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Care Homes: Abuse

Volume 689: debated on Thursday 22 February 2007

asked Her Majesty’s Government:

What evidence they have of abuse of patients in National Health Service care homes.

My Lords, there are no comprehensive data on how many people are abused in care homes, but all cases of abuse are to be deplored. No Secrets, the statutory guidance issued in 2000, embraces multi-agency policies and procedures to protect vulnerable adults from abuse.

My Lords, I thank my noble friend for that reply, but abuse has been reported, as he well knows. That abuse includes people being raped and people being tied to a wheelchair or a bed for up to 16 hours at a time, as well as routines being established for the convenience of staff rather than patients. Will my noble friend confirm that the Healthcare Commission reported as long ago as last June on some of these shocking cases and issued another report recently on yet another hospital where there has been further abuse? Can he tell us just how many more commissions, reports, inquiries, investigations and policy reviews are necessary before these patients can be treated in a civilised manner?

My Lords, I said that there were no comprehensive data, but a number of reports by respected organisations, including Action on Elder Abuse, have detailed the kind of serious issues and incidents to which my noble friend referred and the recent shocking cases in Cornwall and in Sutton and Merton. No Secrets, the statutory guidance to local authorities, makes it absolutely clear that adult protection committees need to be established and multi-agency working needs to be adopted. The Commission for Social Care Inspection has very clearly been charged to investigate all potential cases and it takes decisive action against homes that are found to abuse people. Clearly, we must be ever vigilant in this area.

My Lords, does the Minister think that there is a relationship between this problem and the growth in the practice of contracting staff into the health service on short service contracts?

My Lords, I am not aware of any hard evidence to that effect. Clearly, it is much better if organisations do not have to rely on temporary agency staff, because of continuity of care. This is certainly something that the Commission for Social Care Inspection will keep an eye on, but at the end of the day we depend—and it is right to depend—on the people who run care homes to ensure that whatever staff they have are properly trained and given the right advice and support in dealing with vulnerable people.

My Lords, given that 91 per cent of care home places for older people are in the private or voluntary sector and that the Government know that it is important for the Human Rights Act to be widely interpreted, what are the Government going to do about the loophole after the Cheshire judgment in 2001 for privately run care homes? What will they do about the large number of vulnerable older people who lack the protection of the Human Rights Act in that regard?

My Lords, the noble Baroness is right to refer to the large number of people in private care homes. Clearly, if there are gaps in the legislation, as she implies, that needs to be looked at. More generally, we very much rely on the Commission for Social Care Inspection inspecting standards. I remind noble Lords that, as a result of the action of the commission, in the past 12 months 69 homes were compulsorily closed. There is a wide variety of problems behind that but it shows that the enforcement agency has teeth.

My Lords, in the opinion of Her Majesty’s Government, what is the cause of the unacceptable practices of which the noble Lord spoke?

My Lords, that is a difficult question to answer. I suggest that there are a number of causes, which relate to poor training, a poor ethos of leadership and problems with the vulnerability of certain patients, but at the end of the day I put it down to poor leadership. If you do not have a proper ethos of caring in care homes, and you do not ensure that all staff know it, you will end up with problems.

My Lords, does the Minister accept that this certainly shocking but also very sad state of affairs reflects the lower value that we have all, perhaps subconsciously, placed on older people at the end of life? We seemingly place little value on the considerable contribution that they have made to family, the community and the well-being of the country. What plans do the Government have to address this aspect of the problem?

My Lords, the noble Baroness raises a profound question, which covers attitudes in society towards older people. This House of all places knows the value of older people. I believe that our average age is 68. Noble Lords have evidence of the valuable role that people who might be regarded as older play in society. The passing of the age discrimination legislation is one important aspect of identifying the value of older people to the public and employers. We need to build on that. We have policies and programmes to encourage public authorities to recognise the value of older people, but as the demographics mean that more and more people will be regarded as elderly in the future, the more we can identify their contribution to society, the better and more positive attitudes will be.

My Lords, does not the Minister agree that any abuse of people in care homes is quite unacceptable and very often horrific? Some of this occurs because the staff who do the direct caring are poorly, if at all, qualified to do the job that they need to do. Will the noble Lord assure me that the Government will take very seriously the efforts that are being made to produce qualifications and training for those low-level care staff so that they are recognised, and that the Government will take this up as a priority?

My Lords, the simple answer to that is yes. Any act of abuse must be deplored, and we do so. I thoroughly agree with the noble Baroness about that. Thousands of people work in care homes. The great majority of them do a very good job indeed and we should acknowledge that. However, they need support, training and leadership. Clearly much more needs to be done, and the Government will address this in partnership with the regulatory bodies concerned.