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Older People: Health and Social Care

Volume 737: debated on Monday 18 June 2012


Asked By

To ask Her Majesty’s Government how they plan to implement the recommendations in the report Delivering Dignity.

My Lords, the Government welcome the report from the dignity in care commission and will consider carefully all the recommendations addressed to government. We will respond to the commission in detail in due course. Many of the solutions to the issues in the report lie with the local NHS, social care providers and other key stakeholders. The Government will encourage the sharing of best practice by bringing people together and putting in place the right system incentives to enable providers to increase the quality of their services to older people.

Following the report, Delivering Dignity, which was published today, will the Government instruct Monitor and the Care Quality Commission to require all authorised providers to seek, monitor and act on feedback from patients and their families, and will the Nursing and Care Quality Forum be widened to look at all aspects of care home staffing, root out poor care and ensure that action is taken so that respect of the individual is an “always” event in the delivery of care?

My Lords, the NHS outcomes framework contains two domains that are highly relevant to this area. The NHS Commissioning Board will be in prime position to monitor those areas of the domains that relate to the patient experience. However, I have no doubt that the CQC will continue to do its work in maintaining essential standards of quality and safety. The Nursing and Care Quality Forum is an independent group and it is therefore for the forum itself to consider how to take forward the issues raised in the recommendation, but I understand that its chair, Sally Brearley, was already planning to consider care homes as part of the next phase of the forum’s work. She has already approached a number of individuals to strengthen the forum’s membership and add further expertise in that area.

My Lords, one of the most important levers for change in the Health and Social Care Act is the mandate that has been agreed between the Secretary of State and the NHS Commissioning Board. Does my noble friend consider that one could include some of the principles that are established in this very good report within that mandate?

My Lords, decisions about the content of the mandate will be made on the basis of a full public consultation, which will take place in the summer. More details on that score will follow in due course so there is a limit to what I can say at the moment. However, as I indicated during the passage of the Health and Social Care Act, the mandate is likely to include expectations for improving healthcare outcomes for patients, based on the NHS outcomes framework. That framework reflects the Government’s ambition for an NHS that provides high quality, safe and effective care, treating patients with compassion, dignity and respect.

What measures will be taken by the national Commissioning Board to ensure that clinical commissioning groups always pay proper attention to dignity when commissioning services for older people?

I come back to the point that I made to the noble Baroness, Lady Finlay. Domain 4 of the NHS outcomes framework is about ensuring that people have a positive experience of care and reflects the importance of providing that positive experience, including treating patients with dignity and respect. Domain 5, which is about treating and caring for people in a safe environment and protecting them from avoidable harm, also relates to that area. These areas will be centre stage in the way that the NHS CCGs in particular are monitored by the board.

My Lords, the recommendations of the Delivering Dignity report focus on tackling the underlying causes of poor care in hospitals and residential care. As the Minister knows, there is widespread concern among key stakeholders, including voluntary organisations, care professionals and care providers, about the serious impact that the growing crisis in social care funding is having on providing good-quality care in residential homes. Does this not make it even more vital for the Government to stand by the Prime Minister’s pledge to deal with social care funding and with the recommendations of the Dilnot commission in this Parliament?

The noble Baroness makes a very fair point. As I made clear last week, our aim has been and remains to legislate in this Parliament to create a fairer, more just and better funding system for social care.

Given that Delivering Dignity recommends that,

“All hospital staff must take personal responsibility for putting the person receiving care first”,

and that staff “should be urged” to challenge practices that they believe are not in the best interests of residents, what measures have Her Majesty’s Government taken to support staff who whistleblow in this respect?

My Lords, the right reverend Prelate draws attention to an area that we have focused on quite hard in recent months, and the NHS constitution has been changed to strengthen the areas around whistleblowing. In the care home context, often the care home is looking after someone who is not publicly funded and the arrangements there are often ones that the care home itself has put in place. We believe that the CQC needs to focus carefully on the arrangements in the care homes that it inspects to ensure that staff feel free to speak up if they are aware of any problems of maltreatment or anything of that kind.

My Lords, does the Minister agree with the final recommendation in the report that we need a major cultural shift if we are to get this right? A very simple and straightforward way of ensuring that would be if every person receiving care was protected under human rights legislation. That would simplify this and make it work straightaway.

The noble Baroness is right. This is about a culture shift and nothing unfortunately can happen overnight. To extend the Human Rights Act to apply to private providers in purely private arrangements in which there is no involvement by a public body would be a radical extension of the Act. The Ministry of Justice leads on humans rights but we will be discussing this recommendation with it and will consider whether further action is needed. However, we need to remember that everyone in a care setting is already protected by the law. I have mentioned to the right reverend Prelate the Care Quality Commission’s registration requirements which set essential levels of safety and quality in the provision of services. Those cover, in a nutshell, the care and welfare of service users, safeguarding service users from abuse and respecting and involving service users. The CQC has extensive enforcement powers to ensure that those standards are met.