Safeguarding Vulnerable Adults: Care Homes

Speaker’S Committee for the Independent Parliamentary Standards Authority – in the House of Commons at 8:44 pm on 26th February 2019.

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Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport) 8:48 pm, 26th February 2019

Thank you for calling me, Mr Deputy Speaker, and thank you for being in the Chair for my first Adjournment debate, which concerns such an important matter.

The UK has a world-class national health service, full of the most fantastic doctors, nurses and support staff. It is a testament to our fantastic NHS that, for decades, we have generally seen life expectancy increase across the country. With increasing life expectancy, however, we have seen a growth in degenerative diseases such as dementia. For families living with a relative with dementia, it is an incredibly difficult experience to see a parent, for instance, lose the ability to talk and forget the essence of who they are. You never forget the first time that they look straight through you, having no idea who you are. I am sure that the Minister will extend her sympathies to the families across the country who live with those circumstances day in, day out.

Many families are increasingly reliant on extra care facilities and nursing homes to manage the healthcare needs of their elderly and vulnerable relatives. They will therefore experience the heart-wrenching feeling of visiting dozens of care facilities and wondering if their loved one will be happy and safe there—will the care be good enough? Sadly, my family and I have found out what happens when the answers to these questions is no. While the majority of those working in the care sector are wonderful and deserve medals for the incredible service they provide, there are, as in any industry, those who are not, and who, sadly, prey on the vulnerable.

I am going to now share something that is not at all easy to talk about. Minister, there are some phone calls you never wish to receive, and I can say that one of them is the hushed phone call from a carer who knows your family, who tells you that as a matter of urgency you need to come to the care facility and check on your loved one because they have been hurt. Nothing prepares you for arriving to find your loved one with black eyes, bruises, cuts and blood on their face. And I can tell you, Mr Speaker, that nothing prepares you for discovering that these injuries in fact happened three days previously and nobody called you, no one alerted you, nobody called an ambulance despite the fact that somebody had a head injury, was on blood thinners and is elderly, and with not a single person—not one—having any answers as to how this may have happened or any proof at all as to how this occurred.

My father has dementia. It started very young and affects a part of his brain that is involved with speech. He is fully aware of everything and even has memory, but his days as a university lecturer would be hard to imagine now were you to meet him, as not only does he not speak, but he can only sing in his mother tongue—which I have never heard him even speak in my lifetime. This makes him extremely vulnerable as he is unable to communicate with those who do not know him. As his children, however, my brother and I can understand his body language and his emotions; we know when he is happy, we know when he is sad, and unfortunately we now know what his demeanour is when he is deeply, deeply frightened.

He was found extremely distressed by a carer covered in bloody injuries which would have caused a great deal of blood loss wherever they had taken place. To our horror we were told that he had not left the building overnight, there was no evidence of him having fallen and no other resident had any evidence of injury. Quite unexpectedly, the centre manager suddenly left and not a single person had any excuse for what had happened or why we were not called. Three days—three days—it took for us to receive a phone call, which came in the manner of a hushed call from a carer who was leaving the very next day. She said she was entirely aware that we had not been told and deeply thought that we should know.

As any family would, we complained immediately to Wandsworth Council, which contracts out the care to London Care, which manages Ensham House, which is owned and run by Optivo. I am sad to say that there our nightmare began, and that nightmare is the reason for this debate, for if two young professionals can endure what happened in the following months in pursuit of answers I fear deeply for the elderly in our community, such as the 80-year-old woman who herself is frail, who is caring for her husband with dementia, and who is too fearful to speak out for fear of going through what I am about to describe.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I congratulate the hon. Lady on bringing this matter to the Chamber. She and I spoke about it last night, so I had a bit of an idea of what the issues were going to be. I commend her for bringing us her personal story and this exposé of what has happened to her family. Does she agree that the ability of former owners and management of care homes that have received bad ratings simply to operate elsewhere under a new name is not conducive to openness and transparency, and that consideration must be given to introducing further and better regulation of the staff, management and ownership of these homes, which house some of the most vulnerable people in the UK? Unfortunately, we have had similar circumstances in Northern Ireland, and they are heartbreaking for the families. I understand exactly what the hon. Lady is saying.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport)

I thank the hon. Gentleman for his intervention, and I entirely agree with him. This debate is about safeguarding all our vulnerable adults, including his constituents and all the people up and down the country who want and deserve the very best for their families.

Photo of Peter Heaton-Jones Peter Heaton-Jones Conservative, North Devon

The hon. Lady is making an incredibly powerful speech, and I congratulate her on securing this, her first, Adjournment debate. The experience that she is sharing with us speaks volumes as to why we need to make improvements to the way in which care homes are regulated, and particularly to the way in which the complaints and concerns of relatives are dealt with. This Minister for Care and her predecessors in the role will know that I have raised consistently the case of my constituent, Mr John Barrass, whose mother passed away in a care home in circumstances that have never, in his view, been satisfactorily explained. He has fought for eight years to get the answers that he requires. Does the hon. Lady agree that the points she is raising illustrate only too well the need to ensure that there is more transparency and clarity for relatives?

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport)

I thank the hon. Gentleman for his intervention, and I am sorry that his constituent has had to live through that for eight years. I know how terribly difficult it has been to deal with such a situation for one year. His constituent is very lucky to have him raising this matter on his behalf again.

From the very first meeting with the safeguarding team at Wandsworth Council, my brother and I felt as though we were being put on trial. A new manager from Ensham House was present, but he had no idea about what had happened to my father, despite having been sent the horrific photos of his brutal injuries. The safeguarding team had not even looked at them. London Care had no answers as to why we were not called, and again had no answers as to how it could have happened. It was not until the wonderful police officer arrived, at my request, viewed the photos and showed visible alarm at the injury patterns that the Wandsworth Council staff actually took notice. I would like to extend my thanks to the fantastic police that we have in Wandsworth and up and down the country, who give of themselves day and night to ensure the safety of our community, even though they often stand up for people for whom they may never get answers.

It was agreed with Wandsworth Council’s safeguarding team that a police investigation would now commence, but it was explained to us that because Optivo housing association had not placed any CCTV cameras anywhere in Ensham House other than in the communal areas, and because my father could not communicate what had happened to him, it was very likely that we would not receive the answers we were looking for, and that a criminal conviction would be very difficult to obtain. As the police commenced their investigation, we expected the council to start conducting its own investigation, at the very least, because regardless of whether there had been criminal activity, questions needed answering. They were not answered, however.

In the following months, we found my father bruised again on two further occasions, with no explanation. He started to sleep in the communal area, for fear of being alone in his room. By this time, the Ensham House care staff knew that we were paying close attention because we were incredibly concerned, and that is when they started to attempt to claim that, despite a year of living there with no issues relating to him, my father was being difficult. The allegations were not corroborated by his community psychiatric team or any staff at the day centre where he spent up to 25 hours a week, and there had been no record of any issues prior to the first incident. Relatives of other residents started to tell us that staff had boasted that they were trying to get dad out because we were asking too many questions.

Photo of Marsha de Cordova Marsha de Cordova Shadow Minister (Work and Pensions) (Disabled People)

I congratulate my hon. Friend not only on securing this debate, but on sharing her personal experience. By doing so, I hope that we will see some change. Where Wandsworth Council and other councils contract out care to private providers, does she agree that the right checks and balances must be in place to ensure that her father’s situation happens to no one else?

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport)

My hon. Friend is absolutely right that this is about scrutiny, but it is also about saying that a Care Quality Commission rating is not good enough, because vulnerable patients cannot articulate their needs, fill in forms or speak the truth accurately to a shiny inspection team when a care facility prepares for their arrival.

Photo of Ruth Smeeth Ruth Smeeth Labour, Stoke-on-Trent North

My hon. Friend is brave to make a speech in the Chamber about her personal experiences. Does she agree that one of the most disconcerting things about what has happened to her family is to think about the impact on other families who are not as well informed or as articulate and who do not have a doctor or MP in the family? They will be vulnerable and distraught, but they will not have the opportunity to engage in the same way as my hon. Friend.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport)

It is for the very reasons that my hon. Friend so beautifully articulates that I am using this platform to raise this issue. This is no longer about my father; this is about every single member of our society—the veterans who fought in our wars, the older people who worked so hard for us to enjoy the liberty that we have today. I am speaking about this for our families, friends, neighbours, loved ones and the people to whom we owe our lives.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

I join colleagues from across the House in commending the hon. Lady on her incredibly brave speech. I am in awe of how she is articulating her case this evening. As a former co-chair of the all-party parliamentary group on dementia, I am conscious of the fact that we are at the start of a ticking dementia timebomb and that more and more people will fall victim to this cruel, horrible disease in the coming years, making them far more vulnerable in their communities than ever before. Does she agree that now is the time to ensure that the right safeguarding measures are in place, both for today and for the future?

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport)

I thank the hon. Lady—I will call her my hon. Friend—who is tireless in fighting against loneliness and for people to have dignity in their communities, and she makes the most essential of points: we are at the start of a ticking timebomb.

While all this was going on, my father was admitted to hospital one afternoon for a routine issue. As we were undressing him, we found bruises all over his body. Did the Ensham House care staff phone to check on him? No. Did Optivo show any care? No. Instead, we were served an eviction notice, detailing a list of allegations against my father without any evidence. How heartless is it to receive an eviction notice while in hospital? What did Wandsworth Council do at this time? Nothing. What was London Care doing? In the space of just five months, London Care had five separate managers at Ensham House. This all started after the first incident with my father. One manager after another came and went, unfamiliar with my father’s safeguarding cases. Some were hostile, others made up incidents involving my father being difficult. Dementia is a degenerative illness, but it does not spiral downwards overnight. Prior to those incidents, as I previously mentioned, not a single issue regarding my father’s difficult behaviour had ever been reported.

In all meetings, it was agreed that the extra care setting was appropriate for my father as he still knew his way around the area, he had a level of independence and my very young daughters felt comfortable visiting him there. Why deny someone their last few months of independence? The extra care setting was deemed by the social services team and everyone involved to be entirely appropriate for him. However, each time we interacted with Ensham House care staff following the first incident in which we found my father beaten, and when we had not been called, we felt as though we were on trial, that we had somehow made up the fact that he was acting afraid, and our concerns were dismissed by a different manager every month.

We found multiple examples of my father’s medication not being written on the drug chart, with London Care saying that he had refused medication when we had seen him take it. We even found one manager had written a note in the staff communication book asking staff to write negative comments about my father in his care notes. The final nail in the coffin, and the point of no return, was when we found my father unconscious on the floor, with blood on the walls and the floor, and a carer’s set of keys left next to him. Following this, he spent one month in hospital.

Four months after that final event in October, there was nothing from Wandsworth Council addressing any of these concerns. The catalogue of disasters crescendoed last week, when the director of adult social services at Wandsworth Council, Liz Bruce—who had refused to look at photos of my father’s injuries, did not know how many open safeguarding complaints there were relating to my father, did not talk to anyone else who knew my dad and had never met him herself—declared that my father had sustained the injuries because “he had asked for it.” Despite police voicing their concerns in the meeting and saying that they cannot rule out abuse, despite her failure to investigate London Care fully and despite her clearly having no detailed knowledge of the case, she chose to use Optivo’s letter, which was full of unsubstantiated claims in the language of the Ensham House managers, as her proof. Well, I think we can all agree that this is a dangerous, highly unprofessional and highly unsatisfactory approach.

Of course it is easier to blame the patient and the family, anything other than looking inwards and accepting responsibility for the fact that the council is awarding care contracts to organisations that are, frankly, unsafe. Quoting CQC ratings in safeguarding communications, when it is well known that patients are fearful to talk, is frankly unacceptable. If this were happening to the UK’s children, the country would be in uproar, and rightly so. Someone living with dementia is just as dependent in their final years as children are in their first years.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Digital, Culture, Media and Sport) (Sport)

I am just finishing.

With an ageing population and an increase in degenerative illnesses, this issue will only get worse. As parliamentarians, we must act now to ensure that even more families do not experience the horror of finding their loved one bruised, bleeding and terrified. We owe it to the elderly in our community. We owe it to the vulnerable. We have to be their voice. They should not be deprived of their quality of life. We must give our vulnerable a fair chance at ageing safely and gracefully. Their voices must be heard.

Photo of Caroline Dinenage Caroline Dinenage Minister of State (Department of Health and Social Care) 9:09 pm, 26th February 2019

I would like to start by congratulating Dr Allin-Khan on securing this debate. Her speech this evening has been described as brave, but she took the time out yesterday to talk me through this incredibly distressing case, so she has been brave twice. She deserves all our respect and credit for doing that, because, as has been pointed out by others, she is not just talking about her own individual case, tragic though that is, but by articulating it in such an incredibly courageous way, she is also helping to support others who do not have this opportunity to share their voice and raise their concerns in the same way.

Everyone in this House has the same motivation, which is to ensure that our care services for the most vulnerable people are safe and of the highest quality. The hon. Lady talks powerfully about dementia, which is a priority for me personally. I have experienced what it is like to have a close family member, my grandmother, living with dementia. So many people up and down the country share that experience, and I think we all recognise that a dementia diagnosis is one for not only the individual concerned but their whole family. That is why I am so passionate about the need to ensure that those affected by this condition and others are cared for in the best possible way and that a robust complaints process for redress is in place if their care falls short of that.

It would be bad enough if the terrible situation that the hon. Lady describes was taking place in care homes—that would be disgusting and terrible—but she is talking about an extra care facility. Such a facility is where people have their own self-contained homes; they have their own front doors and their own legal right to occupy. So this is a failure of care in someone’s own home—it is a domiciliary care situation. That is why I am even more concerned about what can happen behind closed doors in an individual’s own house. To have a loved one affected by a degenerative illness is terrible for the individual and a matter of huge worry for their family. So I have previously said in this House that every allegation of abuse and neglect should be thoroughly investigated, with prosecutions brought where this is found.

Photo of Alex Sobel Alex Sobel Labour/Co-operative, Leeds North West

First, I wish to pay tribute to my hon. Friend Dr Allin-Khan for her courage and alacrity in her speech. Some constituents came to me about their mother, who had been sexually assaulted in a care home, not by the staff, but by another patient. I was dismayed to hear that unlike nurseries, care homes have no minimum staffing ratio. Will the Minister look into having minimum staffing ratios in care homes, so that these events do not happen?

Photo of Caroline Dinenage Caroline Dinenage Minister of State (Department of Health and Social Care)

That is a very interesting question. I have not considered the minimum staffing issue before. We are of course very concerned about training and ensuring that all care staff have a care certificate, so that there is a minimum level of skills training. However, the point about ratios is interesting, and I will take it into consideration.

I do not have a massive amount of time left, so I am not going to discuss in full the details of the individual case raised by the hon. Member for Tooting. However, I must reassure her that what she has raised today is something I take very seriously. My officials have informed me that her raising her concerns so effectively and our inquiries from our office as well have prompted Wandsworth Council to hold another meeting today to discuss her case and review the evidence. As a result, there will be an outcomes meeting—

Photo of Caroline Dinenage Caroline Dinenage Minister of State (Department of Health and Social Care)

It will be held for all parties to consider recommendations going forward and the hon. Lady will be able to attend. We look forward to hearing the outcome, and we will all be keeping a close eye on what transpires.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

Does my hon. Friend agree that this is slightly shocking to us all and in particular the family member of the victim in question, who has not been told by the council that this meeting is taking place? In many respects, that is part of the issue raised by Dr Allin-Khan: the family of the victim have not been included in any of these discussions or any of this process in the first place.

Photo of Caroline Dinenage Caroline Dinenage Minister of State (Department of Health and Social Care)

That is a very fair point and I am very keen that family members should be involved in the next stage of this meeting going forward. I will be keeping a very close eye on whether that does happen.

In the last few moments available, I want to talk about some of the things we have been doing to protect vulnerable people and some of the actions people can take if, heaven forbid, they find themselves in a similar situation. The Competition and Markets Authority published its care homes market study in 2017, shining a light on some instances of very poor and unacceptable consumer practices in the care homes sector. We accepted all its recommendations and have been putting forward a package of measures to address this. The CMA has also recently published guidance that it provides to care homes on how to meet their consumer law obligations. That has been a key milestone for the sector, and I am encouraged by the commitment some providers have already made to challenge some unfair practices.

Individuals and their families always have a right to complain about the care in a care home or about a domiciliary home care provider. Care homes must make it easy to complain and deal with the complaint quickly and fairly. Any care home that does not meet its obligations is in breach of consumer law, as well as many other things, and could face enforcement action by bodies such as trading standards or the CMA. The CQC encourages the public to share their experience through an online feedback mechanism.

Of course, it is only worth having a complaints system if people know about it and how to access it, which is why, through a joint sector initiative called Quality Matters, we are taking action to improve access to complaints systems and improve the feedback culture in the sector. That is an ongoing piece of work involving the local government and social care ombudsman—to which complaints and concerns about adult social care should be raised—and Healthwatch.

We are committed to preventing and reducing the risk of harm to adults in vulnerable situations. We have made it clear that there is statutory guidance to support the Care Act 2014, and we expect local authorities to ensure that the services they commission are safe and of high quality. We also expect those providing the service, local authorities and the CQC to take very swift action if there are any allegations of abuse, neglect or poor care.

Under section 42 of the 2014 Act, local authorities have a duty to carry out safeguarding enquiries. To aid them in that, they have the power to request information from a provider’s business. The CQC monitors how well providers are giving that information. As part of its inspection regime, the CQC also has to check whether there are effective systems to help to keep adults safe from abuse. The CQC has a duty to act promptly whenever safeguarding issues are discovered during inspections. As the hon. Member for Tooting said, abuse is ultimately a police matter, and if it is suspected, the police must carry out an investigation to determine whether offences have been committed.

We have introduced the new wilful neglect offence specifically to help to eradicate the abuse of people who depend on care services. We have also introduced tougher inspections of care services by the CQC. Thanks in part to this strengthened regime, we have seen a steady improvement in the quality of services, with 83% of adult social care settings now rated as good or outstanding by the CQC. Obviously, every single incident like the one the hon. Lady described and every single concern raised by worried family members makes us want to redouble our efforts to raise the quality. We have been supporting the CQC to understand how it can better hold providers to account where there is any failure.

Let me end by highlighting the hon. Lady’s enormous dedication, representing not only her constituency but the whole country. Whether someone is looking after their own father, mother, husband, wife, son or daughter, we all expect the care provided to be caring and of good quality. We must work and redouble our efforts to ensure that where failure happens, it must be stamped out and cannot be allowed to continue.

House adjourned without Question put (Standing Order No. 9(7)).