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NHS (Elderly People)

Volume 476: debated on Tuesday 20 May 2008

It is a pleasure to be under your watchful eye, Mr. Atkinson. I recognise that I must approach this important subject with a degree of caution. If my remarks are not balanced, it will diminish the arguments that I seek to make. I shall therefore start by putting on record the fact that millions of elderly people are treated successfully every year in the national health service. Staff across the NHS do heroic work to care for people whatever their age, and we owe those dedicated professionals our profound thanks. My family and I have received superb care from the NHS, and while spending a day as a porter at my local hospital, the Royal Berkshire hospital, I witnessed superb care being given to elderly patients.

However, I would not want that glowing accolade to cover up the key point of this debate, which is to show that there are problems with care for the elderly in the NHS. I aim to draw to the House’s attention the plight of a minority for whom hospital is a frightening and often unpleasant place. I am sure that I am not alone in finding in my postbag and hearing in my surgeries increasing concern about the negative experiences of elderly patients in hospital. That does not necessarily apply only to my local hospitals; people come to us to talk about the treatment of relatives all over the country.

The moving force behind my application for this debate was a well-known constituent of mine who contacted me. The name Jenny Pitman will be familiar to anybody who has been involved or has an interest in racing, but her name has gone further. She is not just a successful trainer of grand national winners; she is a woman of huge strength of character and forthright views. Having recovered from cancer herself, she knows all about how the NHS works. Her elderly but hitherto healthy father died of clostridium difficile in a local hospital. That tragedy prompted her to make some remarks that hit the national press. After that, she was deluged with letters and e-mails from around the country detailing horrific cases of appalling care standards and neglect. She has shared that correspondence with me. I have some of it with me today, and I intend during this debate to give voice to the many families who have experienced the distress of witnessing a loved one die through neglect or receive treatment that falls short of the standards that we all expect. I shall detail some of those tragic cases in order to highlight the range of ways in which elderly patients are being failed by the NHS, outlining problems with hygiene, a lack of basic care and respect for patients, poor nutrition and, perhaps most importantly, a lack of specialist training in dealing with the elderly, particularly those with dementia.

It is important to note that older people are the main adult users of most NHS services. However, it is clear that the NHS is not organised with older people’s needs at the forefront. That is not just my view; it is also the view of Age Concern. Recent research by the British Medical Association showed that doctors believe that health care services for elderly people are simply not good enough. The research found that eight in 10 doctors believe that health care services for older people are not up to scratch, and only one in 10 believes that enough money is being spent on care for the elderly in the NHS.

I congratulate my near neighbour on securing this debate on an important issue. He referred to the level of resourcing; we are all aware of the challenge presented by an ageing population. Does he agree that many instances of inappropriate care or lack of adequate nutrition—constituents have certainly drawn to my attention cases of people not being fed properly in hospital—have less to do with the level of resourcing than with the need to improve training and supervision in hospitals on day-to-day care, such as actually feeding people rather than just putting a tray in front of them? That is something that we all want to see.

I agree entirely. The right hon. Gentleman makes a good point. Nobody in this House would deny that enormous resources have been put into the NHS. I am simply voicing doctors’ opinions on resources as expressed through the British Medical Association. He is absolutely right: the problem is often not financial but cultural, the result of individual, fairly low-level managerial decisions, and it can be rectified without any great call for new resources. However, I shall come to that in a minute.

On 13 March in this Chamber, Members debated the 2007 report of the Joint Committee on Human Rights on the human rights of older people in health care. The report—this is the point that the right hon. Gentleman alluded to—found that a complete change of culture is needed to protect the human rights and dignity of older people in the NHS. Health care professionals as well as patients are speaking out, and it is important that the Government not only listen but act.

Our ageing population is arguably a product of the NHS’s success in other areas. There are just under 5 million Britons aged 75 and over, and the number of people over 85 will double nationally in the next 20 years. In my constituency, and possibly that of the right hon. Gentleman as well, it will double in the next 10 years. Unless we address the problems now, we face a demographic time bomb that will cause huge problems for future health care provision. With more elderly people in the UK relying on the NHS for treatment, it has never been more important that the problems with standards of care for the elderly are addressed.

I should like to extend this debate to the issue of care for those with learning difficulties, but I recognise that an important inquiry is going on in the Department of Health involving six cases, one of which occurred in my constituency. We await the report, which is the product of important work by Mencap, but it is vital to recognise that too many cases of unforgivable neglect occur because staff have not had the time, training or ability to attend to their patients’ most basic needs. That must change.

It is clear from reading just a few of the letters that Jenny Pitman and I have received from people whose elderly relatives have had unpleasant or upsetting experiences in our hospitals that the problem—when it occurs; it is important to make that point—lies in an absence of the most basic care. Nursing staff are clearly overstretched. There are far too many patients per nurse. As a result, the most fundamental aspects of care, such as feeding, changing and bathing, are being overlooked.

I spoke this weekend to a nurse who discussed the shortage of nurses going into geriatric care. She told me how an average shift is structured. It is not unusual for half of it to be taken up with—I shall choose my words carefully—bodily functions: bedpans, soiled bed linen and so on. It is not glamorous work. It can take about 45 minutes to feed a patient. While doing their best to keep the ward clean, cater for new admissions and handle patient crises, NHS staff just do not have the time to give the level of care that most of them would like to give.

One constituent told me of the experience of his father, Mr. Albert Unwin, who died earlier this year. Mr. Unwin went into hospital for treatment for a knee injury. He was left in a side room, unable to get out of bed and with his urine bottle and emergency alarm out of reach, for long periods. On one occasion, Mr. Unwin grew desperate and, hearing voices outside the room, started shouting to get a nurse’s attention. Twenty minutes later, and growing increasingly desperate, he was forced to use a Marmite jar left beside his bed to bang on his metal rails to draw someone’s attention. Another 20 minutes later, a nurse came in and chastised him for making such a racket. Where is the dignity and, more worryingly, the care, in that?

All too often, it seems that older people are being made to feel invisible in our hospitals and driven to “misbehaving”—that was the word that the nurse used in that case—to get the attention of staff when in urgent need of assistance. Cases such as Mr. Unwin’s prove that simple elements of care, such as ensuring that a patient’s emergency alarm is within reach, are not being carried out, resulting in unnecessary distress to patients. Just last month, the Department of Health released figures on its website revealing that despite massive investment in the NHS, the patient experience is actually getting worse. Hospital standards have slipped on cleanliness, friendliness and comfort from last year.

A student nurse wrote to Jenny Pitman outlining her own experience working in a hospital. She exposed massive understaffing resulting in the gross neglect of elderly patients, and recorded incidents of patients being left sitting in their own faeces and ending up with severe bed sores, of rough and disrespectful treatment of patients while washing and of a shocking lack of attention to cleanliness, whereby wash bowls were not changed or properly cleaned between patients—that means patients having their faces washed in a bowl that had cleaned previous patients’ bodies. Nobody can read that e-mail without being profoundly shocked. I recognise that it is an exception, but even with that caveat it is absolutely disgraceful that such things happen in this day and age.

Unfortunately, such reports of a lack of attention to hygiene are a recurring theme in letters that I receive. As we know, hospital cleanliness is of the utmost importance, particularly for elderly patients, who are known to be the most vulnerable to superbugs such as clostridium difficile and MRSA. According to the Health Protection Agency, in 2007, there were an estimated 49,785 record cases of C. diff across the UK in patients aged 64 and older, and 6,383 reports of MRSA between 2006-07. Professor Brendan Wren, from the London School of Hygiene and Tropical Medicine, claims that 6,500 people die of C. diff in UK hospitals every year, which is the equivalent of one person dying every hour in our hospitals. In 2003-04, there were 7,700 reported cases of MRSA, which means that there would have to have been a total of 3,850 or fewer cases of MRSA last year to meet the Government’s target. However, HPA figures released in April showed that there were 3,471 cases in the first three quarters, meaning that we really must question whether the Government are meeting their target for controlling such hospital-borne infections.

Frankly, infection control in hospitals needs improving, and the lack of management of infection control in some hospitals, wards, and hospital facilities needs to change. Although it is encouraging that work is being done by PCTs and trusts to tackle the issue of cleanliness in hospitals, more needs to be done. I accept that we are deep cleaning our hospitals, but there is no evidence that this is a long-term solution. What really needs to be addressed is the attitude of staff to hygiene through managerial support and appropriate training, so that cleaning wash bowls, for example, becomes a priority, rather than something that can be overlooked owing to lack of time. Regular hygiene control must become a habit, rather than a one-off.

I have tabled some written questions on venous thromboembolism, which is known as the silent killer, cases of which have increased dramatically—in fact, my predecessor but one as the Member for Newbury, died of just that condition. I feel very strongly about it, and we are starting to see an increasingly huge number of claims against the NHS. It is an area of concern that will mirror concern about MRSA and C. diff in coming years.

An issue that seems disproportionately to affect older people in hospitals is the lack of dignity that they are afforded. The fact that grown adults, who have worked all their lives, brought up and supported families and even fought for their country are being left in their own faeces for hours on end, or told off for trying to draw someone’s attention to the problem, is a national disgrace. Unfortunately, however, that is not the only way in which an older patient’s dignity can be taken away. There are more subtle, but always equally upsetting, ways in which older people are being degraded while in hospital.

The Healthcare Commission reports that the three most common causes of complaint in relation to dignity were patients being addressed in an inappropriate manner, being spoken about as if they were not there and not being given proper information. Those seemingly small things combine to make the experience for vulnerable, older patients not only degrading but often frightening and upsetting. One case of best practice that I particularly liked, which I heard about from the same nurse at the weekend, was the displaying of photographs of patients by their beds, showing them in younger years. She described someone near to the end of her life—a husk of a body—next to whom was a photo of her, in earlier years, as a head teacher of a much-respected local school. All around the ward, there were pictures of patients as soldiers, parents and pillars of the local community. That brought home to the staff working there that they were dealing with real human beings who deserved the respect that they were giving them.

Mixed sex wards also continue to be an issue—my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, has been talking about this today—affecting older patients’ sense of dignity. Despite the Government’s repeated promises to abolish mixed sex wards, there has been a disappointing lack of progress, with targets being missed and many elderly patients being inappropriately placed in mixed sex wards. The Healthcare Commission’s 2007 annual inpatient report showed that one in four patients had to share a sleeping area with the opposite sex when first admitted to a hospital ward. In his reply, I hope that the Minister will talk about that and say, in particular, what defines a mixed sex ward. For example, we know that elderly people are concerned about walking past other wards containing people of the opposite gender on their way to use the lavatory. This needs to be looked at through the eyes of the patient. I am aware that Lord Darzi has started to retract the pledge given on mixed sex wards, but this remains a matter of great concern to elderly people.

Older patients are more likely to have health issues additional to those for which they are being treated in hospital, of which dementia is a leading example. The lack of training and knowledge in our hospitals for dealing with patients suffering from dementia is of very great concern.

I thank the hon. Gentleman for securing this debate and for allowing my intervention. The all-party group on dementia, of which I am a member, produced a report on the use of antipsychotic drugs in the care of dementia entitled “Always a Last Resort”, and last Wednesday, I introduced a ten-minute Bill on the same subject. One in three of over-65s—that includes us in this Chamber—will face dementia towards the end of their lives. Does he agree that his description of the inadequacies in training should include the inadequate training for dealing with dementia? Half of patients in private care homes being prescribed antipsychotic drugs had their prescription started in hospital. Too frequently, antipsychotic drugs are used because staff do not have the time or training to deal with some of the distressing symptoms associated with dementia. That is a really crucial issue that I hope will be addressed in the national dementia strategy, which will be published later this year. Does he agree with that?

I certainly do; and I hope that the Minister will touch on the national dementia strategy and training.

I shall come on to the transfer of responsibility for the patient from the hospital to social services. The control of drug use by a patient with dementia is very important. That is particularly relevant to me, because someone in my community found themselves in that situation recently. The hon. Gentleman was absolutely right when he said that the work of the all-party group was vital. He will be much missed in the House when he hangs up his boots because he has great experience in issues such as this. It is vital that the Government listen to such views.

I was told about a patient who was suffering from dementia. She was left unfed for long periods of time, and often had full plates of food taken away because no one would help to feed her. Even if she had been able to feed herself, it would not have helped because the food was often left out of reach. The patient’s daughter was forced to go into hospital at meal times. That is not a one-off case. Patients’ families often have to make the time to go into hospital to feed a relative because no one else is doing it. When the daughter asked a member of staff why they would not feed her mother she was told that the “demented”—she actually used that word—had a choice to eat or not and that it was not the job of the staff to feed them. That was in a hospital in Kent. Again, with my caveat that such examples are the exception rather than the rule and that much wonderful work is being done, the fact that that happens once in this country is something that many of us find deeply shocking.

Dementia sufferers need a completely different level of care from other patients. The fact that our hospitals often cannot provide such care is a matter of deep concern. The right hon. Member for Islwyn (Mr. Touhig) made a very good contribution in the debate on the Public Accounts Committee report last week. He said that

“between half and two thirds of people with dementia never receive a formal diagnosis at all, let alone an early diagnosis. Absurdly, many dementia sufferers are not diagnosed unless they go into hospital with another illness or an injury.”—[Official Report, 15 May 2008; Vol. 475, c. 1599.]

The PAC report said that the main obstacle that prevented correct and early diagnosis is GPs’ poor knowledge and lack of training. It said that compulsory training on dementia or older people’s health is not a statutory part of GPs’ training and there is no requirement in their continuing professional development to study older people’s mental health.

Would the hon. Gentleman further agree with me that in cases in which there has been best practice in the treatment of dementia in its early to middle stages—both in private care homes and in the NHS—non-pharmacological approaches are often much more successful because they do not damage the quality of life, shorten life or increase the risk of stroke and all the attendant problems that are associated with the use of antipsychotics?

The hon. Gentleman makes a very good point. As a layman, I would like to understand why drugs are being prescribed in a different way in different parts of the country. For example, I would like to know why, in some places, treatments other than antipsychotic drugs are being prescribed. The fear is that a dementia patient can be put in a state so that they will not be any trouble in a busy ward. In 2008, in the fifth richest country in the world, that is a matter of massive concern.

The situation on training is no better for nurses. The Royal College of Nursing told the National Audit Office that student nurses have between two to five hours’ teaching on older people’s mental health. I know that anyone who wants to go far in politics should not criticise nurses. However, I am not criticising the nurses, but the system that allows only two to five hours’ training on older people’s mental health. The NHS should insist on dementia training for health care professionals; it should be a clear requirement in the NHS that all trainee doctors and nurses learn about dementia.

I have gone on for longer than I intended, but I want to cover two very quick points. The issue of nutrition in hospitals is very important. Some 97 per cent. of trusts claim compliance with standards regarding help with eating in hospital, yet, according to Age Concern, only 58 per cent. of patients say that they always get the help that they need. A recent editorial published in the British Medical Journal found that about 20 per cent. of patients in general hospitals are malnourished, thin or losing weight. Up to 80 per cent. of those patients enter and leave hospital without any action being taken to treat their malnutrition because screening tools are underused and poorly enforced.

The National Institute for Health and Clinical Excellence recommends that all patients are screened for nutritional risk on admission to hospital. However, NICE estimates that fewer than one in three patients is screened on admission to hospital. One case that was brought to my attention was that of a stroke patient who was left for some 15 hours on a trolley without being given any fluids, despite severe vomiting the previous night. He was in such a state of dehydration that he was unable to talk due to the lack of saliva to lubricate his tongue. His family had to ask staff two or three times to provide intravenous fluids before anything was done to ease his discomfort.

I know that my hon. Friends have repeatedly urged the Government to do more to tackle nutrition. The amendments that they tabled to the Health and Social Care Bill would have created a statutory requirement for the proposed health regulator, the Care Quality Commission, to issue nutrition guidelines and to enforce them through new inspection powers and penalties. It was a great pity that those amendments were rejected.

I mentioned to the hon. Gentleman the handover from hospitals to social care. I believe that that process needs improving so that patients who need long-term care are given the best standard of service possible. It was very interesting to see the impact that a case, such as the one that I am about to mention, had on the community in which I live. An elderly person, whom I have known nearly all my life, was released from hospital and sent home without a proper statement of her needs being carried out. She was left in an entirely inappropriate way. She has no family and so had to rely on her neighbours, who have been quite exceptional in their care of her. They eventually got her readmitted to hospital, and she is still there today. The effect on the individuals around her was profound and it has stretched throughout the whole community. I cannot overstate the collateral damage that such a case does to the reputation of the NHS. Most people in my community, who have had a good experience of the NHS, were shocked when they heard of such an awful case. The damage done to the NHS, both locally and nationally, was profound. The Government must recognise that.

Help the Aged has reported a vast number of cases of inhumane discharge due to a desire to get rid of bed-blocking patients. The problems that occur in the transition between hospitals and social services seem to stem from a lack of consultation, lack of vital information, lack of clarity about options and a lack of choice for older patients. In the case that I just quoted, there was a complete misunderstanding of what drugs were prescribed and how that individual was supposed to understand when she was to take them.

There needs to be a change in the ethos of the NHS management so that nursing staff can provide the standard of care that they wish to give and that their patients deserve. Our nurses, health care assistants and carers do an extremely difficult job in incredibly tough circumstances. The job is made harder by bad management and a lack of specific training in how to care for the elderly. Understaffing and a lack of strong management on a hospital ward inevitably lead to low morale among already overworked staff. That contributes to the low standards of care that some elderly patients are reporting.

In conclusion, poor management and a diminished culture of care are allowing the NHS to fail in its duty of care for too many elderly patients. There needs to be a change in the culture of the NHS so that those who are most vulnerable—whether that be temporary or permanent—are given the standard of care that they deserve. I am aware, as we all are, that a number of Government initiatives have recently been announced that will go some way to addressing care for the elderly within the NHS. I look forward to hearing the Minister refer to them. I welcome the initiatives but I would like to emphasise the need to take active steps in applying wide-scale reform to the culture and ethos of the management of the NHS so that treatment of the elderly is changed for the good. The Government need to recognise that there is a problem for that key group, and that they have an obligation to ensure that the elderly are treated with dignity and respect while in the care of the NHS.

I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this important debate on a topic that is close to a lot of our hearts and which we all take seriously.

As we all know, the elderly are often the most vulnerable in our society and among those most in need of care. They are also the most likely to have the most complicated care and treatment needs. I think that we would all agree that how those needs are met in our health service must be a key indicator of how the NHS is fulfilling its role in society.

Like the hon. Gentleman, I acknowledge that there are many wonderful examples of care for the elderly in our health service. Unfortunately, as he said, there are still far too many examples not only of their needs not being met, but of people being subjected to treatment that is completely unacceptable and in some cases, such as those that he highlighted, absolutely scandalous and possibly criminal. Again, we would probably all agree that the societal attitude in this country still seems not to put as much value on older people as on younger people in all sectors of society. The Government cannot necessarily address that, but we all need to take it seriously and try to change it.

Turning to current developments in health, I say to the Minister that although the health agenda is changing fast, with a lot of initiatives and a lot of positive things happening, the debate brings into focus the fact that such things must not be pursued at the expense of the basics of care, which have been mentioned this morning. All health organisations must focus on simple things such as hygiene, nutrition and, particularly in the case of older people, dignity. Those values need to come to the fore a little more when NHS trusts release their mission statements, for example.

It is extremely worrying that 18 of the 23 hospital trusts studied in the report that the hon. Gentleman mentioned, “Caring for dignity”, were deemed to be failing to care properly for the elderly. That is a damning indictment of health care provision in NHS trusts. Doctors, GP consultants and staff grade physicians responding to a British Medical Association survey, the results of which were released earlier this month, believe that health care services for elderly people are simply not good enough. For example, 68 per cent. of doctors believe that staffing levels are inadequate, and three in five believe that the necessary continuity in health and social services does not exist.

Not surprisingly, older people account for the highest use of acute hospital services. The NHS spends 45 per cent. of its expenditure on them, but that is not necessarily reflected in the priorities given by health trusts. I say to the Minister that that can be addressed at the grass-roots, organisational level of the NHS. That needs to be the focus. There have been positive developments such as the national dementia strategy, but I hope that the Minister will acknowledge that there still appears to be a disconnect between the positive policy initiatives that we all support and what is happening on the ground.

Older people’s organisations, older people themselves and their relatives, families and carers highlight dignity in particular. As we know, older people are particularly vulnerable because they are often in positions of reduced control over their health and well-being. Help the Aged states:

“Stories of older people left in pain, ignored, or distressed by a lack of privacy in health and social care settings emerge at such a frequency that they cannot be dismissed as isolated cases.”

It also states that that is in spite of policy guidance. Again, things are not happening on the ground. The Healthcare Commission reports that the three most common causes of complaint in relation to dignity are patients being addressed in an inappropriate manner, being spoken about as though they were not there and not being given proper information.

The hon. Member for Newbury highlighted the problem of mixed sex wards and mentioned the figure in “Caring for dignity” showing that almost a quarter of elderly patients have had to share a room or bay with someone of the opposite sex at some time during their treatment. That is simply not acceptable. I echo his comments and ask the Minister when that figure will come down and when people will be put in mixed sex wards only in situations of emergency or absolute necessity. That is one of the major concerns for older people and their families.

The hon. Member for Newbury mentioned some particularly terrible cases of people not being taken to the toilet when they asked. In some of the worst cases, people have been allowed, or even told, to go to the toilet in their bed. He was right to highlight the knock-on effect of that on hygiene and health care associated infections. I chaired a Westminster health forum conference on that subject this morning.

We are not making the connection as we should, as is clear from the Healthcare Commission report on the appalling incident at Maidstone and Tunbridge Wells, which says that the families of patients

“told us that when patients rang the call bell because they were in pain or needed to go to the toilet, their call often wasn’t answered, or not in time. Particularly distressing, nurses had told patients to ‘go in the bed’, presumably because this was less time consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets.”

I accept that that was a particularly awful and, I hope, isolated situation, but if we do not address the key issues of people’s dignity, we will open a can of worms in relation to health care acquired infections.

I wish to highlight a couple more areas of concern. The hon. Member for North-West Leicestershire (David Taylor) rightly mentioned dementia. The wider issue of older people’s mental health is of particular concern. Age discrimination is explicit in the health service in the case of people with mental health conditions. Someone over 65 is subject to a different service regime from someone under 65.

The difference between the services can be seen most starkly among those who experience a transition from adult mental health services to older adult mental health services when they turn 65. Many of them find that vital services on which they rely are no longer available to them. That is simply wrong, and I ask the Minister to look into it. I have said that the national dementia strategy is a good thing and that the focus on that distressing condition is welcome, yet age discrimination is inherent in the system. That is not acceptable.

The hon. Member for Newbury mentioned the need for training and I reiterate that there must be far more training for staff in the area of mental health. I also agree with him that the provision in this area within nursing training is not acceptable.

The final point that I want to make is about the worst problem in this whole area, which is elder abuse. In this country, elder abuse still goes on far more often than it should. It is often undetected and it still does not seem to be taken as seriously as it needs to be by the authorities. Help the Aged has estimated that at any one time about 500,000 older people are being abused in the United Kingdom. The Community and District Nursing Association told the Health Committee that 88 per cent. of district nurses report having seen cases of elder abuse. We know that the majority of elder abuse happens within the family, which makes it a difficult and distressing problem to deal with. Nevertheless, a considerable proportion of elder abuse is down to care workers and that must be clamped down on.

I ask the Minister this question: when will we start looking at providing more training in prevention and recognition of elder abuse? Surely, such training should be a mandatory element of all staff training for all front-line staff in the health and social care sector. Furthermore, to widen the debate, when will we see adult protection becoming a compulsory part of police training and would it not be a good thing for such training to be placed on a statutory footing?

I ask those questions because I am very focused on the human rights agenda and I know that the Government are also committed to that agenda. However, it still appears that the human rights of older people are simply not recognised in the same way as those of younger people. That is a situation we simply cannot accept.

In conclusion, I echo the point made by the hon. Member for Newbury, who said that in many years’ time we will have considerably more older people in our society, so this issue will come into even greater focus. In 20 years, a quarter of the UK’s population will be over 65 and the number of people over 85—that is the particular age group where a lot of these problems occur—will have doubled. So, this is something that we must tackle and an issue that we must address now, as a society; it is not just about Government.

As I said at the start of my speech, there are some positive policy initiatives, but we now must ensure that they are carried through on the ground and that we have a change of culture in the NHS, so that the dignity and care of older people are paramount. I hope that the Minister shares those sentiments, and I look forward to him addressing some of the points that have been raised by the hon. Member for Newbury and by me.

I appreciate that the right hon. Member for Oxford, East (Mr. Smith) has changed his mind about speaking. I also appreciate that it is somewhat unusual for a Back-Bench contribution to come after the winding-up speeches have started—the hon. Member for Leeds, North-West (Greg Mulholland) will not have the opportunity to comment on the right hon. Gentleman’s speech—but I gather that there is no objection to that and, as we have plenty of time, I call Mr. Andrew Smith.

Thank you, Mr. Atkinson. I was taking account of the time available. I thought that I would take the opportunity to make a few points, and I am sorry that the hon. Member for Leeds, North-West (Greg Mulholland) has already given his winding-up speech.

I congratulate the hon. Member for Newbury (Mr. Benyon) on raising this vital subject. It is crucial that elderly people receive the best treatment, whether in hospital or elsewhere in society, and none of us can be anything but very unhappy when that treatment is not provided.

I want to set my remarks in a wider context. Across the NHS, I believe that a fantastic job is being done by staff, including nurses and doctors. Indeed, I receive many more positive messages and letters, including from elderly people, about the treatment that they are receiving in the NHS than I do complaints. However, that in no way diminishes the importance of the points that the hon. Gentleman and other hon. Members have made in the debate.

Although incidents of poor treatment of the elderly are in the minority, when there are instances of people’s dignity not being respected they are enormously concerning to us all. For example, I received a complaint from the daughter of one patient, who, on visiting her mother, saw that she had not been eating properly, her bed gown was dirty and she did not seem to be receiving proper care.

I feel sure that there would be common ground for the view that, although professional development, training, inspection and all those types of work are, of course, really important, what is also important is the daily entrenchment of a culture of sensitive caring on the part of everybody who is managing the treatment and care of elderly people. It is shocking when such good treatment is not provided and when there are these cases of neglect, including people being left in their own faeces or not being fed. We think, “Well, somebody is seeing them and somebody is responsible for that ward, so why is the treatment not being provided?” The Department of Health—together with trusts, matrons and managers, and working with the nursing professionals, who will be fully signed up to the highest aspirations for standards of care—must make a concerted effort to root out totally unacceptable practices.

I take the points that were made about the importance of the national dementia strategy. There is a particularly poignant dimension to the position of people suffering from dementia. Often, they are not in a position to signal their needs and feelings, other than sometimes through what is seen as aggressive and inappropriate behaviour.

Furthermore, the idea that such aggressive or inappropriate behaviour should be controlled inappropriately by anti-psychotic drugs is utterly abhorrent. The Alzheimer’s Society has estimated that more than 100,000 elderly people with dementia are being prescribed anti-psychotic drugs and that, in two thirds of cases, those drugs are unnecessary.

There clearly must be a thoroughgoing revision of the prescription policy on the use of those drugs. As was mentioned earlier, alternative therapies and ways of managing people’s conditions should be used instead. No one pretends that the situation is easy, but this is a critical challenge that we all must face up to, in partnership with those in the NHS.

On nutrition, I do not think that it is just a question of monitoring, measuring and inspecting, although all that work has a role to play. I believe that there is also a common-sense issue of putting wholesome food, which people want to eat, in front of patients. I know that there have been pilot schemes in the west country—I dare say that the Minister will refer to them—using locally sourced produce, rather than the prepared meals that travel a long distance, are reheated and sometimes stuck on a tray that is out of reach of patients. Getting food that is nutritious and good to eat must be a common-sense part of the solution to those problems. Furthermore, the amount of food that is thrown away in the NHS is, in itself, an indictment of the inadequacy of the food supply system.

I hope that the right hon. Gentleman may move on and take the opportunity to bend the Minister’s ear on the question of specialist orthopaedic hospitals. I mentioned hospital-borne infections. It is worth noting that the level of infections is far lower in those specialist hospitals, yet they are suffering the difficulty of financing themselves, due to the question of the tariff.

I hope that the right hon. Gentleman, who is a very able chairman of the all-party group on specialist orthopaedic services and hospitals, will raise that point with the Minister.

The hon. Gentleman has done it for me. I can also assure him that barely a week goes by without my bending the Minister’s ear on the position of orthopaedic hospitals in general and Nuffield Orthopaedic Centre in particular.

The hon. Gentleman is quite right: there are very low infection and cross-infection rates in the orthopaedic sector. Indeed, I hear enormous praise for the treatment that people receive at the Nuffield. That reinforces the powerful case for resolving the tariff problems that affect that sector, and in a meeting with the Minister a couple of weeks ago, I urged him to do that. This debate gives him the opportunity to discuss that important issue as well.

The point that I was making about food is that the predominant existing sourcing of food for the NHS clearly is not working that well in many instances, as judged by the colossal amounts that are thrown away. That is a dreadful waste. I presume that the amount ordered is thought to be the amount that patients might need to eat, but the fact that so much is thrown away is in itself an indicator of nutrition not being what it should be.

I look forward to the Minister telling us about the experience gained from efforts that have been made to give people wholesome and attractive food. The fact is not only that the general hospital experience benefits, but that there are direct health benefits, which aid recovery. Again, that is common sense and not at all surprising.

The hon. Member for Newbury mentioned the important matters of care after leaving hospital and social care. I certainly urge a continuing drive to maintain and enhance standards of care in social care homes. There are many examples of good practice as well as bad. I visited a St. John Care Trust home in my constituency a couple of weeks ago, and I was very impressed with the ambience of the place, the caring attitude of the staff, the positive feedback that I had from residents and the extra efforts being made. The aromatherapist who comes in happens to be blind, and she brings her dog so that the elderly people have something to pet. There was a warm and caring atmosphere.

The social care sector is often spoken about as a sort of Cinderella, but it is important to signal that very good work is done in it. There are issues around the training of social care staff, but I believe that many of them, through their caring attitude and day-to-day supportive work, bring an enormous amount that perhaps compensates for the lack of formal professional qualifications. It is important to enhance people’s wish to care for elderly people and to attract and retain such people in the service, including the many migrants who have come to this country and done a good job. That should be praised, but it is clear that we need to learn from best practice and apply it more generally.

I close with a bit of lateral thinking, which was drawn to my attention just last week. The Ridgeway Partnership, which is the learning disability trust in Oxfordshire, is an excellent provider. The hon. Member for Newbury said that the treatment and care of learning disabled people are relevant to this debate. The partnership does a wonderful job with homes in the community and support for learning disabled people. It is one of the best performing trusts in the country. At a reception, it voiced to me the potential that there might be for applying the expertise that it has developed in domiciliary care precisely to the needs of elderly people, including the vulnerable elderly. In other words, it would support the third option. Many people would like to be not in hospital or a social care home, but in their own home.

I look forward to the Minister’s response as to whether we might look at that example of best practice and run pilots whereby we could explore whether the service of such a trust, which has a track record of excellent service to the learning disabled, might be diversified to elderly people who may have higher-level needs and would like to stay in their own home.

This is a vital area. It is important that our criticisms are couched in an overall context of recognition of the terrific amount of valuable and successful work that is done through the NHS. However, there is no doubt that there is a formidable challenge in ensuring that the dignity of elderly people is properly respected, that they get the standards of care that we would all want for our own loved ones, and that unacceptable practice is driven out and, equally importantly, good practice is learned from and applied more generally.

I begin by congratulating my hon. Friend the Member for Newbury (Mr. Benyon) on introducing this debate and highlighting the very real problems of caring for the elderly in the national health service. In my speech, I shall pick up on some of the points made by the right hon. Member for Oxford, East (Mr. Smith). It is important to have balance in a debate such as this one. We realise that some very good practice is being followed, and it is important to pay tribute not only to the nurses and doctors but to all the care staff involved in looking after elderly people who are doing an excellent job; on the other side, however, there is no doubt that there are problems and areas of concern.

I gather that my hon. Friend was inspired to introduce this debate because of the experiences of Jenny Pitman, who felt that standards in the NHS had fallen well short of that which she expected. He highlighted cleanliness and dignity, and in all the issues that he raised he stressed the importance of the detail. The hon. Member for Leeds, North-West (Greg Mulholland) spoke about the basics. This debate is about the basics and the detail. It is about getting things right and setting the bar high for standards in the care of elderly people.

[Mr. Eric Martlew in the Chair]

When discussing cleanliness, my hon. Friend obviously had to raise the matter of some 6,500 people dying every year from C. difficile. Many agencies say that the problems with C. difficile and MRSA are down to standards and about nurses having the time to carry out procedures properly. I shall return to that later.

My hon. Friend also raised an interesting idea of having photos of people above their bed. I will refer to that when I close, but it is terribly important to remember that elderly people were young once and that some had terribly important jobs—perhaps more important than those of us in this House feel we have. We sometimes lose sight of that when we see in front of us someone who is, perhaps, incontinent, or who cannot feed themselves. People who have had a stroke at a young age tell us that the problem is particularly acute for them because they are treated as though they are elderly, when, in fact, they might be 45, and only the day before had responsibility for a full-time job and a family at home.

My hon. Friend discussed the care of people with dementia or mental health problems. There is no doubt that our concern about older people and the care that they receive should increase 100 per cent. when we consider the care of older people who have dementia or mental health problems. It is not easy to care for people who have dementia, who are confused, or who are older. It is triply difficult to care for people who have all those problems. The dignity with which we treat them is extremely important.

Speaking of dignity, I make no apology for the fact that much of what I say today relates to my experiences as a nurse in general hospitals and as a district nurse in the community. I am sure that the hon. Member for Crawley (Laura Moffatt), who is now not in her place, would agree with my comments, as she was a nurse. I remember somebody once saying to me that when a person goes into hospital they hang up their dignity as they go into the ward and pick it up when they leave. That was said to me many years ago, but it probably remains true today.

There is much talk about human rights and the human rights of patients. I always feel slightly despondent when I hear people talking in such terms, because things really should not get to that point. We should not need to demand that people’s human rights be respected. This is a matter of courtesy, respect and being civil to people. It is not about patients, but about treating people. Somehow, it seems, people hang up their dignity and become a patient and a different being, and we are entitled to treat them differently and not with the same respect. We need to remember that we are treating people. People are being cared for by the state, so we have a duty of care to them that we should feel acutely. It is a long time since a radio programme called “Does he take sugar?” was broadcast, but a lot of what has been said today echoes what we heard in that programme. We often forget the person sitting in front of us.

Mixed-sex wards have been mentioned. I understand that the most recent Healthcare Commission survey reported that 30 per cent. of people are still sharing bathroom areas. The Government are trying to deal with this, but that is not good enough. Male and female patients having separate facilities is fundamental to respect and dignity. Generally, in all wards, there are curtains around a bed, but even if people are sharing a same-sex ward, that is not enough to afford them privacy when intimate procedures are being carried out. Everybody can hear what is going on and what is said behind the curtains, and often the curtains do not meet. Mixed-sex wards in any form are not acceptable. I should like the Minister to tell us what progress the Government feel they are making on this problem, which has been hanging around for much too long.

The British Medical Association recently reported that 20 per cent. of people in hospital are malnourished, thin or losing weight and that 80 per cent. enter and leave hospital without any action being taken to address their nutritional needs. Some studies have found that the number of malnourished people leaving NHS hospitals in England has risen by 85 per cent. in the past 10 years. During the Committee stage of the Health and Social Care Bill, the Minister and I discussed weighing and measuring children. If my memory serves me correctly, I mentioned that we are keen to do something about childhood obesity, but said that, at the other end of the scale, we should also be keen to do something about older people’s nutrition. Poor nutrition can lead to older people getting thin and frail and can lead to confusion, mental health problems, dementia and depression. I should like the Minister to reassure us that the Government are taking malnutrition in elderly people seriously. It is not only what happens to elderly people when they go into hospital that matters: often, they are malnourished before they enter.

The right hon. Member for Oxford, East mentioned wholesome, locally sourced food. All hon. Members would go along with that. However, I think he missed the point. The problem in respect of much malnutrition in hospital is not that the food is not getting to the person’s bedside, but that it is not getting into their mouths. A lot of people cannot feed themselves.

I mentioned trays being put out of reach. People need both wholesome food and the means to eat it.

I do not think for one minute that the right hon. Gentleman does not consider that to be a problem, but it needs emphasis. How many times have hon. Members been on a ward or in any sort of care setting and heard a patient say, “Can you hand me my drink?” or, “Can you pass me the tray of food?” What is important is individual care, paying attention to people’s nutritional needs and what food they like to eat and providing them with the ability to eat the food that is put in front of them. Although I am not one to rush into monitoring, staff need to be given clearer guidelines and we need to raise this matter as a priority. The danger is always that nutrition slips down the list of priorities and other things get attention first. I said to somebody the other day that the danger with oppressive targets in health care settings is that they become the priority. If nurses in hospitals that are short of staff are rushing around washing their hands, which we commend, they simply may not have the time to feed people. I would not like to see any issue gain importance above another.

My hon. Friend the Member for Newbury mentioned resourcing, which is an issue, along with training, support and nurses having the time to nurse and care. One of the most common problems that nurses contact me about is their feeling that they do not have the time to care for people in the manner in which they were trained and hoped to be able to practise, or in a way that maintains people’s dignity and privacy and gives them the care that the nurses themselves would expect to receive.

I have to return to how managers treat their staff. To some extent, if we want people to care for others, they have to be shown the same amount of dignity, respect and courtesy and have to be treated with the professionalism with which they are expected to treat their patients. I am concerned that sometimes the management styles in the NHS do not necessarily engender that. The hon. Member for Leeds, North-West mentioned some of the problems experienced in Maidstone and Tunbridge Wells NHS Trust. Whether or not it is in the Health Commission report, there is a lot of anecdotal evidence suggesting that the management styles in that trust were poor, staff were not treated well or with respect, and staff had no way to complain to their line managers about what was going on in the wards. That is important. Although such feelings are subtle and hard to put one’s finger on and cannot be measured, a lot of NHS staff feel that they are oppressed by targets and the need to produce figures and numbers, and that not enough time and attention are given to their concerns about the quality of care that they need to give. Quality takes time, and it means that people need more resources.

Hon. Members mentioned discharge from care—not only from care in hospitals, but from nursing homes and other settings. At every step, people’s dignity must be maintained. We sometimes forget the fear following, for example, a fractured neck or femur or a stroke and the imminent prospect of discharge. I heard recently about an elderly gentleman who is frail and has been admitted to hospital with a stroke. He is in a fantastic stroke unit that is an example of the best practice that we have talked about. His discharge home is being planned: the man’s wife is having a stair lift installed and is employing a carer to look after him. However, she and her husband have considerable fears. At the moment staff are on hand to help him to the lavatory, but he is concerned that, when he gets home, he will not make it to the lavatory. Those are the sorts of things that people are concerned about. Many people would prefer to be looked after in their own home, but there are some big buts for those people and their families. They want to be looked after at home, but only if they have help to get to the lavatory, only if their wife has somebody to help with the shopping and only if their wife has the time to feed them.

There are also complicated issues to do with people’s feeling that they are a burden on others. The language used in respect of discharging people from hospital has been most unfortunate at times. People are referred to as bed-blocking, as though they were staying in hospital on purpose or as if it were their fault. It is not their fault; there is no doubt about that. I make no party political points about this matter. I hope that we will have a joint approach to the concerns about the huge number of elderly people for whom we will have to care and offer support in the years ahead. When I was training to be a district nurse a very long time ago—probably well over 20 years ago—I did a project on discharge home from hospital, and I read some research that pointed out that being in hospital is very brief interlude in someone’s life. It is a brief spell out of their home, and at every step we must consider what people’s needs would be in their own home.

The hon. Member for Crawley was not in her place when I mentioned her earlier, but I am sure that she shares my feelings about the care of the elderly in the NHS, because I know that she trained as a nurse. I am also sure that, like me, she was taught to provide the highest standards of care for the people she looked after. I continue to be proud of the fact that I trained at St. Bartholomew’s hospital and of the training that I received there. All that I learned at that time stands me in good stead: it guides me as a politician. It is extraordinary how useful such training is for a politician—to some extent, that training and experience on the front line took me into politics.

Barts was a challenging place, and some senior nursing officers could have come straight from the “Carry On” films. They had buxom figures and were terrifying, but they reminded us that nurses in charge of a ward were in charge of a place that was someone’s home for the time being and that we should treat everyone as if they were in their own home. The bar was extremely high on standards: nothing less than the best would do. I hope that the Government will continue to engender those feelings.

Hon. Members do not often recite poetry in this Chamber, but a poem that appeared in a textbook, “An Ageing Population”, in 1981 has become famous. It refers back to the point made by my hon. Friend the Member for Newbury about photos above people’s beds. It was found in the locker of a lady who had died and who had been unable to speak, and I shall read the beginning and the end.

What do you see nurses

What do you see?

Are you thinking

When you are looking at me

A crabbit old woman

Not very wise,

Uncertain of habit

With far-away eyes,

Who dribbles her food

And makes no reply,

When you say in a loud voice

‘I do wish you’d try’

Who seems not to notice

The things that you do,

And forever is losing

A stocking or shoe,

Who unresisting or not

Lets you do as you will

With bathing and feeding

The long day to fill,

Is that what you’re thinking,

Is that what you see?

Then open your eyes nurse,

You’re not looking at me…

I remember the joys,

I remember the pain,

And I’m loving and living

Life over again,

I think of the years

All too few—gone too fast,

And accept the stark fact

That nothing can last.

So open your eyes nurses,

Open and see,

Not a crabbit old woman,

Look closer—see ME.

The Minister may introduce strategies and policies, but when thinking about how to address the dignity of older people, will he take himself out of his shoes, turn himself around, put himself in another pair of shoes, and see himself in 20 years, 30 years, 35 years, or even 40 years on? Will he think of himself having to be cared for and saying, “Once, in 2008, I was a Government Minister.”?

How does one follow such poetry? With reference to the final remarks made by the hon. Member for Guildford (Anne Milton), as a teenager I nursed my mother through Alzheimer’s to death, so I know a little about looking after elderly patients and caring for them, their needs and their dignity.

I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this debate on such an important issue, and apologise to him and other hon. Members that the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), who is responsible for this policy area, is not here to respond to the debate. He is absent from the Chamber for very good reasons, which I shall come to later.

We all agree that how we treat the most vulnerable in society, including the elderly, is a measure of our civilisation. We have a growing elderly population, who are healthier, longer lived and more materially comfortable than any previous generation. We also have a society in which people have higher expectations of their health and social care, and their quality of life. People not only expect that for themselves, but we in the Government expect the private and public sectors to provide it.

Although many elderly people are living longer and healthier lives, many need care in hospital or a care home, and stays may be more frequent or longer than previously. As the hon. Member for Leeds, North-West (Greg Mulholland) acknowledged, all parts of the Government, but not just the Government, have a responsibility to ensure that people enjoy dignity in old age. I shall outline some of the matters for which my Department is responsible.

First, statutory guidance in both the health service and social care places a legal obligation on all staff to ensure that people are treated with dignity. It provides a complete definition of abuse and a framework for public bodies to work with the police, the NHS and regulators to tackle abuse and prevent it from happening in the first place. It also sets out the framework for partnership working throughout Government and other agencies to deal with and prevent abuse of vulnerable adults. As well as that, we have a new local performance framework for the NHS, which builds on that and means that every nurse and every health care professional has a responsibility to safeguard and respect an individual’s dignity.

Subject to parliamentary approval, the Health and Social Care Bill will create a new, integrated, independent health and social care regulator—the Care Quality Commission. The hon. Gentleman is aware that we are seeking to amend the Bill to reinstate the Government’s original intention when passing the Human Rights Act 1998, which is that the independent care home sector should be directly subject to duties under that Act for the publicly arranged residential care that they provide.

Whatever the care setting, the Care Quality Commission will provide assurance that services are safe, people are not put at risk of harm and essential levels of service quality are maintained. The requirements that providers will have to meet will be set by the Government in secondary legislation—we debated that at length in Committee—and monitored and enforced by the Care Quality Commission. They will replace the existing core standards for better health in the NHS and the national minimum standards and regulations that apply to social care and independent sector care providers.

The independent Healthcare Commission’s most recent survey, of 14 May, states that overall satisfaction with care remains high and is increasing with 92 per cent. of patients saying that their care is either good, very good or excellent. The same survey shows that only 3 per cent. of patients say that they have been treated in an undignified way. The survey also shows improvements on some other issues that hon. Members raised, such as food quality. I shall come to some specific matters in a moment and explain how we hope to do better.

The national health service operating framework is basically the orders that go out to the service from the chief executive of the NHS, David Nicholson, setting its priorities in every year. For the last year, it has contained for the first time a core strategic requirement for a good user experience so that users of the health service feel that their dignity is respected. Health and social care providers will be measured against that standard.

A number of hon. Members talked about the importance of investment in nursing and the quality of nurse training, including issues of dignity. I am sure that they are aware that we have invested considerable extra resources in the number of nurses and in nurse training. There are 80,000 more nurses in the NHS than in 1997, 51 per cent. more students entered training to become nurses or midwives during the same period, and there are more senior nurses to help to drive up standards, including 831 nurse consultants and a commitment to increase the number of matrons to 5,000 to improve the quality of nursing.

I assure the hon. Member for Leeds, North-West that dignity is a core part of nurse training. The issue is not that it is not there and needs to be introduced. No nurse has ever been educated to say to anyone, “Go in the bed.” That was one of the appalling findings that came out of the Tunbridge Wells and Maidstone inquiry.

I wish to clarify the fact that, regarding dignity being a core value, I was talking about organisations such as NHS trusts, rather than nurses.

I hope the hon. Gentleman will forgive me if I misunderstood, but I thought he implied that he would like dignity to be a core part of nurse training. It already is. However, it is also a core part of what is required from health providers. He can check the record on that if he wishes.

On training, I said that we need more and more specific training. I mentioned mental health specifically.

I suggest that the hon. Gentleman check the record.

The hon. Member for Newbury mentioned the case of one of his constituents, Jenny Pitman, who had a terrible experience in relation to a parent who was in hospital. My information is that the trust concerned is working closely with Jenny Pitman. She has quarterly meetings with the director of nursing to monitor progress on infection control; I think she has such a meeting next week.

On the general issue of infection control and health care-associated infections, I am sure that the hon. Gentleman will be pleased to note that the latest Health Protection Agency figures show a 30 per cent. decrease in MRSA—methicillin-resistant Staphylococcus aureus—to December 2007, for the last 12 months for which figures are available. There has been a decrease in C. difficile of 23 per cent. during the same period.

The hon. Gentleman’s local hospital, which I imagine is the Royal Berkshire in Newbury, has had an encouraging 60 per cent. decrease in MRSA in just six months between April and December 2007. That is a tremendous tribute to the hard work of the staff and management of that hospital, which also had a 15 per cent. reduction in C-difficile in the same period. I hope that he welcomes those great strides forward by his local hospital.

The hon. Gentleman was kind enough to acknowledge that overall the NHS does an excellent job, that heroic work is done and that millions of people get excellent treatment—indeed, the hon. Member for Guildford (Anne Milton) said the same from the Conservative Front Bench—but he gave a number of specific examples of the service that people received not coming up to scratch.

The examples used by the hon. Gentleman related to unacceptably poor treatment. It is important that if a patient—an elderly patient or, indeed, the relative of an elderly patient—experiences what they believe to be unacceptable treatment, they use the robust and independent complaints process that is now in place to put those matters right. I have seen a number of cases involving people who have gone to the newspapers or come to my surgery to make such complaints. People need to have more confidence in the independent complaints process.

We have an independent Healthcare Commission to deal with such matters and an ombudsman, which is the second tier for complaints. It is important that people use that system because in the annual reports of the Healthcare Commission trusts are judged by the number of complaints made and how they dealt with them. If people do not bother to complain, the danger is that there will not be an incentive for the service to get better.

Is the Minister aware that last year a report by Which? stated that people are concerned about what to do when an elderly relative is already in a care setting? There is huge concern—I have felt it myself—that if a complaint is made, it will be taken out on the relative who is still in the care setting.

Yes, I am aware of that report. As politicians, it is important that we all encourage people to have faith in what most of us accept is a sound and robust independent complaints structure. It would be completely unacceptable for any organisation or trust to take it out on anyone who complained, as the hon. Lady mentioned. In my experience, only by using the complaints process are some of the problems uncovered and therefore resolved.

Incidentally, I also encourage staff to complain. I think the hon. Lady said that staff are often nervous of complaining when they see substandard behaviour in their own hospitals. We have a culture of encouraging whistleblowing in the health service and it is important that staff feel confident to complain—anonymously if they prefer to do so—to ensure that problems are dealt with firmly and robustly.

A couple of surveys on mixed-sex wards have been published in the past few weeks. One was from Ipsos MORI and the other was included in the annual Healthcare Commission patient survey. Both found a welcome decrease in the number of patients who reported sharing a sleeping area with a patient of the opposite sex. We welcome that. However, we also acknowledge that there remains some way to go for us to deliver on our commitment to reduce mixed-sex accommodation to a minimum.

Although occasionally the need to treat and admit a patient has to take precedence over complete gender separation, everything possible should be done to maximise privacy and dignity in those situations. We do not think it desirable to turn patients away just because the right bed is not immediately available.

This year’s NHS operating framework states that, at local level, primary care trusts should assess the situation in all trusts in their area and agree, publish and implement stretching local targets for improvement. Given that, we hope and expect to see significant improvement in the Healthcare Commission survey scores for next year.

As I mentioned, my hon. Friend the Member for Bury, South normally speaks on this issue, but he cannot be with us today because he is launching the latest strand of the dignity campaign, which he established in 2006. As a number of hon. Members are, I am sure, aware, the purpose of the campaign is to create a health and social care system in which there is zero tolerance of abuse and disrespect for older people. That includes simple things that many hon. Members have mentioned, such as respecting privacy, helping people to use the bathroom, addressing people in the way that they prefer, listening to people, helping people to eat food if necessary, and ensuring that food is placed where it can be reached. All those small things can make a huge difference to an older person who is staying in hospital.

The hon. Member for Newbury and his Front-Bench colleague, the hon. Member for Guildford, mentioned nutrition. We had a long discussion about that in the Health and Social Care Bill Committee. I wish to correct the hon. Gentleman: the issue was not that the Government were not interested in doing anything on nutrition, as he implied. As my right hon. Friend the Member for Oxford, East (Mr. Smith) made clear, we are doing a lot in relation to nutrition and nutritional standards are improving all the time, although they are improving more quickly in some hospitals than in others.

The Government resisted an amendment tabled by the hon. Gentleman’s party to include a requirement in the Bill for nutrition to be part of the new system that the Healthcare Commission will police, alongside health care-associated infections, which are fatal in many cases, as he rightly outlined. However, we have made it clear—we are consulting on this—that, under the new auspices of the Care Quality Commission, nutrition and nutritional quality should be part of the registration standards. Therefore, in extremis, if a hospital was not providing adequate nutrition or adequately helping patients with eating and feeding, it could lose its registration and therefore its licence to operate.

We also had a long debate on the issue of people who come into and go out of hospital suffering from malnutrition. If the hon. Gentleman is interested in the matter, he may want to check the record. Without going over the matter in great detail, one has to be careful about taking the statistics at face value. If someone goes into hospital with an underlying malnutritional problem, that will often not be the first episode for which they are treated, so they will be registered as being treated for something else apart from malnutrition. Only after they have been in hospital for a while and when the initial superficial condition for which they are being treated or operated on is dealt with will malnutrition be registered as an episode. That can often be the last episode, which is why, when one considers the stark figures, it looks as if more people leave hospital malnourished than enter hospital malnourished. That is not the case, and it is important that we bear that in mind when we make such claims.

On the dignity campaign, we now have a network of more than 1,800 dignity champions who are out in the community, improving dignity in their local areas, putting dignity on the local agenda and tackling bad practice when they see it. They are unpaid volunteers who are often managers, councillors, health and social care staff and ordinary members of the public. They are making a difference.

As Nursing Times has pointed out, the number of cases of abuse of older people coming before the nursing regulator has halved in the last year alone. In addition to the dignity champions, to whom I have already referred, thousands of people in care homes and hospices have benefited from the—