Registered Homes

Health and Social Services and Social Security Adjudications Bill [Lords] – in the House of Commons at 8:15 pm on 11 May 1983.

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Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health) 8:15, 11 May 1983

I beg to move amendment No. 15, in page 58 , line 38, at end insert— (aa) as to the numbers and qualifications of staff to be employed in such homes;(ab) as to the numbers of suitably qualified and competent staff to be on duty in such homes;'.

Mr. Deputy Speaker:

With this it will be convenient to take Government amendments Nos. 16, 19 and 20.

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

We have now reached that part of the Bill that deals with the improvements that the Government are making in the registration arrangements in England and Wales for voluntary and privately run residential and nursing homes. The Government readily acknowledge the valuable contribution that many private residential care and nursing homes make to the care of the elderly. We believe that it is important, if we are to make proper provision for rising numbers of elderly people, to encourage the growth and increased contribution of such homes.

At the same time, it is important to keep the proprietors of homes in close contact with local statutory bodies, especially local authorities and their social services departments, and, in the case of nursing homes, with health authorities. It is also important to ensure that the right standards are maintained because we want to ensure that, when elderly peple go into a residential home, they can be assured of an adequate quality of accommodation and staffing. When they go to nursing homes, they should be assured of adequate accommodation, staffing and the right level of nursing skill and care. That is why we introduced proposals which greatly improve the registration arrangements.

As well as primary legislation, we shall update regulations that will contain the most explicit requirements about the standards that must be provided for the care of elderly and frail residents. I am glad that a code of practice is being produced by a working party. That will ensure that the best practice is spread throughout all residential care and nursing homes.

In Committee, some hon. Members tried to improve the powers that we were giving ourselves to make regulations to ensure that they covered explicit concerns of their own. The amendments in this group honour the undertakings that were given to the right hon. Member for Norwich, North (Mr. Ennals) in Committee. Amendment No. 15 confers explicit powers to make regulations that govern staffing of a registered residential care home. We have already reached the stage of issuing a consultative note on the regulations. It proposes that the regulations should require, as appropriate, the size of the residential care home and the number, age, sex and condition of the residents and that there should be suitably qualified and competent staff to be available by day and night in numbers which are adequate". We had to take an explicit power to include that type of requirement in the regulations when they were finally drafted. Amendment No. 20 makes similar provisions for voluntary children's homes that are registered under the Child Care Act 1980.

Amendment No. 16 confers the explicit power to make regulations governing the absence of more than four weeks from a residential care home of the person registered in respect of that home. We decided that it would be best to specify the detailed requirements in the regulations proposed rather than to set them out in a schedule. In the regulations we propose to provide that notice of intended absence from the home shall be given to the registration authority at least one month before it occurs, unless the authority agrees to a shorter period. If the absence arises from an emergency, the notice should be given to the authority within a week of its occurrence, unless circumstances preclude that. The notice shall state for how long the registered person will be absent, or is expected to be away, the reason for the absence and the arrangements proposed for the management of the home in his absence. Further detailed provisions will be made after the consultation process when the full regulations are produced.

Failure to comply with the requirements will constitute an offence against the regulations, which carries a maximum fine at level 4, which is at present £500. I hope that the House will add to the welcome given to this desirable part of the Bill and will approve the amendments that we have tabled following our undertakings in Committee.

Photo of Mr Peter Griffiths Mr Peter Griffiths , Portsmouth North

Amendment No. 15 adds two subsections to the existing subsections of clause 19(1). I have expressed interest in the matter, and discussed with my hon. and learned Friend the Minister the qualifications of persons authorised to provide care in homes established under the Nursing Homes Act 1975 — what were called old people's homes before this legislation but which will now be called residential care homes. It creates a new category of home somewhere between the two traditional ones.

Nursing homes are subject to registration, control and inspection by the area health authority. In south Hampshire, there is a requirement that such homes will have a 24-hour cover from a state registered nurse. My hon. and learned Friend will recall that I wrote to him mentioning the wish of some proprietors to provide that cover with state enrolled nurses, whose qualifications are only slightly different from those required by the area health authority. My hon. and learned Friend referred me back to the area health authority on that matter, which was resolved satisfactorily, but since the publication of the Bill, and even since the publication of the amendments, I have received many representations from those who are unhappy with the way in which the supervision may be carried out in the new residential care homes.

The amendment provides that the Secretary of State will control the numbers and qualifications of staff to be employed in such homes and the numbers of suitably qualified and competent staff to be on duty in such homes. However, the problem, as presented to me by the proprietors of nursing homes registered under the Nursing Homes Act 1975, is that the residential care homes established under the Bill will care for not only the traditional elderly people in an old persons' home, but for those listed in paragraph 1 of schedule 4, which states that the homes will provide, whether for reward or not, residential accommodation … for persons in need of personal care by reason of old age, disablement, past or present dependence on alcohol or drugs or past or present mental disorder. I am a layman but it seems that these are persons who might well in the past not have been accommodated in what were called old people's homes but would normally have been accommodated in nursing homes where, for example, there was 24-hour nursing cover and staff capable of dealing with the problems of those with physical and mental disabilities.

9.15 pm

I understand that in the old people's home and in the residential care home there is no requirement that there be staff with medical qualifications to supervise those who are by definition disabled. The body that is charged with the supervision of such homes and the extension of them is the local social services department. Those who carry out inspections on behalf of the department do not have medical qualifications. They are more concerned about the administrative responsibilities of the home towards the social services department, with the general application of the regulations and with ensuring, for example, that there are proper conditions for people's privacy and adequate space for cooking facilities. They are not qualified to deal with those who are disabled who under the Bill will be specifically permitted to be accommodated in residential care homes.

I appreciate that this is a late stage at which to raise these matters. However, I raised them with the Under-Secretary on a previous occasion when he assured me that they had been fully considered and that the worries being expressed by nursing home proprietors were not justified. I hope that my hon. and learned Friend will be able to give me an assurance that when disabled persons are accommodated in residential care homes, as opposed to nursing homes, they will be provided with the sort of supervision that can be given only by qualified persons, and that the area health authority will also be included in the supervision and control of such homes where disabled persons are present.

Those who are disabled, either physically or mentally, require an environment that is enriching to the quality of life. They require facilities other than mere rooms and beds. They require a proper regime that will help them to maintain and develop themselves as full, responsible members of the community. It is that assurance that I am seeking on behalf of the responsible body which presently administers nursing homes with full nursing care, the relatives and others of those who may take accommodation in residential care homes and, not least, the disabled persons who, under the Bill, may find themselves living in residential care homes, which must, therefore, have adequate accommodation and facilities to look after them.

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

I think that I can give my hon. Friend the Member for Portsmouth, North (Mr. Griffiths) the reassurances that he seeks. We recognise that there is a clear distinction between the type of care to be provided by residential care homes and that to be provided by nursing homes. Nursing homes are specifically suitable for dealing with those who need professionally trained nursing care as well as the care and attention that they could get from sympathetic and skilled staff in any setting. For that reason the nursing home will have to satisfy the health authority of the professional competence and training of those who are giving nursing attention to the people who reside in the nursing home, whereas a residential care home will be inspected and registered by the local authority social services department, which is better placed to judge whether the general standards of accommodation, the good order of the home, as well as the general cleanliness and attention given to the residents, justify registration.

I know that there are those in the nursing homes movement who fear that residential homes may try to intrude upon the nursing homes. However, the present law even before these amendments is adequate, under the different Acts of Parliament that govern the two types of home, to ensure that it will be illegal for anybody running a residential care home to go too far and start providing the nursing and attention that needs the approval of a health authority and registration as a nursing home.

One change that we have made in the Bill is to allow a particular home to register as both types of home. This is a new provision for dual registration because we appreciate that there are some individuals who enter a home needing the minimum amount of care and supervision because they are reasonably fit and competent but who, as they grow more elderly, may acquire medical and other problems and need nursing care. It is desirable that the rules are not too inflexible, but that it should be possible in one place to provide the whole range of care that a resident may need for the last few years of his or her life. If a home wishes to do that, and wishes to take in residents and keep them there until their death, giving them the nursing attention that they require in the last few years, it will be necessary to register both as a residential care home and as a nursing home to satisfy both the social services department and health authority and to demonstrate in the case of the health authority that the nursing staff have the competence and training that it regards as satisfactory.

My hon. Friend the Member for Portsmouth, North expressed doubts about the residential care sector—the homes that do not attempt to go into nursing—hut the Bill and the amendments extend our power to make regulations to require adequate staff and staffing numbers and to inspect them regularly. The regulations that we propose to make will particularly insist that suitably qualified and competent staff shall be available by day and night in numbers that are adequate and will require the registration authority, the local authority, to inspect the residential care home not less than once every 12 months. It will enable a local authority to carry out inspections at any time and at more frequent intervals if the local authority finds it necessary in the case of any particular home about which it has doubts.

Nobody who provides valuable care such as this to the old and the disabled need fear that other people will intrude on their province and provide a lower or inadequate form of care or be allowed to pretend that they are offering skilled nursing attention when they are not. The range of legislation that the Bill improves and extends will make sure that the best standards are maintained and will make it easier for us to go on to give that help and encouragement to those who provide nursing homes and residential care homes because, with the rising number of elderly, we shall need more of such provision of the right type. This paves the way to welcome growth in such provisions.

Amendment agreed to.

Amendment made: No. 16, in page 58, line 41, at end insert— (ca) as to the giving of notice by a person of a description specified in the regulations of periods during which any person of a description so specified proposes to be absent from a home;(cb) as to the information to be supplied in such a notice;'. —(Mr. Garel-Jones.]

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

I beg to move amendment No. 17, in page 60, line 37 at end insert— '23A. In section 1 of the Nursing Homes Act 1975—(a) the following sub-paragraph shall be added at the end of paragraph (c) of subsection (1)—"(v) treatment by specially controlled techniques.";(b) the following subsection shall be added after that subsection—(1A) In subsection (1) above 'specially controlled techniques' means techniques specified under subsection (3) below as subject to control for the purposes of this Act.(c) at the end of paragraph (e) of subsection (2) there shall be added (but not as part of sub-paragraph (iii)) the words "unless they are used or intended to be used for the provision of treatment by specially controlled techniques and are not excepted by regulations under paragraph (g) below"; and(d) the following subsections shall be added after that subsection—(3) The Secretary of State may by regulations specify as subject to control for the purposes of this Act any technique of medicine or surgery (including cosmetic surgery) as to which he is satisfied that its use may create a hazard for persons treated by means of it or for the staff of any premises where the technique is used.(4) Without prejudice to the generality of section 19 below regulations under subsection (3) may define a technique by reference to any criteria which the Secretary of State considers appropriate.(5) In this section 'treatment' includes diagnosis and `treated' shall be construed accordingly.".'.

Mr. Deputy Speaker:

With this it will be convenient to take Government amendment No. 18.

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health)

The effect of the amendments is to confer a power on the Secretary of State to extend by regulations the range of premises that are required to register under the Nursing Homes Act 1975. The two amendments arise directly out of the great public concern that has recently been expressed about the improper use of lasers and the giving of laser treatment to patients by people who are not qualified to give that treatment or perhaps have some medical qualification but are not skilled in the use of the particular equipment that they are using on the patient. There is some evidence that that treatment has been given in premises that are not registered for use as a clinic.

The media has focused its attention on this subject. The television programme "That's Life", which is compèred by Esther Rantzen, and which is not always popular with hon. Members, has been conducting a considerable campaign on this subject for the past few weeks. Doubt is not cast about the proper use of lasers in medicine, which is well-established in several specialties. Evidence was produced by the "That's Life" programme and by other branches of the media to show that some people had been given less than adequate laser treatment. It is possible to give some forms of laser treatment in premises that are not registered for the purpose or inspected.

The Nursing Homes Act 1975 covers a wide range of establishments in the private health care sector, from large acute hospitals to small nursing homes which provide long-term care, as well as day-care clinics providing surgical procedures under anaesthesia, endoscopy and dialysis. The laser treatments can usually be described as surgical procedures, but are not always given under anaesthesia. There was, therefore, a doubt whether the present legislation actually required the registration and therefore inspection of the procedures that were being used for laser treatment. The Government have decided to close that loophole which will enable the Secretary of State, following necessary consultation with interested parties, to ensure that by extending the definition of a nursing home premises in which certain equipment is used are required to be registered with the appropriate district health authority. The amendment does not specify lasers. The Government have taken the opportunity to extend the definition to a range of treatments and specially controlled techniques which may enable us to extend these provisions to cover other potentially hazardous techniques used in premises in connection with the treatment of patients. The Government will include within the regulations the use of lasers for surgical purposes. At the same time, the opportunity will be taken to consider whether other potentially hazardous techniques should be included. This would be a welcome improvement.

Before anyone is allowed to use the premises for such purposes the premises will have to be registered as a nursing home and the person seeking registration will have to satisfy the health authority that the applicant or any person employed or to be employed by the applicant is a fit person to be employed in the home. Furthermore, the health authority must be satisfied after examining the position, construction, state of repair, accommodation, staffing and equipment of the premises that they are fit to be used as a nursing home. The authority must be satisfied that the premises will not be used for purposes that are in any way improper or undesirable. The authority will also have to be satisfied that the home is in the charge of a qualified nurse or a registered doctor. Health authorities will be required to inspect homes for registration purposes. Should they find that the persons administering the home or in charge of the home either lack the qualifications or skills required or appear in any way to be improper persons, the registration can be withdrawn.

The effect of carrying out operations of this type in unregistered premises, where a health authority has inspected and refused registration or where registration has not even been applied for, will be that fines may be imposed to a maximum of £1,000. If the premises continue to be used, charges can be repeatedly brought and fines repeated until the abuse is stopped.

The Bill provides a welcome opportunity to close a potential loophole in the law. I am unable to comment about the specific cases that the television programme and other lobbyists on this subject have brought to the Government's attention. However, each and every complaint either against a person or about premises will be investigated by my Department, although the General Medical Council is the relevant body to deal with allegations of unprofessional conduct against doctors. I am sure that it will use its powers to the full in appropriate cases. The amendment puts the legal provisions right and will ensure that the health authorities use the powers that we are giving them. The General Medical Council will, I know, use the powers that it has and I hope that we shall not see a repeat of the fears expressed at present about the kind of treatment given by a few doctors at a few clinics in and around London.

Amendment agreed to.

Amendments made: No. 18, in page 60, line 39, leave out 'the Nursing Homes Act 1975' and insert 'that Act.'.

No. 19, in page 61, line 22, at end insert— '25A. The following paragraphs shall be inserted after section 5(1)(a) of that Act—(aa) make provision as to the giving of notice by a person registered in respect of such a home of periods during which he or, if he is not in charge of the home, the person who is in charge of it, proposes to be absent from the home;(ab) specify the information to be supplied in such a notice;(ac) provide for the making of adequate arrangments for the running of such a home during a period when the person in charge of it is absent from it;".'

No. 20, in page 70, line 6, at end insert— '38A. In section 60(1)(a) of that Act after the word "accommodation" there shall be inserted the word ", staff'.'. —[Mr. Kenneth Clarke.]

Photo of Kenneth Clarke Kenneth Clarke Minister of State (Department of Health) 9:30, 11 May 1983

I beg to move amendment No. 21, in page 74, line 30, leave out 'welfare' and insert `social'.

This is, in effect, a drafting amendment which replaces "experience in welfare work" by "experience in social work" to enable a person to qualify for appointment to the panel of experts for the registered homes tribunals. There was some discussion about it in Committee and I think that all Committee members agreed that the rather old-fashioned term "welfare work" no longer had clarity of meaning. Everyone understands what "experience in social work" means, and we have taken this opportunity to insert a tnore up-to-date and suitable phrase into the legislation.

Amendment agreed to.