The images that we saw on our screens last night were truly disgusting. No one deserves treatment like that. The family and loved ones of care home residents should not have to endure that. Poor care is completely unacceptable. Everyone should receive the highest standards of care delivered by well-trained and compassionate staff. We are committed to making that a reality and to preventing abuse and neglect. We are putting in place, through reform of the Care Quality Commission, a range of measures to improve the regulation of care homes, to hold to account providers that are responsible for unacceptable care, and to improve the quality of social care.
The chief inspector of social care at the CQC is putting in place new rigorous inspections carried out by specialist inspection teams. New fundamental standards of care are being introduced as requirements for registration with the CQC, which will allow the CQC to prosecute providers—and their directors—that are responsible for unacceptable care. We are introducing a new fit-and-proper-person test for directors of companies that provide care, which will allow the CQC to remove individual directors. The care certificate is on track to be introduced in March 2015 and is currently being piloted by employers. That certificate will include compulsory training. The CQC is being given the power to produce ratings of care providers that will provide a fuller picture of the quality of care than mere compliance with minimum standards.
A new statutory duty of candour on providers of care is being introduced, which will place a legal requirement on organisations to be open with patients about serious incidents. We are introducing a new offence of ill treatment and wilful neglect—one for an organisation and one for individuals. It will apply not just to those who do not have capacity, as is currently the case, but to all users of health and adult social care and all health and adult social care settings. A consultation on the new offence ended on 31 March, and we are now considering the responses. We aim to bring forward legislation at the earliest opportunity.
I thank the Minister for his statement. The majority of residential care providers provide good, if not excellent, care. However, many of us across the country will have been sickened by the contemptible and callous treatment of elderly people in the Oban House and Old Deanery homes that we saw on “Panorama” last night. When we were shown the many calls for help from Yvonne Grant that were ignored, I, for one, railed against her so-called carers.
I acknowledge that the Care Bill will improve the safeguarding of elderly care home residents, but residents and their families need to know that their voices of concern are heard and acted upon when they feel that care is poor. The CQC needs to be up to the job. I met the CQC two days ago and felt that its engagement with residents and relatives could be much better. Can the Minister assure the House that the CQC will have the staff and expertise to carry out all the necessary inspections, including on the financial viability of care homes? Will he ensure that there is effective monitoring of care homes between inspections so that if there is high staff turnover, for example, that will be flagged up? Can he tell the House what training will be required for care homes staff? Will it be on the job and, if so, for how long?
Although it is right that care workers are held to account for their actions, senior managers should also shoulder their responsibilities. The Government failed to support my amendment to the Care Bill, which would have introduced an offence of corporate neglect. That would allow the prosecution of a care provider if the culture they set is a contributory factor in abuse or neglect. Police Operation Jasmine identified that sort of corporate neglect in south Wales. Will the Minister look again at the proposal in order to promote the care we all want for our loved ones in the place that they call home?
I thank the hon. Gentleman for his urgent question and his supplementary questions, which are absolutely legitimate and important. I agree that it is incredibly important that we recognise that there is a lot of great care out there, with incredibly dedicated care workers doing a very difficult job, often in difficult circumstances and without great pay. It would be awful if they were all tainted by the actions of a few.
I am pleased that the hon. Gentleman recognises that the Care Bill can make a difference and improve standards. It allows for the introduction of a care certificate so that everyone will be required, for the first time, to have compulsory training and meet a standard of competence before undertaking unsupervised care work. Part of that will be on the job, as I think is right for such work, but it is essential that people meet that standard.
The hon. Gentleman made the essential point that relatives, loved ones and the users of services themselves need to be heard. One thing we have done in that regard through NHS Choices is introduce the ability for anyone to comment on care services in a care home or in domiciliary care and to put their comments online, so that there is no hiding place for unacceptable standards of care. People’s comments and the judgments of the CQC will be available for everyone to see through the NHS Choices website.
I hope I can reassure the hon. Gentleman in relation to his amendment to the Care Bill. I totally agree with him about the importance of being able to prosecute for corporate neglect, which we will address, but in a different way. We are introducing fundamental standards of care that every care provider, and indeed every NHS hospital, must meet in order to be registered with the CQC. Where those standards are not met and there are serious failures, and where there is culpability because of corporate neglect of the sort he describes, the providers will be prosecuted. The CQC will have the power to prosecute not only the company or trust, but individual directors. This is the first time that that has been made possible. The existing regime is flawed, because the CQC must first serve a notice before anything can be done, and if the company complies with the notice it cannot be prosecuted, which is hopeless. We are removing that so that we can move straight to prosecution, as was the intention of his amendment.
I fear that this case will not be the last. May I invite the Minister to think longer term? I have often reflected on why our society outsources the care of elderly loved ones to the state. In the longer term, with an ageing society, I wonder whether we are going to have to look after our elderly more at home. Is there any policy formation within the Department along those lines, because the last thing I would like to happen is see my relatives being treated in the way we have seen?
My hon. Friend makes a really important point. In ensuring that we have decent, civilised standards of care for older people, but also for people with learning disabilities and others in vulnerable positions, it cannot be any one party on its own that achieves that objective. It is a challenge for the whole of society, and we must recognise that. Government have their part to play in setting very clear standards and making it absolutely clear that where these standards are not met there are consequences. Through the integration pioneers that we have around the country, we are demonstrating that with better collaboration between statutory services and families, wider communities and neighbours, we can achieve better care for people. The state cannot do this on its own. It has a crucial role to play, but this is a challenge for the whole of society.
I think the whole country was appalled last night when the BBC’s “Panorama” programme exposed the neglect and abuse of vulnerable older people at the hands of their carers. When older people and their families take a decision to move into residential care, they must be assured of high standards. Poor care must be stamped out and those responsible properly held to account.
First, I want to press the Minister on the specific case at Oban House. He will be aware that concerns were first raised about the home by whistleblowers back in 2012. What action was taken to address those concerns, and were they brought to the attention of Ministers? In its latest inspection in February, the Care Quality Commission reported that the home had too few staff and that some residents waited too long for staff to answer their calls. Will the Minister set out precisely what action was taken after those failures were highlighted back in February?
The Minister will be aware that following the awful abuse exposed by “Panorama”, a number of staff have been suspended, and HC-One has said it will increase staffing levels and improve training at the care home. However, is he fully satisfied that the safety and well-being of residents at Oban House is not still at risk?
This case raises serious questions about not only the inspection of care homes but the role of local councils. Councils and local authorities, which are much closer to care homes, should have a strong role in monitoring and driving up care standards. They should be the first safety net. Was it not a major error, therefore, to remove in the Care Bill the CQC’s powers to check that local councils are commissioning care services properly?
Care home bosses who fail to ensure that their residents are treated properly must face tough consequences. I heard what the Minister said about holding those bosses to account. My hon. Friend the Member for Blaenau Gwent (Nick Smith), as he outlined, proposed an amendment to the Care Bill to introduce a new criminal offence so that negligent care home owners can be fined or sent to jail. Is it not disappointing that the Government voted against that amendment?
In the first three years of this Parliament, social care budgets have been slashed by £1.8 billion. Yesterday, the growing abuse of zero-hours contracts, particularly in the care sectors, was revealed. Does the Minister accept that we will never get the standard of care that we aspire to from a social care system that has been cut to the bone? Should the coalition not revisit its brutal cuts to social care, which make such a situation more, not less, likely to occur?
This shocking case is yet another reminder that the time has come for a radical rethink of how we care for older people. These abuses must stop. How many more “Panorama” programmes exposing appalling cases such as at Oban House must we see before proper action is taken? Today, the Government must explain how they plan to prevent older people facing further abuse and indignity.
I thank the hon. Lady for those questions. I completely agree that unacceptable practices, and abuse and neglect, must be stamped out. I hope she is pleased that the Government are taking action to ensure that we can prosecute care providers who have allowed unacceptable practices. When I came into my job and had to respond to the scandal at Winterbourne View, the question I asked officials was, “What has happened to the company? How has it been held to account?” I was told that the Care Quality Commission could not prosecute because it had to serve a notice first, and if the company complied with the notice, nothing could be done.
A flawed regulatory regime was established when the CQC came into being. We are changing that so that providers of care can be prosecuted if they fail to meet fundamental standards of care. [Interruption.] I am answering the question. That is precisely what we are doing. The hon. Lady mentioned the issue of corporate accountability and corporate neglect, and that is exactly what we are addressing: we are giving the CQC the power to prosecute when there is corporate neglect.
We are also going further by introducing a fit-and-proper-person test so that every director of every care company will have to demonstrate that they are a fit and proper person. That should already be the case, but this is the first time it has happened. We are also introducing proper standards of training for all staff.
On the care home concerned, I hope it will be helpful if I write to the hon. Lady setting out the whole sequence of events and the entire timeline of the steps taken by the CQC. I commit to doing that in the next few days so that she will have the full picture.
We have made sure that the CQC is independent—we have strengthened its independence. We are introducing a far more robust inspection regime and we are addressing a problem. When the CQC was introduced by the Labour Government, the design of the inspection system was for generalist inspectors who might inspect hospitals one week and care homes the next. We are introducing specialist inspections. When inspectors go into a care home, they will talk to relatives, residents and staff, to get a much fuller picture of what is going on. Care homes will then be rated on their standards of care, so everyone will know what their local provider’s standards are.
I hope the hon. Lady will feel that real, substantial steps are being taken to address unacceptable standards of care and to ensure that people are properly held to account when bad things happen.
Everyone in the House will want to ensure that anyone in residential care is treated with the compassion we would expect if our own much-loved parents were in such care. In addition to supporting the CQC’s specialist inspections, does my hon. Friend not think that we may be reaching a point where health and wellbeing boards will need to consider setting up panels of trained, independent lay visitors to visit residential care homes in their own area—unheralded and unannounced—to check whether people are getting the care and compassion that is merited and that we would all want for anyone in a care home in our constituencies?
I thank my right hon. Friend for that question and I very much share his view. In my own county of Norfolk, a brilliant third sector organisation is doing precisely that. It is arranging for ordinary people to go into care homes, judge the sense of kindness of compassion there and give a much richer view than statutory agencies might be able to provide. I would also point to the role of Healthwatch England, which has been established through the health reforms. Those organisations have the power in every local area to go into care homes—they cannot be blocked from going into them or any other health or care setting—to make their own judgments on where things are going wrong. Through that much greater transparency and openness, we will not only expose poor care but drive up standards.
First, I share the right hon. Gentleman’s recognition of the work that “Panorama” has done. It is interesting that two examples of appalling abuse—namely this case and that at Winterbourne View—have been exposed as a result of hidden cameras. We must acknowledge that and recognise that there might be a role for the use of hidden cameras in the CQC’s work where there is potential evidence of abuse and where we need to establish that evidence in order to take effective action.
On the right hon. Gentleman’s question about registration, my concern is that the registration of nurses did not stop awful things happening at Mid Staffordshire. It is not in itself a panacea that ensures good-quality care. For me, the most important element is proper training to ensure that everyone is trained to an acceptable standard before undertaking unsupervised care work. If we can establish that standard across the country, we can drive up standards.
Care homes should be places of light and laughter, rather than places of fear and neglect. They should be seen as part of their communities, rather than apart from their communities. Will the Minister therefore look again at the proposals in this Government’s White Paper on care and support for commissioning a piece of work delivered by the programme called My Home Life, which is all about delivering relationship-based care? Rather than care that is just about transactions, the programme is about changing the nature of the relationship between those who provide care and those who receive it.
I am certainly happy to have another look at the White Paper and to discuss it with my right hon. Friend, but let me just address his key point. It is absolutely right to say that when we have closed doors, awful things can happen beyond the sight of the public. Professor Martin Green, who is a very good leader of providers of care, has argued the case for care homes to become a sort of hub in their local community, opening their doors to ensure that they become a centre of excellence for that community and providing services and support for people who may live independently at home, but who would benefit from the skills in such an organisation. Openness, transparency and ensuring that the public gaze is cast upon what goes in such places is the right way forward.
Before I came into the House, I worked for the Care Standards Inspectorate for Wales, and when I had concerns about a care home with which I was working, I made unannounced inspections. Will the Minister tell us how many unannounced inspections were made at Oban House, and can he guarantee that the CQC has enough inspectors and enough capacity to carry out frequent unannounced inspections for homes about which it has any concerns?
We are making absolutely sure that the Care Quality Commission has the capacity and the funding to do its job properly. That question was also asked by the shadow Minister, and I apologise for not responding on that point. We absolutely want to make sure that the CQC has the capacity to do unannounced inspections, but, critically, to do much more robust inspections as well.
This is a process—we cannot introduce a different system overnight—but the new system of robust inspections is already being used in about 1% of care homes, with a view to the process being rolled out fully in October this year. The first ratings of care homes will emerge in October this year. Members of the public, when they are making crucial decisions about where a loved one will receive care, will therefore have much more information about which care providers are good and which are not up to standard. I will make sure that the hon. Lady receives the same timeline of what the Care Quality Commission did that I offered to the shadow Minister.
Yet again, it has taken undercover reporting by the BBC and covert recording by families to shine a spotlight on these appalling abuses. Given that people with dementia, in particular, cannot tell their own story—in some recent cases, that has involved their being slapped—should not the CQC not only make unannounced visits, but seriously consider undercover work to record these terrible abuses?
I agree with my hon. Friend. I have spoken to the chair of the CQC, David Prior, specifically about this matter. It is looking at both the use of hidden cameras in appropriate circumstances and at mystery shopping—going into care homes, finding out what is going on and getting a real picture, rather than things perhaps being hidden away from view when a named inspector turns up. All these mechanisms have to be used. We have to be prepared to do these things to ensure that people in very vulnerable situations, particularly people with dementia, are cared for with dignity.
The care homes sector is growing in size and in profitability. In his remarks, the Minister focused on the low wages that are paid to care workers in the sector. Often, the pay reflects the value that is put on the work that is being done. Will he look at pay and profitability in the sector, and consider the impact that it may have on bad practice?
The hon. Gentleman makes a fair point. The difference in the providers that pay people properly is clear. Incidentally, domiciliary care is another area where there are concerns. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) visited Wiltshire recently, which has moved away from the old style of paying people a pittance and now gives care workers a salary. When that happens, the whole culture starts to change completely.
We must ensure that there is compliance with the minimum wage, as well as advocating wages that are better than the minimum. Her Majesty’s Revenue and Customs has done a lot of work in the sector to address the abuse of the minimum wage regulations, which is far too widespread. It is completely intolerable for any care provider not to meet its statutory obligations. As the shadow Minister said, we have to ensure that when they commission care, councils cannot be complicit in an arrangement that they know will end up with people not receiving proper pay.
On the Minister’s last point, I am pleased that Gloucestershire county council, notwithstanding the financial pressures on it, has prioritised spending on adult social care for elderly people and those with learning disabilities. From his conversations with the CQC, is he confident that its culture is not just that of a tick-box regulator, but that of an organisation that sees itself as the champion of those who are receiving care and their families, such that if it sees the sort of abuse that was highlighted on television last night, it will act to ensure that it comes to an end and that the perpetrators are dealt with swiftly?
Thank you, Mr Speaker, for your gentle guidance. I will do my best.
The hon. Gentleman makes an incredibly important point. One cannot change the culture of an organisation overnight. The Care Quality Commission was a dysfunctional organisation, but it now has really good leadership in the form of David Behan and its chairman, David Prior. They understand the importance of changing the culture and ensuring that they are always the champion of the patient.
I say to the Minister and all colleagues in the House that this is not good enough. It is disgraceful. We had it before and we had similar answers. We have to stop this. There are wonderful carers out there—most carers are wonderful—but they need support, good skills training and to be paid properly. Surely we ought to have a charter in every home that says, “These are your rights. Don’t let them be infringed. They are clear.” Every good hotel and business has such a charter hanging up where everyone can see it. Can we not have that tomorrow?
Many care homes are signing up to exactly those standards. The more that happens, the more we should applaud and encourage it. The hon. Gentleman is right that we should all be completely intolerant of such abuse and neglect. It is a challenge for the whole of society. Whichever Government are in power need to hold the line of being absolutely intolerant of any failures of care and must demonstrate that when they happen, there are real consequences that will hold people to account.
As I found out recently when trying to find a suitable home for a relative, trying to get assurances about the quality of care and not just the quality of the buildings, let alone working out how one pays for it all, is a minefield. The truth is that this abuse was uncovered not by the CQC but by the BBC. Following on from the comments of my right hon. Friend the Member for Banbury (Sir Tony Baldry), could we not have a reporting mechanism, be it through residents, their relatives or volunteer visiting friends, which would be particularly appropriate for those who lack capacity, that would trigger such an investigation by the CQC, with the use of undercover cameras and so on? Could we not have something as high profile as ChildLine that works and that people know about?
I thank my hon. Friend for his question. Of course the work has to go way beyond just what the CQC can do. I mentioned in response to my right hon. Friend the Member for Banbury (Sir Tony Baldry) the fact that organisations focusing particularly on compassionate care now carry out inspections and make reports. I have also mentioned NHS Choices, which means that any member of the public can give their comments on the care experience of a loved one. The more people use their power to highlight unacceptable things that are happening in care homes, and indeed great things, the better.
My constituent Maureen Pycroft witnessed appalling standards in the home where her husband Barry was meant to be cared for, and she was horrified to learn that the same care provider went on to run other services and abuse other vulnerable people some years later. Will the Minister assure me that the CQC now has powers to ensure that when there is abuse in homes, the providers who run them will be barred from running homes in the future?
The hon. Lady is absolutely right, and that is why we are introducing the fit and proper person test for every director of every care or health care provider. If they have been complicit in unacceptable standards or prosecuted for unacceptable care, the CQC can require them to be removed from the board of a care provider. The new standards should help considerably.
Nobody who uses schools is unaware of Ofsted and its job. Should we not look for a similar situation with regard to the CQC, and is there not a big public information job to be done to ensure that people know better what the CQC is there for and how to access it?
My hon. Friend is absolutely right. The CQC needs to build a reputation so that everyone has confidence in its ability always to represent the patient’s interests. I believe that the CQC’s leadership understand that mission and are well on the way to achieving it, but it will not happen overnight.
I have seen wonderful examples of residential care in my constituency, but I have also had concerns raised with me about staffing levels and zero-hours contracts in other care homes. There is no one-size-fits-all solution, and transparency is key, so what are the Government doing to enhance and protect the vital role of employees who blow the whistle on poor standards of care?
The hon. Lady is absolutely right to recognise that there is great care out there, and we should applaud care workers who deliver fantastic care. I was at an awards dinner recently at which individual care workers were given awards for providing great care. Celebrating great care is incredibly important in changing the culture of the sector.
The Government took steps to fund a helpline that had previously been only for health workers and extended it to social care, so that anyone can seek advice about what to do if they want to whistleblow. The culture must be that anyone feels able to blow the whistle and get things done, and the CQC must respond effectively when that happens.
The Minister will be aware that we have previously had problems with a care home in Harlow, but we also have some excellent ones, particularly Tye Green Lodge, Alexandra House and a number of others. Does my hon. Friend agree that we should boost the confidential hotline and set it up as a proper hotline like Crimestoppers, to allow people to feel that they can call? Does he also agree that we should ensure that it is advertised properly to everyone who uses care homes and their relatives?
My hon. Friend makes an important point and it is right to highlight the great places that are providing excellent care. The Care Quality Commission makes it clear that it encourages members of the public to come forward and alert it to concerns, but we must do much more to make it easy for members of the public, so that they understand exactly what they need to do if they have concerns.
I applaud my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) for her comments, particularly on local authorities. A major factor in all this and across the care sector has been the widespread privatisation of very good local authority care homes. In my constituency, three superb homes were forcibly closed. They were loved by their staff, their residents and the families, and admired by local health professionals—all closed; all gone. Is it time to re-establish a role for local authorities in providing care services and making all care locally and democratically accountable?
Unacceptable standards of care must be condemned and challenged wherever they occur, whether in the private, public or voluntary sector. Mid Staffordshire hospital was an NHS hospital, yet awful things happened. We must be intolerant of abuse or neglect wherever it happens. On local authorities—the shadow Minister raised this point—we have the power to require the Care Quality Commission to inspect on specific issues, including where there are concerns about the commissioning of care. It is important that those powers are there to be used.
The BBC shone a spotlight in its programme on the practices of specific care homes. What message can my hon. Friend give to people whose vulnerable family members have been in those homes and treated so appallingly? What level of reassurance can he give those families that their safeguarding is being taken care of and that this abuse will stop?
The way I would put it is that we owe it to those families to demonstrate that we are taking effective action to address the very serious concerns they have raised. All the steps the Government are taking, which I have outlined this morning, will go a long way to eradicating such behaviour. Where it does occur—there will always be bad apples in any system—there must be real consequences not only for that individual care worker, but for a company that allowed such things to happen in the first place.
As a constituency MP I respond to CQC reports by visits or by writing to care homes. On a recent visit to a very good care home, staff talked to me about their new apprentice with great enthusiasm. That apprentice will receive good training and support, and I am sure they will be a good employee. Is the Minister confident that the CQC has the capacity to oversee and assess apprenticeship training to ensure that it is not just cheap labour and that apprentices are getting the best education?
First, I applaud the hon. Lady for going to those care homes and seeing for herself what is going on in response to Care Quality Commission reports. We should all be willing to do that. I have already said that the CQC has been given extra funding, and we are completely committed to ensuring that it has the capacity to do its job properly and substantially increase the number of apprentices in that sector. As she says, proper training is vital to ensure a properly trained work force.
Does the Minister agree that the most effective way to raise standards and ensure a culture of compassion and sympathetic care in a full range of care settings is by strengthening corporate responsibility? We need public opprobrium to be aimed at the owners and directors of those companies so that they are persuaded to introduce systems such as lay visitor or advocacy schemes within those care settings, to ensure that examples of this sort do not happen.
My hon. Friend is right. That is why the Government have taken steps to ensure that the Care Quality Commission can prosecute when there are examples of the new fundamental standards of care we are introducing being breached. In future, no one will be able to get away with allowing poor standards of care in their workplace. We will take action through prosecution and the fit-and-proper-person test to drive up standards.
The Minister has spoken a fair bit about the extra powers he will give the Care Quality Commission, but staff at that agency gave the Old Deanery home a clean bill of health in November 2013. Two months later after the “Panorama” revelations they found significant failings. What will the Minister do about inspectors who failed to do their job? Will they be free to carry on as if nothing has happened?
I am grateful to the hon. Gentleman for raising that point. In a way, he makes the case for why the inspection regime needs to be much more robust and not a tick-box exercise. More effective inspection, with inspectors talking to staff and, crucially, relatives of those in the care home, will provide a much better picture of what is going on there. It is for the CQC as the employer to address any concerns it has about the way in which its staff have conducted themselves, but the new tough inspection regime is being introduced, with 1% of care homes already covered. It will be fully implemented by October this year.
I applaud the Minister for his efforts to change the prosecution regime for residential care home abuse, but is he optimistic that he can get the changes through so that we might see some exemplary prosecutions by the end of this year?
I hope that the changes will be implemented in October, but of course criminal investigations take time. The whole purpose is for the changes to act as a deterrent to stop bad things happening, but I take the view that if there is evidence that awful things have happened, the CQC must use its new powers. If it were to do so, it would send a very clear signal to the rest of the sector that this is a serious regulator that will use its powers effectively.
Because of the high turnover of staff in the adult care sector, intelligence on care staff, especially those who have committed abuse and are barred, is very important. Why has there been a 60% drop in the number of people barred from working with vulnerable adults on the basis of information from care home providers in the last three years?
I will investigate the figures that the hon. Lady mentions. She is right to suggest that it is important that if employers—both in the social care and health sectors—dismiss a worker for abuse of patients or residents, they refer the case to the barring scheme. If employers are not doing that, they are failing in their responsibilities. We have to protect people in such cases and I will look into the point she raises.
The CQC has recently published a critical report on some care homes in north-east Lincolnshire that care for people suffering from mental health difficulties. I welcome what the Minister said earlier about the need for better training. Dealing with mental health patients is particularly challenging, so can he give an absolute assurance that more work will be done to ensure that training meets the standards required?
I am grateful to my hon. Friend for highlighting the fact that it is just as important to protect and provide great care for younger adults who have other needs, be those mental health issues, learning disabilities or autism, as it is for frail older people. All the requirements on compulsory training will apply equally in the former settings as they will in the latter. We have to drive up standards there as well.
The Oban House health care home is located in my constituency and I apologise to you, Mr Speaker, the House and the Minister for not being here when the Minister made his statement. I hear that the Minister made a comprehensive statement that covered a lot of the issues. When the dust has settled, will he agree to meet me and any concerned constituents to assess how the situation arose and how we can make progress?