Care Bill [Lords]

Nick Smith Excerpts

Monday 16th December 2013 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow).

There are many challenges for the social care sector as we continue to live longer. In Wales, 20% of our population of 3 million is over 65, and that figure is predicted to rise to 25% over the next 20 years. It is essential that our older people live their lives with dignity, respect and in safety. Other Members have mentioned the costs of care and improving hospitals, but I want to concentrate my remarks on regulation and safeguarding in care homes.

The rising number of elderly people, some of whom need residential care, has led to significant private equity investment in the social care market. In 2011, many Members were troubled by the billion-pound collapse of Southern Cross Healthcare, whose quick-buck business model caved in when the global recession arrived. The media have now reported that care providers NHP and HC-One are expected to be put up for sale soon with US private equity interest.

Private and voluntary providers now account for 92% of all residential care and nursing home places, and 89% of care home care hours are outsourced by local authorities. The Care Bill gives the CQC in England extra powers to oversee the social care market, in particular companies that are deemed “too large to replace”. I welcome that, but we may need to oversee better business models at a more local level. The Association of Directors of Adult Social Services budget survey 2013 showed that more than half of directors expect providers in their areas to face financial difficulty, given the squeeze on local authority budgets that other Members have mentioned. Perhaps those oversight powers should better cover small and medium providers too. I hope the Minister will reassure the House that the CQC will have the resources and expertise to assess whether all care home owners are fulfilling their obligations regarding their financial viability. My constituents who went through anxious times with Southern Cross would like more stable care home operators and better financial scrutiny by regulators.

The other issue I wish to address is adult safeguarding. I have previously told the House about the horrendous instances of historic neglect and abuse in care homes uncovered by Gwent police’s Operation Jasmine. The £11.6 million investigation started in 2005 and gathered 10,500 exhibits and 12.5 tonnes of documents. It led our police to brand the negligence discovered as “death by indifference”. There were 103 alleged victims of care home abuse and neglect, yet, like their relatives, I was dismayed that Operation Jasmine secured just three convictions for wilful neglect by carers. Worse, charges brought against a care home owner did not directly relate to poor care for residents in his homes, but instead to breaches of health and safety legislation and false accounting. That cannot be right.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

At a time when children’s safeguarding boards are subject to so much scrutiny and questions about their performance, does my hon. Friend share my fear that the Government may be adopting a model that is flawed and needs a great deal more work? If that model is replicated for older people and adults in need of care, we may see a repetition of the same problems.

[Nick Smith]

My hon. Friend makes a good point.

I was struck when speaking to victims’ families in south Wales that although many were regular or even daily visitors to their loved ones’ homes, they were not informed about bedsores or concerns that their relatives were not eating or drinking properly—such concerns were just brushed aside. Yes, individuals must be responsible for their actions, but what was uncovered was institutionalised neglect, with instructions on cutting back on food and incontinence pads coming from the top.

I am pleased that in Wales the First Minister has agreed a review of Operation Jasmine, led by Dr Margaret Flynn, who wrote the excellent Winterboume View hospital report. Although it will not report in time to amend this Bill, I hope the Government will consider any additional measures that that crucial review may highlight because we know that such issues are not just a problem for Wales. Information supplied by the House of Commons Library shows that, in 2011-12, 65,580 allegations of abuse of vulnerable adults aged 65 or over were made at different locations in England. Of those, 29,555—about 45%—were alleged to have taken place in care homes. This is a big national issue.

Looking to the future, we must improve the law on wilful neglect. If a patient does not die from poor care and does not have a loss of capacity under the Mental Capacity Act 2005, guidance from the Crown Prosecution Service states that a criminal offence is difficult to identify. Given that, respected groups such as Age UK support the proposal that organisations—not just employees—found to have contributed to abuse or neglect in a care setting should be liable to criminal prosecution.

[Norman Lamb]

The hon. Gentleman is making some serious points. Does he welcome the fact that the Government have consulted on a change so that we introduce fundamental standards of care, and that those providers of care—the organisations, and indeed their directors—can be prosecuted for failures of care? That has not been possible until now due to a flawed regulatory system.

[Nick Smith]

I welcome that but I am not sure it goes far enough. I think the issue needs to be teased out further in this debate and possibly in the Bill Committee.

[Paul Burstow]

I know that the hon. Gentleman is campaigning hard on these issues at the moment. Does he agree that we need a clear criminal offence of wilful neglect in respect of people who have capacity, so that they are not left behind, as in the current position? If the Government cannot be persuaded—although I hope we can persuade them—of the case for a power of entry or power to interview a suspected victim of coercive abuse, they should at least adopt some sort of regulatory powers so that they can introduce such a measure later when they are finally persuaded by the overwhelming evidence.

[Nick Smith]

I thank the right hon. Gentleman for his suggestion. That seems possibly a good idea and something we should pursue in the future.

I congratulate my Gwent colleague, Lord Touhig, who tabled an amendment to the Bill in the House of Lords to introduce the offence of corporate neglect. If we do not get what is needed this time, I would like to table an amendment on the same topic in this House. I hope that following the welcome consultation on strengthening corporate accountability in health and social care that the Minister mentioned, the Government will now make our law fit for purpose.

I support clause 48, which was inserted in the other place and provides equal protection to all users of regulated social care, regardless of where that care is provided and who pays for it. As Age UK says,

“for those at the sharp end of indifference and abuse, it is essential that both the provider and the regulator have clear legal duties to protect human rights.”

As we know, social care and health are devolved issues in Wales, and last week the Welsh Government published a draft “Declaration of the Rights of Older People” to be considered by our older people’s commissioner and an advisory group. I warmly welcome that initiative and think the Government would be well advised to follow the example of Wales and appoint an older people’s commissioner for England—again, I know that the right hon. Member for Sutton and Cheam agrees.

Last Friday I visited the Rookery care home in Blaenau Gwent, now run by Four Seasons after the collapse of Southern Cross Healthcare. I saw how the implementation of the “Pearl” model of care for those suffering from dementia has seen medication levels plummet from around half to just 17% of residents. The staff were dedicated and caring; residents were comfortable and respected. That is the great care that everyone should receive.

A growing, complex market and tightening finances means that effective regulation and oversight is necessary. If neglect or abuse is found, those responsible must be held to account for their failures because the vulnerable and the frail have the same right to justice as everyone else. Older people should feel safe and secure in the place they call home.