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Nursing and Residential Homes

Part of the debate – in Westminster Hall at 12:03 pm on 3rd April 2001.

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Photo of Philip Hammond Philip Hammond Shadow Spokesperson (Health) 12:03 pm, 3rd April 2001

I, too, should like to congratulate Mr. Hughes on securing this debate. He expressed the principal worry that something needs to be done immediately--before implementation of the provisions in the Care Standards Act 2000--to ensure higher standards. My concern, which other hon. Members have already articulated, is that it is questionable whether the 2000 Act and the minimum standards that it will introduce will prove deliverable, given the financial constraints on the sector and local authorities.

I pay tribute to the hon. Gentleman and to others for their contributions, particularly Mr. Gale, who must have found it painful to mask his evident knowledge of, eloquence on and passion for this subject during the many hours in which he has chaired relevant Committees. He put his finger on the key issue when he talked about quality of care--it is indeed a question of measuring not size of rooms or numbers of staff, but the quality of care. Although I entirely agree that there is not a millimetre between the positions of the different parties and individuals in our ultimate aspiration to offer dignity and proper comfort to elderly people in their declining years, there are some differences about how to tackle the issues involved.

One of the important differences is the distinction between measuring inputs and outcomes. If we have a criticism of the Government's approach with the Care Standards Act 2000--and the national minimum standards set within it--it is that it is too prescriptive and too focused on measuring inputs. The Government have too much of a check-the-box mentality, ignoring at their peril the quality of care being delivered, which my hon. Friend the Member for North Thanet emphasised so strongly.

The Minister wrote to me recently in response to a letter that I sent regarding a nursing home in Essex that was under threat of closure. The letter said:

"homes which provide good quality care should have nothing to fear from the introduction of national standards."

There is a narrow definition of what constitutes good quality care. It is evident to me, to people in the sector and to my hon. Friends that homes that provide perfectly good quality care will fail to meet the mechanistic, bureaucratic tests laid down in the national minimum standards regulations. I question the use of a regulatory approach to drive up care standards. None of us disputes that regulations are required to ensure proper minimum standards and the safety and well-being of people living in residential care homes, but the Government seem to believe that we can legislate for everything, including good-quality care. While we need minimum standards to pick out rotten apples and protect people in residential care, it is essential to foster choice and diversity to ensure good standards of care.

Good standards of care are not only about measuring objective things; they are about empowering people. We must remember that residents in homes are people, not numbers or statistics. They will have different needs and wants, some of which may seem strange to those of us from a different generation, but which must be respected none the less. An essential prerequisite of achieving that choice and diversity and ensuring that quality provision can be purchased by responsible local authority purchasers is to secure the supply base and the volume of supply. Unless we can ensure that there is such a supply base, we shall run into Dr. Brand that local authorities will be faced with the dilemma of what to do with a provider who cuts corners and does not comply with the minimum standards regulations. Such local authorities will be placed in an impossible position. They must provide care for the people who need it, but the crisis in which the industry finds itself means that in many parts of the country--although not Dumfries, apparently--there is a significant under supply, which dominates the balance of power between purchasers and providers.

I want to highlight the fact that some of the minimum standards that are laid down under the Care Standards Act 2000 address the matters that need to be considered in a set of minimum standard regulations, and others effectively constrain choice in that they define for people what their choice should be. I put it to the Minister that in practice a prescriptive set of national minimum standards is stifling, not fostering, choice. We believe that that will not enhance the overall quality of care.