Regulation of Care Homes

– in the House of Commons at 10:04 pm on 30th October 2002.

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Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

Photo of Vincent Cable Vincent Cable Shadow Spokesperson (Trade and Industry), Liberal Democrat Spokesperson (Trade and Industry) 10:05 pm, 30th October 2002

I am grateful to have the opportunity to introduce an Adjournment debate on an issue that concerns many of us—the problems associated with residential care homes for the elderly. I was in the Members' Dining Room a few moments ago, and I noticed a headline in today's Evening Standard:

XBetrayal of the Helpless. Standard inquiry reveals appalling regime of neglect in private care home for elderly".

That did not relate to the home to which I shall refer, but it could have done. Despite the introduction of a regulatory system and the National Care Standards Commission, the problem is widespread.

The matter that I want to raise primarily concerns a home called Lynde House, in Twickenham, which is owned by Westminster Health Care. It differs significantly from the home described in the Evening Standard article, as it is owned by one of the largest groups in the country. It is a particularly luxurious home, which, none the less, has been subject to an independent investigation, which I instigated, and which has produced some damning conclusions. I want to describe to the House and the Minister the process through which we had to go to secure that inquiry and its aftermath. I also want to raise some of the wider policy issues in terms of how the National Care Standards Commission will manage its relations with very large private providers, and some of the unresolved questions about how standards will be defined and monitored under the National Care Standards Commission.

I shall start with a narrative of how this situation arose. I became a Member of Parliament in 1997, and, shortly afterwards, I was invited to another care home in my constituency called Brinsworth House, of which the Minister may have heard. It is a famous care home for the elderly, where many retired comedians, musicians and variety artists reside. Thora Hird is among its current residents, and Arthur Askey was a resident there. It is a wonderful institution. I was called in by the general manager, who pointed out a serious problem affecting his home—a care nurse had abused elderly patients, and he had taken steps to have the person dismissed. He had discovered, however, that that person had been hired by another care home down the road a few days later.

The general manager called me in for two reasons. First, he wanted me to note that appalling things were happening in the unregulated private sector, that people were being hired and rehired who were well below acceptable standards, and that it was very important that the Government grasped the need to regulate the sector properly. Secondly, he wanted me to go to the local press to publicise the fact that his home had had this problem and had dealt with it. I took that to heart, as it struck me as being an exemplary way in which providers of care for the elderly in the private sector should deal with problems: in an open, transparent and public way, with nothing to hide.

Having seen that experience and good practice, I was well prepared for the events as they unfolded in relation to Lynde House. I had been made aware throughout most of last year of a growing number of complaints from relatives of residents of the home who lived in my constituency. That came to a head in November when the Catholic priest in an area of Twickenham convened a public meeting—with the local Anglican priest—to draw attention to serious concerns among some of his parishioners about care in this home. I attended that meeting, at which I heard a horrifying succession of deeply felt, very emotional presentations by relatives about the experiences that their mothers and fathers had had.

There was a common thread to the reports. Despite paying extremely large fees—typically, #30,000 a year—the residents had experiences such as sitting for very long periods, being unable to attract attention after ringing bells, sitting in their own waste and being unable to attract any nursing or care attention in an understaffed environment. Perhaps most serious of all was the climate of bullying that existed. Examples were given of old people in their 80s or 90s being expelled or being threatened with expulsion because they had complained about the problems associated with care in the home.

What was worse was that the residents and their relatives told me that they had approached the local health authority—the regulatory body in this instance—and had not been able to attract a reply. They had been reassured that everything in the home was absolutely fine. My concerns developed in the wake of the meeting even further when I was approached by a judge, who asked to meet me anonymously. Despite his senior position in public life, he was clearly a frightened man. He said that he wanted to tell me some things that had happened in the home, but did not wish his name to be used. He was afraid that, if it were, there would be retaliation against his mother who was in her mid-90s. I also spoke to the local GP who told me similar stories about what had been going on. She expressed her concerns and told me that she had approached the health authority, but had been unable to attract a response. She was assured that the home had been inspected and that everything was absolutely fine.

I then wrote a letter to the chairman of the health authority, drawing these points to her attention. Somewhat to my surprise, a few days later I was contacted by the head of Westminster Health Care, Dr. Patel, the owner of the home. Without my knowledge, the health authority had copied to him my letters of complaint, so he said that he wished to set up a meeting with me. We met over breakfast, and that was very charming at one level. However, he threatened me with legal action because I, as the Member of Parliament, had written to the health authority asking for an investigation into conditions at the home. That brought home to me strongly the type of experience to which people at the home were subjected. There were threats of intimidation and legal action if perfectly legitimate points were brought into the public domain.

I then asked the chairman of the health authority, Councillor Julie Ray, to institute a full inquiry into the home and, much to her credit, she agreed. One of the positive elements of this case is the fact that the health service is publicly accountable. She acknowledged that there was a problem, and agreed to set up an independent investigation under a well respected, independent person, Mary McLaren.

Although it was far from the end of the saga, the report was completed last December and January. It did not appear. I was informed that it was stuck because of objections made by Westminster Health Care lawyers. The matter went on and the report was refined. It was officially reported to have been finished by May, but it could still not be released because of objections from lawyers. A public report instituted by the health service and of wide public interest could not be released into the public domain because the company objected to its findings.

The report was eventually released, but I shall not test the Minister's patience by going through it in excruciating detail. However, I wish to report simply for the record some of the main conclusions. They were extremely hard hitting, and half a dozen or so of the main points will capture the flavour of what was found to have happened in the home. The report said that the home:

XAllowed insufficient levels of staff to operate on occasions which did not meet the high level of resident need...Allowed inadequately trained staff to undertake the care tasks and procedures required . . . Allowed nursing staff to continue to undertake poor practice i.e Wound Care, Record Keeping, Drug Administration, Ear Syringing . . .

Failed to ensure that housekeeping and cleanliness standards were maintained at all times as domestic staff only worked until 14:00 hours . . . Allowed unacceptable levels of maintenance of hoists, wheelchairs and other equipment, which put the safety of residents at risk . . . Allowed the unacceptable provision of equipment that did not meet Health and Safety Legislation . . . Allowed an Internal Complaints Management system . . . to continue that made access to . . . Senior Managers seem impossible . . . Allowed an apparent climate of fear and intimidation as perceived by some relatives and residents . . . Allowed an apparent closed organisation that did not encourage 'whistleblowing' by staff when some were very unhappy with certain situations despite a written policy and in our discussions with some staff . . . Undertook a recruitment process . . . that allowed appointed care staff to undertake tasks without fully assessing their competence in a working knowledge of English."

That was in a home that charged fees of #30,000 a year.

The criticism did not end with the home. There were also strong criticisms of the national health service in its capacity of regulator. Two in particular merit comment. The first is that

XThe Health Authority failed to implement a robust complaints system in relation to Lynde House which investigated in-depth, repeated concerns raised by relatives...when it was evident that according to the allegations the care was less than adequate".

The second criticism is that it

XFailed to recognise deficiencies during the team visits and inspections".

Subsequent to the report, the new strategic health authority for south-west London convened a public meeting. It is greatly to the credit of that body that its representative made a public apology on behalf of the NHS by admitting that it had failed in its supervisory responsibility, and apologies were expressed for the distress caused. However, no apology or regret has been expressed by the company. Indeed, it published a rebuttal of every criticism made.

We know from hearsay that Dr. Patel has left the company. I believe that he has also resigned from a series of Government working parties on which he was an adviser and from other charitable bodies. Some of the senior management associated with the home have been moved, or possibly dismissed, although that has never been explained. However, the company has made no public acknowledgment that it was at fault, and that remains the position to this day.

On the back of that, I want to pose a series of policy implications that arise from the events. How will the commission manage and supervise a system in which one of its largest private providers is in default of its obligations and refusing to accept any admission of failure? There is a distinction between a home that gives problems and a company that gives problems. The report makes that clear when it says that

XUnder the registered homes act"

Westminster Health Care

Xis a corporate organisation and the body corporate is the one registered and accountable."

We have to deal with how far the company as a whole is responsible for the deficiencies in one of its establishments.

Since the report was published—it received a great deal of publicity in the national press—I have been deluged with letters from people around the country, bringing my attention to abuses in other Westminster Health Care homes. I now have a substantial dossier of cases, some of which are very serious, relating to at least seven homes owned by the company. I intend to ask the commission if it will investigate the company as a whole.

Let me cite one problem. It is not in my constituency, so I cannot follow up the individual case, but it gives a flavour of the difficulty. A former nurse who worked at one of the homes in Southgate wrote to me. She said that she

Xbecame seriously concerned about dangerously low standards of care and incompetent management, which eventually forced me to whistleblow to the Health Authority . . . I was appalled that my grave concerns were ignored by WHC and the Health Authority. I was constructively dismissed . . . and forced to pursue a new career . . . Westminster Health Care use bullying and intimidatory tactics to silence anyone who questions and complains about the standards of care."

That is exactly the pattern of behaviour that we saw in Twickenham and has been reported across the country.

Many individual patients and their relatives and carers have written to me. One particularly distressing case concerns a former Labour MP, Michael English, who may be remembered, who was the victim of some of these difficulties. I intend to bring those cases to the attention of the commission.

How will the Government, through the commission, deal with such cases? If a company is in denial and is comprehensively mismanaging its collection of homes, the commission has only a nuclear option—it can withdraw the licence, which means that large numbers of residential care homes are taken out of use. Is it possible to have a graduated response? Are there any penalties or sanctions that can be applied to signal to a major private provider that its service is not acceptable and that it is behaving arrogantly in refusing to accept the judgments of independent inquiries appointed by the NHS? The point could then be made without closing down a share of the private sector.

My second set of questions relates to how standards are to be applied within the new regulations, and I am concerned about two or three in particular. It is clear from the Lynde House experience that the contracts between the families and the home were not satisfactory. They provided insufficient protection and were insufficiently clear. Does the commission have it in mind to consider the nature of contracts in the private sector? Will it provide model contracts or explore how existing contracts can be improved?

Is it proposed that bigger companies, which clearly have more resources and are better able to meet standards than one-man, one-house companies, can be asked to operate at higher levels of performance? I am thinking particularly of training. The level of training in the company that I have mentioned was seriously deficient. Would not it be good practice to ask the company to have its own training institution? How can the commission advance that process?

My final question relates to staff and to a problems with staff who are unprofessional and who create serious disciplinary problems. Is there any system within the commission's approach to enable such people to be tracked, so that other homes that hire them have some cross-reference? At the moment, such staff seem to disappear into a void. Will there be a central register of staff so that issues pertaining to a lack of professional conduct can be addressed?

I want to pay tribute to those who have brought this matter to the attention of the public. Many are vulnerable people who have had a devastating personal experience, and they have been very brave. They were initially threatened with legal action and bullied, but they have come forward and made their case in public. I am bringing it to the House because it is part of the process of ensuring that they receive justice.

Photo of David Lammy David Lammy Parliamentary Under-Secretary (Department of Health) 10:23 pm, 30th October 2002

I congratulate Dr. Cable on securing this debate, which is clearly topical and important. All hon. Members want the best for our older citizens, and their treatment is crucial in any civilised society. For that reason it is vital for people to be able to depend on the quality of care homes, and the best way to ensure that quality is through a sensible regulatory regime. I am therefore pleased to have the opportunity to discuss that regulation.

The hon. Gentleman began by bringing to the attention of the House the article on the front of today's Evening Standard, which claims to have carried out an investigation into a care home in Birmingham. The paper's reporter was in the Alexandra nursing home for three weeks, and alleges that she uncovered a catalogue of abuse and neglect.

I make it clear, on behalf of the Government, that care homes for older people look after some of the most vulnerable people in our society. That is why the Government set up the National Care Standards Commission. The commission has been given the power to ensure that poor standards are a thing of the past and together with it, we are committed to tackling the abuse and neglect which sadly still take place in some of our homes today. It is important to point out that we provided local authorities with #300 million, half of which has been used to support the care homes sector. More than #9 million of that money has been allocated to Birmingham city council.

I shall meet the hon. Gentleman on the historical point with which he began. In the 1980s there was a huge expansion in the number of care homes, when uncapped social security money was available for publicly funded people entering residential care. Money flowed from the public purse into the care home sector. Indeed, it was the Conservatives, then in power, who sought to limit severely that unplanned and uncontrolled growth. In those days, entry to a care home was not based on need or user choice, but was driven by providers in the independent sector, which led to the unnecessary and completely avoidable admission of many older people and others into institutional care.

Until 1993, the care home market was not strongly regulated. There were registration and inspection processes, but they were nothing like as robust as those which the Government have put in place. The system of standards introduced by this Government replaced a system in which care homes were regulated by about 250 local authorities and health authorities, each applying its own standards. The old regulatory system had been criticised for many years for lacking independence, consistency and coherence. In the absence of proper checks of individuals and homes, the most dreadful abuse was perpetrated. It was not by any means confined to the independent sector but was very significant in the public sector during the 1980s and 1990s. Indeed, independent providers themselves have been the strongest lobbyists before and after the introduction of the 1990 Act to remove regulation from local control and introduce a level playing field for independent and local authority provision. They have argued strongly for consistency through the use of national standards. It is this Government who have answered those concerns. We have gone one step further than our predecessors and created a regulation body wholly independent of local health and social care agencies.

The hon. Gentleman asked a number of questions about the National Care Standards Commission, which is rightly independent of the Government—it would be wrong for me to attempt to tie its hands at the Dispatch Box. I heard what the hon. Gentleman said about seeking a meeting with the commission to draw these matters to its attention, and I do not doubt that members of the commission will read Hansard tomorrow, and the issues that he has raised can be addressed. However, I am advised that the nature of the allegations mean that legal action may take place so I must be careful about what I say.

Under the Care Standards Act 2000, we made the National Care Standards Commission responsible from 1 April 2002 for regulating—registering and inspecting—all care homes. The commission is part of the Government's programme for modernising social care, particularly for improving quality and protection for people in care services. It is a major non-departmental public body, independent of government.

The commission's main aim, rightly, is to drive up the quality of services and improve the level of protection for vulnerable people in our society, by the regulation of social care and independent health care services. The commission has taken over the regulatory responsibilities of local authorities and health authorities.

We believe that people's safety and well-being are paramount. The new standards will ensure that poor-quality care is a thing of the past. They give care home owners a clear idea of the standards that they have to meet to gain and maintain registration, and users and their carers know what they can expect as a minimum. At the outset, we were aware of concern shown by care home owners that they would struggle to meet some of the standards. That is why we decided that the more challenging standards need not be implemented until 2007, and providers will be given realistic timetables to meet them.

However, we went further than that—the Government also issued comprehensive statutory guidance to the commission setting out the supportive way in which the standards should be applied. The guidance indicates that the standards should be used to help guide care homes on action that they can take to improve their services. Most importantly, the guidance also states that the commission should consider whether care homes could fulfil the needs of service users without making environmental changes to meet the standards. The guidance particularly covers the issues of room size, lifts, baths and shared rooms and has been welcomed by the major associations representing care homes.

The hon. Gentleman spoke eloquently about the problems at the Lynde House care home. I have every sympathy with the concern of the relatives of the residents of Lynde House nursing home to ensure that their relatives are properly cared for, and that where failures in care are identified, those responsible are brought to account. However, I hope that the hon. Gentleman will understand that I am unable to comment in detail on complaints about the running of individual care homes, such as Lynde House. It is not that I intend to be unhelpful in this regard, but the responsibility for ensuring the quality of care provided by care homes lies clearly with the regulator, and proceedings against an individual for neglect or abuse is a matter for the courts.

Until April this year, nursing homes were regulated under the Registered Homes Act 1984 by the health authority in which they were located. Responsibility for considering complaints about nursing homes rested primarily with the relevant health authority as the regulator and the health services ombudsman. I understand that Lynde House was first registered with Kingston and Richmond health authority in 1996. Kingston and Richmond's regular inspections led to recommendations being made to the home owners, who complied with those recommendations.

As a result of on-going concerns expressed by relatives of the residents of Lynde House, Kingston and Richmond health authority commissioned an independent inquiry into the home. The McLaren report was published on 21 August. Kingston and Richmond health authority was dissolved in April 2002, and responsibility for the findings of the McLaren report falls to Richmond and Twickenham primary care trust and the South West London health authority.

How we care for vulnerable people is a matter that we consider to be very important. That is why we introduced the Care Standards Act 2000 to improve the regulation of social services, including care homes. Under the Act, the National Care Standards Commission now regulates all care homes in England. Although the commission has no jurisdiction over the McLaren report, it has completed its first inspection of Lynde House. The commission's inspection report was made available to the residents and relatives of Lynde House on 18 July at the regularly scheduled residents meeting. Action plans have been agreed with Lynde House to address the issues that have arisen out of the inspection, and time scales have been set for requirements to be met. That should ensure that residents receive appropriate good quality care that meets their needs.

The commission will, of course, be monitoring Lynde House on an on-going basis, and we would expect it to take swift action to deal with any failures by the home. I understand that the National Care Standards Commission, the local strategic health authority and primary care trust are also working together to ensure that lessons are learned from the events at Lynde House. I hope that this sorry episode can be brought to a satisfactory conclusion for all those involved.

In conclusion, I stress that we have ensured that the introduction of the standards will safeguard and maintain high quality care homes. The emphasis will be on ensuring people's safety and not on instantly de-registering—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-five minutes to Eleven o'clock.