Adult Social Care

Nick Smith Excerpts

Thursday 8th March 2012 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), and the Backbench Business Committee, on securing this debate. Adult social care is one of the most important social issues of our time.

The announcement by Ministers that the social care White Paper is coming soon—or soonish—is well timed. Given that there are an estimated 400,000 older people resident in UK care homes, I wish to concentrate my remarks today on residential care. The Dilnot report of last summer was well received. It struck the right balance between what an elderly person, their family and the state should pay and contribute to long-term care. Equally important for many were the report’s key premises that the current system of social care was underfunded and that additional funding and better targeting were urgently required. As Dilnot said, this is a price worth paying.

We all want to see a UK in which old people are respected and valued and can make the most of their final years. Alfred Morris, who became a Minister in the 1970s, said that

“if years cannot be added to the lives of the chronically sick, at least life can be added to their years”.—[Official Report, 5 December 1969; Vol. 792, c. 1863.]

People might want to move nearer to relatives or downsize as they grow older, so a national system makes sense. Dilnot was right to recommend the delivery of that objective. It would be unfair to call it a weakness of Dilnot, in that it was arguably beyond his remit, but he concentrates on the demand side of social care and how it is to be paid for. He does not consider the supply side and how it is commissioned and, importantly, how it is delivered.

We have recently seen too many examples of care for the elderly in residential care homes and hospitals that have been shameful. As many have said, we have to ensure that care is compassionate and respects the dignity of elderly residents. The care home business—and it is a business for many providers—has been a target for the quick-buck strategies of venture capitalists. Following the collapse of Southern Cross, another massive care provider, Four Seasons, has expanded. It now operates two homes in my constituency, but residents and staff are still worried about the outstanding debt liability of its parent company, Four Seasons Health Care. The Association of Directors of Adult Social Services has said:

“Care wouldn't have got the level of investment it has had without the use of private money…But in these very complex business structures, good governance is key.”

So, measures to ensure the effective oversight of the social care market to ensure stability and continuity are important for residents and relatives.

I would also like to emphasise the issue of NHS support for care homes. The British Geriatrics Society has published “Quest for Quality”, which identified

“unmet need, unacceptable variation and often poor quality of care provided by the NHS to older people resident in care homes.”

While some homes are well served by the NHS and “Quest for Quality” gives examples of good practice, it records:

“No model of coordinated health care has been developed to meet the needs of care home residents.”

Some residents in residential care have no access to key clinicians such as geriatricians or to community health services such as physiotherapy, podiatry and continence services for their long-term conditions. We have to ask how such expertise can be inaccessible to care home residents? This cannot be tolerated.

The solutions that have been proposed are familiar, and I have heard them several times this afternoon. They include co-ordinated teams of health professionals working together, patient and relative involvement and a partnership approach between health and social care workers. We know what works, but have failed to deliver the best care nationwide. We know, too, that early interventions cost less and emergency treatment costs more. Experts say that £40 million could be saved by a reduction in emergency admissions on hip fractures alone. Some care homes report that out-of-hours GPs tend to say, “Send to hospital”. In 2012, we should be doing much better than that. The report recommends that statutory regulators should scrutinise the provision of NHS support to care homes and the achievement of quality standards.

The Care Quality Commission currently has responsibility for regulating and monitoring care homes in England, with NHS health services providing support to such homes. The Care Quality Commission conducted its special review of the health needs of care home residents, which was published last week, although it was originally expected in 2010. When the CQC came to the Public Accounts Committee in January, I asked it when the report would see the light of day and why it was so far behind schedule. The chief executive told me:

“I suspect because of the complexity of the data collection and, to be honest, the fact that we have been focusing on trying to get the basic inspection processes up and running and right.”

Basic inspection processes are crucial but so, too, is the promotion of residents’ basic health care. This is not good enough.

Finally, in January I was co-signatory to a letter calling for doctors to record whether an injury from a fall, a pressure sore or an infection was present when a patient was admitted to hospital or developed while they were there. This is a simple and cheap mechanism for identifying in hospital a sub-standard quality of care.

Dilnot says that the care system is confusing, unfair and unsustainable, and that reform is urgently needed. I hope that the social care White Paper will build on good practice and deliver the reforms and the investment we need. Worry over the funding of residential care or over poor health care in the place they call home should be a thing of the past for our pensioners.