire and Arran (Patricia Gibson) has pointed out, Caroline Abrahams from Age UK said that it is more important

“to raise the quality of care in care homes across the board and ensure that all older people, their families and staff are involved...and are able to raise any concerns, confident that their feedback will be acted on.”

That is not always the case at the moment.

Dr Peter Carter, former chief executive of the Royal College of Nursing has said that the answer to better care is better recruitment, training and managerial supervision of staff; that would be a better way to deal with this. I agree.

The CQC said:

“We would be concerned by an over-reliance on surveillance to deliver key elements of care, and it can never be a substitute for trained and well supported staff.”

I agree with that too, and I know that other hon. Members do too—there is so much agreement in this place on this subject, which is quite unusual. I am sure that the right hon. and learned Member for Beaconsfield has initiated this debate in good faith, but if we are really serious about ensuring the highest standards of care in care homes, which I believe he and other Members here are, he will join me in urging the Minister to consider reversing some of the funding cuts to social care.

It is a sad fact, but a fact nevertheless, that in response to Government funding cuts local authorities have reduced spending on social care by £6.3 billion since 2010. The cuts are now having a huge impact on care quality—a quarter of all adult care services have the lowest safety ratings, 30% of nursing homes in England require improvement or are inadequate and a growing number of private care homes are handing back their contracts, citing insufficient funds. Many more are teetering on the brink of financial collapse, faced with no alternative but to reduce staff numbers and, inevitably, standards of care.

We have not talked much about the funding implications of CCTV. Given that the sector is short of funds to start with, I am not sure who exactly would pay for CCTV installation and the ongoing monitoring, if it were to become mandatory; if it were to have any value at all, that would be expensive.

Before this debate, the Department of Health and Social Care said:

“Closed circuit television should not be...a substitute for proper recruitment procedures, training, management and support of care staff, or for ensuring that numbers of staff on duty are sufficient”.

I agree, but proper recruitment, training and adequate numbers of care staff have an associated cost, which it appears the Government are not prepared to meet. Quality care for the elderly and vulnerable cannot be delivered on a shoestring by poorly paid and overstretched carers. Our old people, our parents and grandparents deserve better. I look to the Minister to bring forward the promised Green Paper, to embrace the points made in this debate and to ensure that we have the kind of social care and care for our elderly that we can all be proud of.

--- Later in debate ---

[Caroline Dinenage]

I thank my right hon. and learned Friend for that legal advice, which would probably have cost me a fortune in the outside world. I am grateful for that clarification. The provider should consult those affected on the use of surveillance wherever it is possible to do so. It would have to meet the cost not simply of the equipment and the monitoring of it if it is done by a third party, but of the training, staff time, legal advice and consultation activity. There is no point in having such a system unless it is monitored and routinely checked.

The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke compellingly about early years settings. I have experience of that, not just as the former early years Minister but as a mother who has been in exactly the situation that she mentioned. It certainly rings bells with me—leaving children screaming their heads off, and five minutes later being told they are all perfectly fine. As she says, that can be very comforting for parents. CCTV is not compulsory in early years settings either, but there are many similarities between the two sectors: they are both predominantly run by private companies. I hope that early years and residential care businesses see the benefits.

I have an apology to make to the hon. Lady. She asked about the letter that we sent, which suggested it might have to be up to the Ministry of Justice to change the law. That was incorrect, and we have subsequently sent her a letter clarifying that. I apologise.

Ultimately, CCTV can have benefits, but it simply cannot be a substitute for well-supported, well-trained staff and excellent management. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure

“the services they commission are safe, effective and of high quality”.

We also expect those providing the service, local authorities and the Care Quality Commission to take swift action where anyone alleges poor care, neglect or abuse. We have backed that up with more than £9 billion of investment in the sector in the past three years,[Official Report, 11 October 2018, Vol. 647, c. 4MC.] which equates to an 8% increase in funding. That incredible amount of money highlights the challenge we face in the sector.

[Julie Cooper]

Does the Minister not accept that, as a result of cuts to local authority funding, there has been a reduction equivalent to £6.3 billion of spending in the sector?

[Caroline Dinenage]

I accept that there were cuts to local government funding during the time of the recession that we all endured. That was incredibly regrettable, but was one of those very difficult decisions that Governments have to take.[Official Report, 11 October 2018, Vol. 647, c. 4MC.] In the last three years, we have increased funding by £9.4 billion, which equates to an 8% increase. It demonstrates the challenge of this ageing population—people are living longer with much more complex needs, and many vulnerable people need an enormous amount of support and care. It is an enormous amount of money, and yet we still see the sector facing great challenges and stress, which is why we have a Green Paper coming out later this year. We hope it will help address the sustainability of the adult social care sector. Successive Governments have wrestled with this incredibly challenging issue, and we need to find a long-term solution.

We expect serious allegations of abuse and neglect to be thoroughly investigated and prosecutions to be brought where that is warranted. The abuse of people who depend on care services is completely unacceptable and we are determined to stamp it out. That is why we introduced the new wilful neglect offence, which came into force in April 2015. The hon. Member for North Ayrshire and Arran said that we must get the very best quality of staff into this demanding and challenging profession. I could not agree with her more. We have made changes to help services recruit people with the right values and skills, and introduced a care certificate for frontline staff to ensure older and vulnerable people receive the high-quality care they deserve.

The Department for Health and Social Care has commissioned and funded Skills for Health, Skills for Care and Health Education England to develop a dementia core skills education and training framework, which is very important to me. There is also a fit-and-proper-person test to hold directors to account for care. Let us not forget that 82% of adult social care providers are rated as good or outstanding as of August 2018, according the Care Quality Commission. That is a testament to the many hundreds of thousands of hard-working and committed professionals working in care, to whom we owe a debt of gratitude. Surely the best way of building on that is not to say to them, “We’re watching you in case you do the job wrong,” but rather to say, “How can we support you to do the job better? How can we invest in skills training, continuous professional development, great management and more staff on better wages?”