NHS Care of Older People

Nick Smith Excerpts

Thursday 27th October 2011 Westminster Hall

[Nick Smith (Blaenau Gwent) (Lab)]

I congratulate the hon. Member for Stourbridge (Margot James) on securing this debate and on her thoughtful contribution. Other hon. Members have also shown great insight in their representations.

Like others, I was sickened by the reports that we received from the Care Quality Commission earlier this month about the treatment of elderly people in the NHS in England. Unfortunately, we are now receiving a catalogue of such reports. In March, the older people’s commissioner in Wales told us that the treatment of some older people in Welsh hospitals is “shamefully inadequate”. The commissioner found instances of people not being helped to the toilet, poor communication and inadequate attention to patients’ need for food and drink.

One son reported how his mother begged for water after an intravenous drip was removed. Elderly patients in a Cardiff hospital day room were given tambourines to attract nurses’ attention. Again and again, we hear stories of patients not being treated with sufficient care, dignity and respect. Having said that, I should point out that there were also many examples of good practice. My own father has received good care in the Royal Gwent and Caerphilly District Miners hospital in recent years.

Nevertheless, given the blizzard of bad news on treatment for older people, the NHS Confederation succinctly says:

“We are well aware of the problems of poor care. What is less clear is why this has not always been tackled and what needs to happen to effect change.”

People have talked about a culture of indifference or, worse, of neglect, and ask what has happened to common compassion and kindness. It will take time to turn care around, but change must come. Recommendations in the report “Dignified Care?” include four key points: empowering ward managers to run their wards in a way that enhances dignity and respect, equipping staff to support people with dementia, prioritising continence care and looking further at whether there are sufficient numbers of the right kind of staff to care properly for older people in Wales.

We must ensure that we make things better this time. It is unacceptable that hospitals and care homes can flout their legal responsibilities to patients and residents and just be told to do better.

In Wales, the older people’s commissioner has reminded health providers that she has the legal powers to effect necessary change. Those powers must be enforced, key staff must be seen to be accountable and, most of all, patients should be heard. The Minister for Health and Social Services acted swiftly to increase spot inspections in Wales and I am pleased that the Secretary of State for Health has followed that course in England.

Strong professional leadership at ward level is of the utmost importance in securing change. We need the right skills mix in our hospitals and care homes to deliver the care that elderly people want and need. The involvement and feedback of patients and relatives is crucial, but we should not have to rely on relatives and friends to provide basic care, even if it were practical.

As someone who has spent some time working in the voluntary sector, I know that it can be a sensitive and sensible provider. The WRVS has informed us about some of its voluntary services on wards, which include befriending patients and help with feeding. I understand that it is keen to expand those services, which is something that I support.

Residential care is in some flux. One of the largest UK providers, Southern Cross, has collapsed. After a year of worry and anxiety for elderly people in its homes, we must now seize the opportunity to ensure that companies in the sector have a sound business model. They must invest for the long term and deliver high quality care for our elderly.

As a member of the Public Accounts Committee, I recently talked to Department of Health officials about the future of the social care market, which has changed dramatically in the past 20 years from a local market with single owners of individual homes to consolidation of ownership. Southern Cross owned about 9% of the UK market, and 30% of that was in the north-east.

I am not saying that all individually owned homes are perfect. Operation Jasmine is an ongoing investigation in Gwent, looking at the maltreatment of elderly residents in care homes in the late 1990s and early 2000s. The investigation is also looking at some small homes. The first prosecution of an owner and a manager is expected soon.

The position of Southern Cross, which was the subject of a number of takeovers and a massive profit grab by the venture capitalists Blackstone, is perhaps summed up by the reported admission of a former executive, who said:

“It really did seem like we were in a land flowing with milk and honey.”

The money men were working on a substantial projected increase in the elderly population. This week, for example, the Office for National Statistics predicted that the current number of people over state pension age will rise from 12.2 million to 15.6 million by 2035, which is an increase of 28%. The money men thought that with a growing elderly population and the subsequent rise in local authority funding, a rosy future with a rosy profit was guaranteed. The Department of Health’s director of care services said:

“Arguably, the people who invested took this to be an infrastructure project, like toll roads, rather than a care business.”

As someone once said, “If it looks too good to be true, it usually is.”

Southern Cross ran into the buffers, as the squeeze on local authority spending saw referrals and fees go down and occupancy rates drop to unsustainable levels. Given that the budget squeeze is likely to continue for some time, the stability of the care sector is of considerable concern. Yes, it is a business, but it is one that looks after frail and vulnerable people, so low cost and low quality is not an option, nor is it right for such people to live with the constant fear that they may have to move home; some certainty must be part of the care package.

I have said before that the Department of Health was slow to act on Southern Cross. I wish I was confident that Four Seasons, which is taking over a large number of former Southern Cross homes and which has more than £1 billion in debts, has a sound business model to deliver long-term care. It is unlikely to be the only operator under pressure as all private providers are dependent on revenue income from cash-strapped public authorities. Of course, as the PAC was told, the Department of Health does not commission services; such decisions are made by local authorities. None the less, the Department of Health sets the framework for social care providers and that must be robust.

The Department is now consulting on what measures it may need to ensure the effective oversight of the social care market. I hope that we will have more comprehensive measures in place early next year. The challenge for us now is to ensure that wherever our elderly are treated or looked after or helped to look after themselves, quality is embedded in the service, and dignity and respect are accorded without question. Together with our high-tech surgery and sophisticated drugs, we must ensure that we feed patients properly and give them the time, company and comfort they need, so that they can cope with the chronic ill-health, dependency, or terminal illness that will at some point come to us all.