Contact in Care Settings

Nigel Evans Excerpts

Thursday 27th October 2022 Commons Chamber

[Dan Carden]

I am grateful to the right hon. Member for that intervention. The Government have previously pointed to guidance as a defence against bad practice, and we have enough evidence to show that that is not good enough. Indeed, while there are excellent examples of good practice across the sector, significant levels of uncertainty and variability throughout the system seriously undermine the rights of individuals. The guidance leads to a postcode lottery as separate settings interpret guidance differently.

That difference is compounded by the response of the Care Quality Commission, which is an organisation that many have had difficult and negative interactions with. The Government encourage those affected to report care providers who do not meet the guidance to the CQC, but by then it may be too late. The poor response is not because the CQC ignores complainants, although there was evidence of that as well, but that it simply does not have the proper powers or data to support people who have their access rights compromised. In the CQC’s own words:

“We do not have the power to require care homes to report live data on levels of visiting, neither do we have the power to take action against those care homes that are not reporting changes to their visiting status to us.”

The CQC, which regulates all health and care services in England, bases its enforcement action on the capacity tracker. However, providers are not obligated to use the tool—they are merely encouraged. That has led to very little, if any, clarity on the true extent of the problem.

By comparison, in Scotland, the National Care Service (Scotland) Bill, places a duty on Ministers to require providers to comply with any direction made regarding visiting. What assessment has the Department made of the Bill and would it be minded to introduce similar provision in England? The evidence suggests that the only way to guarantee contact in care settings is a legal right to an essential care supporter. An essential care supporter would be able to visit or accompany a person in any health and care setting to help communicate their wishes and needs, and to ensure they receive the correct care. If the Government are serious about their support for these calls, if they are serious about acting in the interests of families and loved ones, if they are serious about balancing clinical restrictions with the impact of restrictions on residents’ health and human rights, then I ask the Minister to immediately consider how to put that into law.

I cannot think of any other issue that commands such unanimous cross-party support. Indeed, as my right hon. Friend the Member for Leeds Central (Hilary Benn), who I know supports these calls wholeheartedly, said at our meeting in Parliament:

“How can anyone be opposed to this?”

There are also 35 organisations in this area who support these calls, including Mind, Mencap, Disability Rights UK and Dementia UK. The new Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay), has previously signalled support for this right. We are ready and willing to work with the Government to make this legal right a reality as swiftly as possible. The Joint Committee on Human Rights has also been unequivocal in its call for legislation in this area. In its report from July this year, “Protecting human rights in care settings” it stated:

“The Government must introduce legislation to secure to care users the right to nominate one or more individuals to visit and to provide support or care in all circumstances, subject to the same infection prevention and control rules as care staff.”

We have not yet had a response from the Government to that report, so may I ask the Government Minister to take that up? We have opportunities in the draft Mental Health Reform Bill and the Bill of Rights to codify this right. The Government could also introduce secondary legislation, which I know campaigners are in favour of. Will the Minister meet me, others and the affected families as soon as possible to discuss making this right as strong and effective as possible? The Government have previously said that legislative options are under active consideration, so please can the Government give much more specific detail on what that actually means?

I want to finish by paying tribute to the tireless campaigning of organisations in this area, in particular the Rights for Residents campaign group, the Relatives and Residents Association and John’s Campaign. The work of Jenny Morrison, Diane Mayhew, Helen Wildbore, Julia Jones, Nicci Gerrard and Kate Meacock has been absolutely inspirational, and they are all in the Public Gallery today watching this debate. Their dedication to this campaign has been phenomenal. I pay tribute to them. In the face of immense loss and personal grief, they have shown incredible selflessness and service to guarantee that no other family member will have to endure the pain of being denied contact again.

Families do not deserve any further delay; they have suffered enough. We must learn from this trauma and bring in legislation. I hope that when the Minister rises to give the Government’s response, she will agree and set out the steps that we can take to get this right.

[Mr Deputy Speaker (Mr Nigel Evans)]

Deepest condolences on your loss, Dan.

I call the debate’s co-sponsor, Tracey Crouch.

[Tracey Crouch (Chatham and Aylesford) (Con)]

Ordinarily when we stand up in the Chamber, we say that it is, for example, “a pleasure to follow my hon. Friend,” but given the very powerful speech from the hon. Member for Liverpool, Walton (Dan Carden), may I say that it is an absolute privilege and that I am very humbled to follow him in this debate, which I am very proud to co-sponsor? I echo his thanks to the people who have engaged with us and taken time to give us their testimony, especially the groups and the people he referred to, as well as those who have sent briefings for the debate.

In 2015, my father had a stroke, which left him physically and neurologically impaired, requiring him to spend the rest of his days in residential nursing care. My sister and I visited him on a regular basis, observing his decline from manly patriarch to someone with childlike vulnerabilities in just over the course of a year. I will not romanticise the relationship that I had with my father, which had been fractured since my teenage years, but I can honestly say that those months of us visiting him in care were the closest that we had felt to him in years. It is true to say that, during covid, I often remarked that I was glad that he had died long before the pandemic, because while no one wants to see their parent or loved one lying on a bed—a thin, pallid skeleton—saying their final goodbyes, blessings or apologies hours before their death, nor should they be denied that right.

Tragically, during the pandemic, and in some cases still today, many of my constituents and others around the country were denied visiting rights, whether that was to care, to celebrate or, sadly, to say goodbye. We should pause for a moment to cast our minds back to the start of the pandemic in early 2020, when the virus was ripping around communities, transport systems, offices, retail places and, of course, health and social care spaces. It was killing people in large numbers, especially the most vulnerable in society. People were frightened and our understanding of the virus was limited. We went into lockdown and isolated our loved ones because we thought that it was the kindest and safest thing to do. We all understood why.

When I looked back through my casework files in preparation for the debate, I found hardly any complaints about limited access to relatives in the first lockdown, because in a Blightyesque spirit, we got on with it and found alternative ways to communicate with those we could not ordinarily see. Many of us here stamped our feet about care workers not getting enough personal protective equipment and rightly included them in our doorstep clapping, because they were heroically looking after their residents when family and friends could not visit any more. We understood the fear that if one resident caught the virus, it could be devastating for the entire setting, and the duty of care that they held. But then lockdown ended, the summer arrived, the virus declined, our understanding of it improved and our hopes of going back to see residents in health and social care settings were raised—yet when I looked at my casework, I saw that that was when the problems began, and, unfortunately, they still continue.

I stress that I am in no way criticising any individual care home manager or any staff for the examples that I am about to cite. My criticism lies squarely with the Department of Health and Social Care. Its guidance that was published for managers to interpret was wishy-washy at best and is why I now firmly believe that, although we can still respect the individual business that a care home is, a right of access should be enshrined in law to give the manager, the resident and the relative clarity about visiting.

In November 2020, I was contacted by Francesca, whose nan was admitted to a care home following a short stay in a local hospital. Francesca’s family were not able to visit, despite having been told that Francesca’s nan was dying and that they would potentially be allowed only a one-hour goodbye. That was hugely distressing, not only for Francesca and her family but for her grandmother, who was coming to the end of her life without her loved ones around her.

The guidance was often cited, but its lack of clarity left care settings making decisions that were understandably in their own interest, but not in the interest of the resident or the family. After my intervention, visits to Francesca’s nan were allowed and goodbyes were said, but the uncertainty and distress caused could perhaps have been averted with a simple right of access that was clear in its intention.

Likewise, Mura’s mother was in a specialist nursing home that houses some very vulnerable and elderly people. Everyone, including Mura, understands the need for caution. When the virus surged in December 2020, care settings like the one that Mura’s mother was in effectively went back into lockdown. Named visitors were allowed if they underwent testing, a process that no relative has ever complained about. However, because the guidance enabled homes to design and implement their own covid outbreak procedures, many were able to prevent access even to the defined essential care giver, denying love and support from loved ones during another period of isolation.

One important point was reiterated when I listened with colleagues to powerful and—as the hon. Member for Liverpool, Walton said—harrowing testimony on access and support rights from campaigners, many of whom are in the Gallery today. This is not just about older people in care homes, or those at the end of life. We heard from Wendy Mitchell, who is living well with dementia, as those who follow her joyous Twitter feed know. She highlighted her experiences of going to appointments alone during the pandemic. I do not need to explain in detail the utter idiocy of allowing people with dementia to attend a healthcare setting where there are discussions about condition, medication and so on. In the head of a 1970s scriptwriter, it would have formed an idea for some sort of sketch show, but it is serious and potentially extremely dangerous.

Youngsters fared particularly badly during the pandemic, and those within care settings were affected quite acutely. I was reading back through my correspondence relating to a young man called Thomas, who has learning disabilities and is in a residential care home. He had a birthday coming up, but the care home was denying his parents the ability to take him home to celebrate, despite the fact that it was—wonderfully, I hasten to add—taking Thomas out for community visits. My correspondence to the care home explains perfectly well what the problem was:

“I have managed to speak to colleagues in both the Health Department and the Education Department about Thomas’ particular set of circumstances and both encouraged me to look at the ethical framework that care settings are required to operate under. I was also reminded that those with learning disabilities, such as Thomas, are not considered clinically vulnerable and therefore do not require shielding in the same way as others with significant health conditions.

I know that Government guidance in residential settings has not exactly been perfect and that care home managers and teams are doing their absolute best to navigate their way through, doing what they think is best for both the client and their staff. However there is a difference between the home Thomas is in and that of an older much more vulnerable person and therefore flexibility is perfectly possible.

It is with that in mind, and with the guidance for the whole nation being slowly eased to allow greater human interaction, alongside an appeal to your sense of compassion given Thomas’ mother’s deteriorating health condition, that I write to urge you to reconsider your decision to not allow Thomas to visit his family home tomorrow for his birthday. There are no ‘rules’ that stop you from doing this and I know that the family will forever be grateful.”

I am pleased to say that the home did allow Thomas to go home for his birthday, but the fact that Thomas’s case related to two different Departments, and the unclear guidance, caused great anxiousness.

In September 2020, a similar case arrived from Dawn about her son with complex medical needs living in 24-hour nursing care. She rightly noted the impact that the first lockdown had had on her son. She wanted me to write to the then Minister, who I am pleased to see back at the Dispatch Box today, to make it clear that a family member could be recognised as an essential part of the care home staff and be allowed to come as much as any member of staff. She felt that homes like the one that her son was in were never mentioned because people automatically thought of care homes in respect of our elderly population. I think that Dawn’s message and that of many others was heard, but its application remains sketchy, even today. [Interruption.] Oh—here is a lesson for Members: make sure you take the last page of your speech off the printer. [Laughter.]

Having reread the accounts of those cases and having listened, back in March, to the testimony of others who had suffered as a result of being unable to visit loved ones, I believe it is a no-brainer to have an absolute position on this matter. The guidance was not clear enough, and it caused distress to residents and relatives as a consequence. I know that the Minister will cite CQC guidance, but it is not strong enough, which is why so many now feel that it needs to be enshrined in one form or another. The Minister will note that there is cross-party support for such a move. We could do it quickly, in time for the winter, so I hope she will consider our pleas seriously. This would protect care home managers, as well as giving residents the right to have their loved ones with them providing whatever support and care are necessary.

We can learn a lot from the pandemic, and I am sure that we will. One of the lessons must be about the devastating impact of isolation on the physical and mental health of those in social care settings. Let me finally repeat my initial point, drawing on my experience with my own father, six years after his death. No one wants to see their loved one vulnerable, incapable of basic functions or in their final hours, but nor should anyone be denied that important time with them. Sadly, many were and some still are, and it is with that in mind that I urge the Minister to think carefully about her response this afternoon, but ultimately to introduce legislation as soon as possible.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call the other co-sponsor of the debate, Daisy Cooper.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

Four Back Benchers wish to contribute, and we have three Front-Bench contributions and Mr Carden at the end, so I ask people to consider the length of their contributions. We will be going to the wind-ups just after half-past 4.

--- Later in debate ---

[Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)]

On a point of order, Mr Deputy Speaker. I made a speech in the previous debate on the national food strategy and food security and I inadvertently forgot to declare my interest in the Register of Members’ Financial Interests as a farmer and a Fellow of the Royal Institution of Chartered Surveyors, for which I wish to apologise to this House and to put the record straight.

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the hon. Member for his point of order and for making it at the earliest possible opportunity. That is now on the record.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

I thank my hon. Friend the Member for Liverpool, Walton (Dan Carden) and the hon. Members for Chatham and Aylesford (Tracey Crouch) and for St Albans (Daisy Cooper) for securing this hugely important debate. I hope my hon. Friend the Member for Liverpool, Walton will forgive me for saying that I thought he spoke incredibly bravely and powerfully about his father, who I am sure would be very proud of him today.

The terrible consequences of banning families from seeing their loved ones in care homes is an issue very close to my heart. It is something that Labour has been campaigning on since the very first covid lockdown in June 2020. Indeed, we first called on the Government to bring forward a legal right for care home residents to see a family member or friend in February 2021. We continue to do so today because, as we have heard in the debate, this issue has not gone away, and because with winter almost here and, God forbid, in the event of any future pandemics, we need to ensure that the rights of residents and relatives are clearly guaranteed by law. We make this case because it is good for residents, good for family members and good for care staff.

I will say more about that later, but I want to start by thanking the organisations that have campaigned so hard on this issue, including Healthwatch, Mind, Mencap, the Alzheimer’s Society, Parkinson’s UK, Dementia UK and Disability Rights UK. I especially want to thank the Relatives and Residents Association, John’s Campaign and Rights for Residents, which have been at the forefront of the campaign. In particular, I pay tribute to Jenny Morrison and Diane Mayhew from Rights for Residents—two phenomenal women who have blazed a trail on this issue. After their terrible personal experiences, they set up Rights for Residents, to give a voice to all the other care home residents and families who had been banned from seeing their loved ones. The reaction to their campaign has been astonishing, which I saw for myself on joining them in Downing Street—or, rather, locked outside it—in September 2021, when they presented a petition calling for a change in the law, signed by more than 250,000 people.

Almost all the campaigners I met had never been involved in protests or petitions before. They were not there because of any political agenda, but because of their personal experience and the fact that they wanted to see a change. The reason why so many people joined Jenny and Diane is that this issue really matters. It matters to the thousands of families who have faced unbelievable anguish, guilt and distress because they were banned from seeing the people they love most—their mothers, fathers, husbands, wives, brothers, sisters, sons and daughters—at a terribly frightening time. It matters because of the physical and mental impact that isolation has on older people and, as the hon. Member for Chatham and Aylesford said, crucially, on people with physical and learning disabilities. We have heard much evidence about increased depression and anxiety, and people losing weight because they are not eating. The truth is that, as the hon. Member for St Albans said, families are not just visitors; they are an essential part of the care given to residents, and should be treated as such.

Banning families from seeing their loved ones also matters to care home staff. There is lots of international evidence that staff in many countries have faced increased workloads because some of the emotional and other support that was normally provided by families, such as helping people with eating and taking them on walks, completely disappeared when they were banned.

There is much I could say about all the powerful things that hon. Members said about their constituents; I was contacted by many deeply distressed constituents too. Because time is short, however, I will emphasise something that has not really been mentioned today, which is that families have always understood the need to protect their loved ones from covid and never wanted to expose them to unnecessary risks. All they wanted was to be treated the same as care home staff. They could not understand, once the PPE, testing and vaccines were finally available, why they were banned and treated differently from everybody else.

Throughout the pandemic, the Government have resisted calls for residents to have a legal right to see their family member. They have consistently said that the guidance they issued was enough, but the guidance, which changed more than 30 times during the pandemic, is not enough, as we have seen time and again. I will make two points. First, anything that is issued 30 times will be totally unclear. People will lose track and it will not be properly followed. Secondly, the clue to the problem with guidance is in the name—it is guidance, which can be ignored.

Neither is oversight from the CQC enough. The Joint Committee on Human Rights said in May 2021 that there was an

“astonishing lack of awareness by the CQC as to whether care homes are…allowing visits”.

The Chair of the Committee, my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), said at the time that the CQC’s assurance

“that visits are being allowed…is wholly unconvincing”.

We have heard evidence today that that remains the case and we know that the guidance and regulations are not working or being enforced.

The Relatives & Residents Association and Rights for Residents recently surveyed more than 650 families. They found that visiting restrictions during the majority of covid outbreaks between April and September this year were more restrictive than advised by current Government guidance. One in five outbreaks saw residents confined to their rooms. One in nine outbreaks saw residents not allowed any visitors at all. Shockingly, 45% of families who responded said that there were visiting restrictions in place despite there being no covid outbreaks. That is why those organisations have repeated their call for a new legal right to guarantee people’s access to in-person support from at least one care supporter—a person important to them, such as a relative or friend.

Opposition Members agree, as does the cross-party Joint Committee on Human Rights, which says that the default position must be that those in care homes can receive visits from a “significant person” and that blanket bans are in breach of the legal right to family life. We can learn quite a bit from other countries on this issue. I understand that the Dutch Parliament recently accepted a corona Act that guarantees that each resident has the right to welcome at least one visitor in the case of covid-19 outbreaks.

I ask the Minister to look at this subject again. She should heed what families want, what organisations representing residents and families demand, and what is done in other countries, and put this legal right in place.

[Mr Deputy Speaker (Mr Nigel Evans)]

I remind the Minister to leave a couple of minutes at the end for the hon. Member for Liverpool, Walton (Dan Carden) to wind up.

--- Later in debate ---

[Dan Carden]

I am grateful to you, Mr Deputy Speaker, for chairing the debate. I was watching the faces of the campaigners in the Gallery, who I am sure wish they had a voice in the Chamber. Having said that, I will take the Minister at her word. It may have been a bit much to ask that, on her first day, she would commit to legislation, but she knows that the campaigners will not be going away and that I and other hon. Members will continue to make their case.

We must put right what has gone wrong during covid. Loved ones are an essential part of care and, as many colleagues have said, there is an easy solution: essential care givers and loved ones should be treated in the same way as staff. The only way to resolve the situation is for this place to put a right in law through legislation. I think that we can all agree on the principle that, whether it is the state, a privately run care home or a hospital, it does not have the right to separate family and loved ones. The right to visit a loved one in a care setting is one that we should all enjoy across the country.

[Mr Deputy Speaker (Mr Nigel Evans)]

It has been a privilege to chair this emotional and effective debate.

Question put and agreed to.

Resolved,

That this House has considered the matter of guaranteeing the right to maintain contact in care settings.

[Sarah Jones (Croydon Central) (Lab)]

On a point of order, Mr Deputy Speaker. The shadow Home Office team has been seeking clarity on security breaches involving the Home Secretary and serious discrepancies in the information provided to Parliament. Yesterday, the Prime Minister stated in this House that the Home Secretary

“made an error of judgment, but she recognised that, she raised the matter and she accepted her mistake.”—[Official Report, 26 October 2022; Vol. 721, c. 289.]

That was contradicted last night by the former Conservative party chairman, the right hon. Member for Rossendale and Darwen (Sir Jake Berry), who stated that the Home Secretary was presented with evidence of her breach, rather than proactively reporting it. Similarly, the Home Secretary has claimed the breach related to a written ministerial statement on immigration, but the former Conservative party chairman claimed it related to cyber-security and other media reports state it was a set of Cabinet papers.

The Cabinet Office has now reportedly confirmed that it will investigate neither the circumstances of the Home Secretary’s original departure nor her reappointment. These are questions of national security and are incredibly serious. The public and Parliament deserve answers. Mr Deputy Speaker, this is the latest in a series of attempts to get answers. I ask your advice on how we can compel the Home Secretary to come to this House and answer questions about the accuracy of her resignation letter and the media briefings that have followed.

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the hon. Lady for her point of order and for advance notice of it. The Chair does not have the power to compel Ministers to come to the Dispatch Box in the way that she is asking, but there have been previous points of order on this matter and urgent questions—indeed, it was raised at Prime Minister’s questions. I know that the next question time for the Home Secretary is some way off, but none the less I have no doubt that there will be other opportunities for this matter to be raised. Those on the Treasury Bench will have heard the point of order and will ensure that it is brought to the attention of the Home Secretary.