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Nursing and Residential Homes

Part of the debate – in Westminster Hall at 10:59 am on 3rd April 2001.

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Photo of Simon Hughes Simon Hughes Shadow Spokesperson (Home Affairs) 10:59 am, 3rd April 2001

That general market economy argument is controversial. If supply is greater than demand, that does not always mean better quality. Logically, that should deal with some of Mr. Brand and local authorities should then have a choice, but a proper regulatory regime is necessary. Adequacy of supply is important, but we do not have adequacy of qualified and competent people to work in existing homes.

Privately run care homes--or even those in the voluntary sector--need to keep their costs down, so they may employ the least qualified staff because they are cheaper, and offer the poorest quality of care. I have done some work and have examined the legislation, but I am still unclear about the requirements, so should be grateful for a specific answer from the Minister today.

I discovered in a meeting that it is sufficient to have only one qualified nurse responsible for 24 residents in one of those nursing homes. I understood from that meeting that, although the nurse on duty had to have assistance, there was no requirement for any of the assisting staff to have qualifications. I accept that Southwark, like other local authorities, has specifications for the provision of nursing care homes, setting out matters to do with staffing and so on. However, can families be certain now--without waiting for the new regime to kick in--that every member of the full-time, part-time and agency staff working in a care home has no relevant criminal conviction or a previous employment record, rendering them unsuitable or undesirable for work in that environment? What guarantee is there that the staff have sufficient qualifications to do the job properly? Several issues that have been gathering over the years strike me as troubling, such as the issue of general qualifications and capability.

It has been pointed out to me that there have been advertisements for German students to work in a care home as a holiday job, for example. Often residents and retired workers who have tried whistleblowing have let us know that care workers have been found asleep when they should have been awake, that they look after themselves before the residents and do not pay attention to what is going on. I have been told that some residents have found it almost impossible to understand what care workers are saying, as their level of English is so poor. I appreciate that there may be a racism issue underlying that complaint, but whether someone comes from Finland or Zaire, a resident's care is not helped by not being able to understand what is being said. Therefore, we must consider the important issue of basic literacy, numeracy and intelligibility in carrying out care functions.

How can the public get quick, effective, authoritative checking and inspection of homes and achieve resolution of issues of concern? When the community health council in Southwark has had matters brought to its attention, the general secretary has gone to check and look round homes, often amid considerable antagonism. An extraordinary story was told by the deputy leader of the council when she and my colleague, Councillor Capstick went to Southwark Park home. They went in without being checked and wandered round. When a fire alarm sounded, the only people who moved were the staff. The person on duty appeared to believe that the two councillors were agency staff and started issuing them with instructions, even though they had never been seen before. That sort of thing causes considerable concern.

I do not pretend that looking after old people is easy. It is tough and I know that I could not do the job well. Some old people can be extremely demanding. I have done my stint as a hospital porter and looked after old people as part of holiday jobs when I was a student. I know how difficult it is. The objectives of the Care Standards Act 2000 must be achieved. The quality standards are urgently needed. I have heard too many complaints over the years about the standard of care in geriatric wards of good hospitals like Guy's and St. Thomas's. I have been in too many residential and nursing homes, some very expensive ones, where there is no stimulation and very little personal care. People are got up, put in a chair in front of a television, given their food and sometimes assisted with the toilet, although they may have to wait a long time for that. Even though geriatricians say how important it is, residents never enjoy the stimulus of being with young people or animals or of going out in the fresh air.

Having cared for relatives who have become senile and suffered badly from the aging process, I know the frustration that families feel when their elderly relative grows old with no dignity. I had an aunt in an old people's home who was surrounded by people who did not know what day of the week it was and who were talking nonsense. It was sad and depressing and I remember thinking that I would far rather that she was taken out for a ride every day in her wheelchair with the risk that she might not live as long, because at least she would have been having a good time. If she had a bit of a bumpy ride and a caught a cold while out in the fresh air, it might be far better than sitting cocooned indoors all day in that sterile atmosphere.

There is no difference of aspiration between hon. Members. The debate is not meant to be critical of either Labour or Conservative Governments. We all strive after the same thing, but my concern is what we can offer now until the higher standards to which we aspire are legally required. For some people it is already too late and others need a response urgently. We are going to have an inquiry in Southwark. The local authority will have a scrutiny panel. The local council and the health authority have accepted my request for an independent inspection and an independent inquiry. I hope that that will be carried out soon by someone who does not have a vested interest in the finances. I hope that it will raise the standards. I should be grateful if we could know what the minimum standards are now and what we can do if we find homes where there are so few qualified staff. What can we do to ensure that there are enough good places in nursing and residential homes, which we will need as we have more and more older people?