Elderly People: Abuse
(10 years ago)
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Baroness Cumberlege
To ask Her Majesty’s Government what assessment they have made of the incidence of elder abuse across the nation.
Baroness Cumberlege (Con)
My Lords, I start by declaring my interests which are in the Register of Lords’ Interests.
I am very grateful for the opportunity to have this debate to ask Her Majesty’s Government what assessment they have made of elder abuse across the nation, albeit I appreciate that we are in the sunset of this parliamentary Session.
According to the Office for National Statistics, there are 3 million people aged 80-plus in the United Kingdom. By 2050 this figure will rise to 8 million. The vast majority of these people are well and active and are a great source of strength in supporting their families and communities. Society would, of course, be so much poorer without them. However, the Alzheimer’s Society informs us that there are currently 800,000 people living with dementia. By 2050 the figure will be 1.7 million. They are the most vulnerable and their care is often a challenge for their families and society in general.
It was the wonderful Sir Alec Douglas-Home, a former Member of this House, who said:
“To my deafness I’m accustomed,
To my dentures I’m resigned,
I can manage my bifocals,
But oh how I miss my mind”.
I suspect that few of us here today have not had the responsibility of caring for others at the start of life in bringing up a family and then at the close of life when caring for someone who is increasingly frail. Whereas Patrick and I made a reasonable fist of bringing up our three sons—I do not believe that any of them has helped the police with their inquiries, but I could be wrong—we are now challenged by a close relative with dementia who has lived in residential care for eight and a half years. We acknowledge that we do not have the skills or patience to look after her. Fortunately, she lives in easy walking distance of our house. The staff, who are exemplary, are local, as are many of the residents, and the front door is never locked. We are always welcomed and never cease to admire the quality of the care that is given. Of course, I appreciate that this is not the case throughout the land. Through the media, the CQC and other organisations, we know that there is abuse in nursing and residential homes, hospitals, prisons and, sadly, within families, and this abuse is the most prevalent and the hardest to detect.
The Department of Health estimates that just under half a million elderly people are subject to abuse in the community. Action on Elder Abuse defines abuse as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.
Abuse of elderly people is a huge subject, but I shall this afternoon concentrate on only two areas. Before I do so, I want to pay tribute to successive Governments who have enhanced the lives of retired people through increasing the state pension and introducing other saving schemes. With the Better Care Fund, this Government have strengthened support for carers; and the Care Bill, which might have just been enacted, places safeguarding adults boards and safeguarding adults reviews on a statutory footing for the very first time. Therefore, much is to be commended but still more needs to be done.
There is no statutory code of conduct to hold care workers to account. The majority, with the right support and supervision, do an excellent job in challenging circumstances. However, there are too many reports of staff delivering poor care. There are individuals who, having abused elderly and vulnerable people, are dismissed from one employer and then employed by another. The Cavendish report advocated standardisation of training and supervision for support workers and greater responsibilities for employers. The CQC is strengthening its inspection regime and identifying poor care.
Those initiatives are very welcome but not enough. The Health and Care Professions Council suggests three ways forward: first, a statutory code that articulates the requirements for honesty, integrity and respect; secondly, an adjudication process that can hold individuals to account; and, thirdly, public access to a register of those not fit to work as carers—a barring system. These measures would make a real difference. They would be proportionate and cost effective, and strengthen the current system, but they need to be backed by legislation. The Law Commission spent three years undertaking a huge task in revising the regulation of professional bodies, and that is much needed. It produced a draft Bill incorporating these and many other ideas. I know that it is the wish of the regulatory bodies that the draft Bill be incorporated in the Queen’s Speech. If that is not possible, I ask my noble friend to use his considerable talents to urge his colleagues to set up a cross-party, pre-legislative scrutiny committee of both Houses to at least start the work to examine the proposed Bill so that we can protect elderly people who are in situations of vulnerability.
My second area of concern is financial abuse, which has a devastating effect on older people. Not only can a comfortable lifestyle disappear but older people do not have the time or opportunity to recover financially. Such a profoundly disturbing experience can be a life-threatening event. Cases are complex and often involve family members or others who have “befriended” an older person—first by giving them gifts, then winning their trust, and then demanding a disproportionate amount for services. These cases can be especially difficult where the older person has mental capacity but seems to be under undue influence from the family or friend and cannot resist their requests.
Age UK receives many cries for help on its advice line. For example: Helen is one of three children who all hold powers of attorney for their mother and is becoming increasingly concerned about the actions of her two sisters, who she feels are not acting in the best interests of her mother. One has moved into her mother’s house without paying rent and the other has set up direct debits from her mother’s account to pay personal bills. They have both pressured their mother into selling personal items and taking out loans in her name and giving them the money. Helen is not sure whether her mother is really aware of what is going on but is finding it difficult to talk to her because the sister who lives with her mother is stopping Helen from contacting her. What can she do? That is one example but there are countless others.
A recent study found that financial abuse was the second most common form of mistreatment for those living at home, nearly twice as common as psychological or physical abuse. It is estimated, that 57,000 people aged 66 and over have experienced financial abuse by a friend, relative or care worker. Indications are that 60% to 80% of financial abuse takes place in the person’s own home and 15% to 20% in residential care. The risk is likely to increase as the population ages, with more people living with dementia and increasing financial pressures on people caring for older relatives. As more bank branches close and services move online, a greater number of older people are likely to rely on family and friends to help to mange their finances, including accessing cash.
What should we do about this? I suggest there should be a national task force to tackle financial abuse. It should aim to ensure better co-ordination between banks and other agencies such as trading standards, the Financial Conduct Authority and the Association of Chief Police Officers. The task force should establish clear reporting lines where financial abuse is suspected. It should consider: how to prevent financial abuse, based on the principle that older people are citizens, not just users of care services; how to raise awareness in all sectors, among older people themselves and the public generally; how advice can be provided to older people on issues relating to lasting power of attorney; and how adult protection committees could work better to prevent financial abuse.
This is not a cheerful subject, but it needs to be addressed. One of the objections to the proposed Assisted Dying Bill is the fear of greedy relatives: where there is a will, there is a relation. I thank noble Lords for taking part in the debate and for their contributions. I look forward to what I hope will be my noble friend’s affirmative reply.
Lord Griffiths of Burry Port (Lab)
My Lords, I thank the noble Baroness, Lady Cumberlege, for giving us this opportunity—albeit at such a late hour—to exchange at least some views on what is an increasingly important subject for us all.
The community where I have responsibilities has a safeguarding policy, but we do not limit it to creating a safe environment for children; we also look at vulnerable adults in the remit of our policy. Perhaps what I predominantly want to say in the short speech that I will make is how important it is to avoid turning a safeguarding policy into a mechanistic exercise. Sometimes one suspects that it safeguards the interests of the institution against potential litigation, rather than creating a safe environment for children or the vulnerable elderly, which ought to be our concern. That is why, in implementing our policy, we try hard to have adequate training across the board and, in various teaching situations, to undergird the requirements of the policy with emotive as well as intellectual consideration.
It is important to create communities of care and for people to encourage each other to look out for each other. As the noble Baroness, Lady Cumberlege, properly said, apart from all the institutional examples of abuse of the elderly, which we know only too well from the media in recent days, people whom we know very well can suddenly show evidence of coming under stress and strain and, when we investigate it, it turns out to be a result of abuse for financial, psychological or other reasons in their domestic scene. We have to attune ourselves to identifying the signals that will allow us to follow through caringly and compassionately on such people when we meet them.
Rather than go into statistical or story-telling mode about this—there is plenty of evidence about it—for me it is simply that, whatever we decide and wherever this debate goes, this issue is not going to go away. It will increase. It is like the environmental debate: all the evidence is there but we do not do much. In the case of the elderly in our community, all the evidence is there but we are very tardy at doing much. I welcome the fact that statutory provision is now available to ensure regulation of certain activities in certain places, but that is very difficult in the domestic scene.
We try to find ways of helping each other to create a culture within which people are alerted to the needs of other people. This Parliament cannot do that. It can do its statutory business but somehow there is a cultural job to do, building an ethos in which people look out for each other and enriching society at a time when we run our affairs with increasing individualism. I simply want to throw that in. I had not expected to be the second speaker in the debate and therefore to be catapulted into making a national statement on all this. However, in all the evidence that is going to come forward, I hope that the undergirding or surrounding of the issue by human qualities of care and sharing is never forgotten or lost from view.
Baroness Barker (LD)
My Lords, I thank the noble Baroness, Lady Cumberlege, for the opportunity to return to this issue. The law is an important expression of what we as a nation believe should be the common standards by which everybody in our society should be held to account. It is an important driver of professional behaviour. This afternoon, I wish to contend that, although we are making progress, our law in relation to elder abuse is still deficient in two respects.
In the Care Bill, we have taken a significant step forward by putting into law statutory duties on authorities to investigate adult abuse. Scotland already has the Adult Support and Protection (Scotland) Act 2007, which I want to come back to. We have a new corporate responsibility for wilful abuse or neglect by NHS staff and the Government are considering doing the same in relation to social care. I welcome that. However, during the passage of the Care Bill it was wrong and remiss of the Government not to increase powers of entry in circumstances where there is good reason to suspect that an older person is being abused and access is being denied by somebody else. For that reason, I think that we will continue to see incidents of abuse against older people.
Early last year and in the early part of this year, I took part in the review of the Mental Capacity Act. A very important part of the report produced by our committee under the excellent chairmanship of the noble and learned Lord, Lord Hardie, concerned the criminal law provisions of the Act, known more commonly as Section 44. Section 44 of the Mental Capacity Act introduced a criminal offence of ill treatment or neglect of a person who lacks capacity. However, there is an important flaw in that legislation. It requires the person to lack capacity or the person looking after them to have reasonable belief that they lack capacity for an offence to be committed. That is not the case in Scotland. There, if somebody is guilty of abuse of an older person, whether or not they lack capacity, that is an offence.
When people from the Ministry of Justice came to talk to us, we asked about the use of that provision. First, our committee was rather surprised to know that the Government do not collect any data; they use only media reports. We thought that that was rather remiss. However, from the media reports that they had, it was clear that there is a gap. The noble Baroness, Lady Cumberlege, talked about the millions of people who may be affected by such abuse, yet there have been only a handful of prosecutions under the Mental Capacity Act. It is clear to us that that law is deficient. Professional staff who may abuse older people do not really understand it. They do not understand their responsibilities and they certainly do not fear prosecution under that legislation. The central point of the legislation was to prevent older people and vulnerable adults from being susceptible to abuse. There is widespread recognition that that law is deficient and several judges have said so in making pronouncements about case law.
My plea to the Government today is that, in their response to the report of the committee on which I sat, they signal that we treat abuse of older people every bit as seriously as abuse of children and that we look at dealing with those two deficient pieces of law.
Baroness Masham of Ilton (CB)
My Lords, I thank the noble Baroness, Lady Cumberlege, and congratulate her on securing this vital debate. Parliament is about to prorogue and I hope that your Lordships will take with you the realisation that there is abuse of elderly people across the country.
Going back some years, I received a letter from an elderly lady in a care home in Leeds. She was desperate. She said that she was a prisoner in a room with an alcoholic; the staff were inadequate; and urine was left in the room. Her letters were read and so the one that she sent me was smuggled out by a friend. I knew someone on the health authority, whom I contacted. When the lady wrote to me again, she told me that she had been moved to a care home in Harrogate and that it was like going from hell to heaven. There is much variation across the country.
On watching the recent “Panorama” programme on abuse in a care home, I am concerned that it is the press that is highlighting these matters. Promoting one of the worst abusers illustrated that the management must have had its priorities completely wrong and did not know what was going on. I wonder what the response of the CQC is on this matter.
I hope that the Minister will update us on the protection of whistleblowers, the people on the ground who know what is going on. Many people are frightened of losing their jobs if they report misdoings. There should be openness and honesty, and protection of those people who speak out on behalf of vulnerable elderly people. Does the noble Earl agree?
Age UK supports the Government’s vision of the “open care home”. So do I. Care settings should never be closed off from the outside world. I am pleased that Age UK is currently developing a toolkit for local partners to enable them to implement and evaluate comprehensive procedures and training for staff, volunteers and trustees in order to prevent neglect and abuse.
There is often neglect and abuse of disabled elderly people who have difficulty in eating and swallowing. No one should be denied food and drink when they need and want it. There is often hidden abuse in the community behind closed doors, when vultures can be waiting for elderly relatives to die. We need to develop a more caring, kind and understanding society.
I consider discrimination against elderly and vulnerable people a form of abuse. The gift of life should be respected at all times, but it needs the right people in the right place to care for them.
The Lord Bishop of Oxford
My Lords, I am grateful to the noble Baroness for giving us the opportunity for this short debate. The stories of the abuse of older people hardly need rehearsing—the media are full of them—and the scandal of a particular care home recently has shocked the nation. Some of us will have had opportunity—even in our own families, doubtless—to experience some of this problem.
The Health Secretary has conceded that something is badly wrong with the care system. However, rather than dwell on the horror stories I want to ask a couple of deeper questions. The first question is: how did we get here? We have lost the quality of belonging together that in Africa is called “ubuntu”, the consciousness of a common humanity. Western culture has developed—or, rather, deteriorated—into an atomised individualism, where we do whatever seems good to us in our own lives and for our own benefit. As we have scattered to our own personal enclaves, as it were, we have left the elderly behind as unproductive, unrewarding problems.
The 2007 study by the National Centre for Social Research stated that neglect was the predominant type of mistreatment of older people in society rather than physical violence. The risk factors are being aged over 85, being female, being in bad health and already being in receipt of some form of support services. A former Commissioner for Older People in Wales has estimated that one person in four reports elder abuse in one form or another, ranging from impatient behaviour to physical mistreatment. We have lost the quality of ubuntu.
The other question is this: where do we start looking for answers? One place must be in our schools. All the primary schools I visit have ubuntu in spades. Their value statements invariably speak of community, belonging, caring for one another, tolerance and respect, and all that works really well at that level. When the pressure is on at the secondary level, we must insist that values education is still more important than narrowly conceived academic achievement; character trumps even five A to Cs. Care for the other, respect for the elderly and the common good are the values that contribute to ubuntu, and they can be experienced, taught and internalised in our schools.
The other key factor in recreating a compassionate society is aligning the different strands of civil society to that common goal. Here I must put in a word for the way the churches cover the entire country with a network of care so ubiquitous that it is often missed by commentators and decision-makers. The church is the largest voluntary organisation in the country by far. In my own diocese we have 815 churches—an outlet on every high street, as it were—with over 600 clergy and 50,000 members who are all motivated to care for their neighbour. The result is a network of care in the form of visiting, lunch clubs, good neighbour networks, dementia groups and drop-ins, as well as countless opportunities for older people to use their skills, experience and wisdom. We have to break down the boundaries between formal and informal care so that a spectrum of modes and levels of care is provided, not just relying on a culture of, “Let’s leave it to the professionals”. My question is: why should we not have ubuntu in Britain; a British ubuntu?
Lord Turnberg (Lab)
My Lords, I, too, am grateful to the noble Baroness, Lady Cumberlege, for raising this important issue. We cannot say we have not been warned about abuse of the elderly. Numerous detailed reports have been published over many years, and we have not neglected to talk about it in your Lordships’ House either. The Government’s response to the Francis report on the Mid Staffs affair was well meant and the Care Bill we passed last week is very helpful, but to my mind, neither of them is aimed at the right targets, nor are they sufficient. They both place far too much emphasis on inspection and punishment for wrongdoing, which of course is essential, and far too little emphasis on measures to prevent bad behaviour happening in the first place.
It is possible that we do not recognise often enough how difficult and taxing, both physically and mentally, the job of caring for elderly people really is. Quite apart from the nature of the job of feeding, toileting and cleaning physically disabled people, many of whom may be mentally disturbed and sometimes resistant or even aggressive, we have to face the fact that these jobs are spectacularly underpaid and underappreciated. They are not appealing jobs and they attract only very specific types of people: those who are dedicated to caring, angelic individuals who are devoted to looking after others. We are fortunate that there are many who fit into that category, but we should not take advantage of these remarkable people by giving them such poor recognition and little to bolster their self-esteem. No wonder there is a high turnover and absentee rate. Job satisfaction depends on being appreciated and there is no doubt that, where carers are appreciated, those who they are caring for gain the benefit. So what can we do to attract carers, and having done so, give them a sense of esteem and job satisfaction?
First, we must pay them better. Jobs in care homes are among the lowest paid anywhere. I fear that the profit motive of some care home operators may be just too strong and the low wages on offer will put off many whom we want to bring in. Also, local authorities are so cash-strapped now that, after a 30% drop in their funding, their services are clearly failing to keep up with rising demand. Poorly funded and understaffed services, leading to rushed overworked carers, are hardly conducive to the sort of care we aspire to.
Secondly, there is then the problem of a lack of professional training and qualification for care workers. We have gone some way along that route, with the help of the noble Earl and with a recognition that training should be an essential part of these posts. However, we are still some way off offering registration to allow care workers that self-satisfaction that comes with belonging to a qualified profession. We have been trying for some time in this House to correct this anomaly and I have no doubt that we will hear more about this topic.
Thirdly, there is the big problem of poor supervision in care homes and hospital wards. There seems little doubt to my mind that a well qualified, competent and active person supervising care at that level is of enormous benefit. These people are the key element in the mix leading to high-quality care. However, here again, recruitment to these posts and retention of people in them is dependent on making them attractive. Nursing sisters in charge of hospital wards should be recognised as having career-grade posts, so that these nurses are not attracted by the prospect of promotion off the ward after a year or so. They should be rewarded appropriately.
Finally, it is good to see in the Care Bill a duty on local authorities to investigate accusations of abuse. However, again, this is after any abuse has occurred and it is rather more important for those commissioning services to take greater care in ensuring that standards for the care that they commission are up to scratch. I look forward to the noble Earl’s response.
Lord Willis of Knaresborough (LD)
My Lords, I congratulate my noble friend Lady Cumberlege on this debate and on not only highlighting the issue of abuse but putting forward a raft of suggestions as to how the Government can take a positive stance. That is important. My contribution is unashamedly a return to the question of how we train those staff who are caring for the vulnerable elderly. Unless we create a culture where those working with vulnerable patients see it as part of their caring role to protect and care for those people, and they are properly trained and empowered to deal with abuse, we will not get much further.
Is it not ironic that, in the heath and care sector, the personnel with the greatest levels of contact with the most vulnerable patients, particularly the elderly, receive the lowest levels of training? Medics are not only well trained at the start of their careers but are required to engage in continuous training in order to continue practising with high levels of safe professional care. However, the thousands of health and social care assistants, who are often left to deal with the most challenging needs of elderly and confused patients, receive little training and have no test of fitness to practise or opportunity to engage in continuous upskilling—nor, of course, are they registered and regulated.
Fortunately, thanks to Members on all sides of the House and, in particular, the efforts of my noble friend Lord Howe during the passage of the Care Bill, we now have the opportunity to address this. The promise of basic training and certification of healthcare support workers, as recommended by Francis, Cavendish and, indeed, my own report, are already under way, with the new care certificate being piloted.
Tomorrow, Health Education England and the Nursing and Midwifery Council launch a major review of the training of the whole of the caring workforce, from healthcare support workers to postgraduate nurses. The review, entitled the “Shape of Caring”, brings together key professional groups—including Health Education England, the Nursing and Midwifery Council, the Council of Deans of Health, the Royal College of Nursing, Unison, employers, the Department of Health, NHS England and, crucially, a wide range of patient forums—with the sole aim of creating an integrated training pathway for all who, day to day, care for patients, in whatever setting they are in. The aim is to ensure that patient care is the golden thread that runs through the whole of training and that continuous professional development is guaranteed for everyone who comes into contact with patients or clients.
All staff should have a grounding in what good care looks like; all should have an understanding of other people’s skills and competences; and all should recognise that care is dependent on a team, no matter how important an individual member might be at a particular time. I am enormously privileged, and declare an interest, that I have been asked to chair the review and to report at the end of February to Health Education England. It is my hope that, if we could get the framework and standards right, and if we could get agreement across this House and the other place that those proposals should be taken forward, we would have for the very first time an integrated pathway of training, qualifications and care right throughout the profession. That would be something that was worth striving for.
Lord Mawson (CB)
My Lords, I, too, thank the noble Baroness, Lady Cumberlege, for introducing this debate. Three months ago, my 95 year-old mother, living alone, had a heart attack early one morning at home in Bradford. The ambulance was called and the paramedic saved her life by deciding to take her by blue light the 15 miles to a hospital in Leeds because he feared the local hospital in Bradford, serving half a million people, was not up to the job. That paramedic’s good judgment saved her life and now she is back home and, amazingly, recovering well.
My mother has fortunately lived a well and independent life and so has not often had to use the health and social care system, so this was all quite new and a fresh experience for her as she became catapulted into the NHS institution. As a person who was now totally dependent on others, at this point she felt that she had a good experience of the system and was treated well by many of the NHS staff. Those of us in the family, however, less dependent and observing the system close up, were left with a few questions to ask. Abuse of the elderly can be subtle, and large, well-meaning government-facing institutions with a tick-box culture can be very inhumane and impersonal, with the best will in the world.
First, on visiting my mother in hospital after the incident, I was greeted by more than 71 notices either side of the door of the ward telling me what to do as well as to wash my hands. If we are the environments we live in, then McDonald’s has a more welcoming environment and clear communication with the customer than this. It is all very amateur and confusing for visitors and patient alike.
Secondly, why did the initial meeting with the social worker not include a person from the health service? It was held in the hospital. Why was a plan that was agreed to by the family then totally ignored and not taken forward when my mother reached the community hospital nearer home? The health people down the line knew nothing about it. Personal communication is essential if vulnerable elderly people are to feel secure. Why are these basics still so difficult in the age of the internet?
Thirdly, why were staff in the local cottage hospital telling us confidently that they did not normally speak with social services—“Nothing to do with us, love”? Why was there no evidence to us that health and social care were partners? At one point, when they did meet, they had an argument in front of the patient. If it is all about working in partnership at a basic level, they still did not seem to get it. My family’s experience of the system was that, despite all the rhetoric about a seamless service, in reality health and social services still seemed to work in separate universes.
Fourthly, why was my mother not given a bath at the new cottage hospital in the four-week period that she was there but had just hand-washing? Is this not rather basic care for a 95 year-old? She wanted a bath. Why when she came home did the social worker then tell my brother, a retired experienced nurse, that he could not arrange a bath at home either until she was given a “bath assessment” at the end of May, weeks later? And we are still waiting. Why did he tell us that the policy was that he could help my mother out of a bath at home but not help her into it? It was health and safety, we were told. Members of the family did the business, but it is all very confusing for sane people.
Finally, why when an assessor comes around to visit my mother at home is this professional not allowed to use her common sense and good judgment? My mother told me she arrived with a pen and piece of paper in her hand, and asked my mother if she knew how to make a cup of tea. “Sit down, love”, my mother said. “I’ve been making tea for 90 years. If I haven’t mastered it by now, there is something seriously wrong”. Treating elderly people like children for the sake of a form that keeps civil servants happy up the tree is abusive, makes the elderly people cross and, by the way, often tells us little about the reality on the ground. My questions to the Minister are: when will these systems receive some innovation and when will we learn—as the noble Lord, Lord Griffiths, rightly said—what caring communities are all about?
Baroness Greengross (CB)
My Lords, the noble Baroness, Lady Cumberlege, has given us the opportunity to consider a whole range of abuses of elderly people. In my very short time, I will concentrate on the rather hidden abuse of people in the community. Unfortunately, as we learnt from the Health and Social Care Information Centre, in just one year—2013—there was a 4% rise in cases of alleged abuse referred for investigation. Sadly, the hidden abuse is very likely not to be referred at all. I have been involved in this issue for many years and helped to establish Action on Elder Abuse because nobody took these issues as seriously as they need to be taken. I am really appalled that we still have to take into account the fact that most of this sort of community-based hidden abuse is not understood or reported.
There are reasons for this. An elderly woman, a mother, who is smashed up by her son will not report it because that makes her seem a very inadequate mother to produce that sort of son. There are other reasons, too. For example, a lot of elder abuse is the result of a whole history of domestic violence in a family that continues into the old age of one member of that family. Sometimes it is a question of revenge, such as for a daughter who was abused in some way in childhood by her father. There are other examples. There is a lot of fraud, which personalised budgets and choice can in fact increase very easily. It is very simple to extract money from benefits or pensions from somebody who is elderly, frail and confused.
Abuse is very hard to detect if a confused elderly person is cared for by a family who provide the basics of food and drink but then shut the door and leave that person in a room alone without any real contact with other human beings. We know that, worse, it is not difficult to use the personalised money they receive for the family’s other needs. I agree with the noble Baroness, Lady Barker, about deficiencies in the law in this country. I have also tried to argue with the noble Earl that some sort of easier method of gaining entry to someone’s home if there is a suspicion of abuse is needed because it is extremely difficult to detect what is going on if you wait until it is publicly recognised. Social workers—very specialist ones—need some way of investigating what is going on.
We know that the elderly people most likely to need care in their homes very often suffer from dementia. The noble Lord, Lord Turnberg, said how difficult it is to care for many years for somebody who has dementia and can be aggressive and difficult. People just do not always have the stamina to continue year after year doing that. We must do something to make sure that these people are better cared for and supported in their task.
Lord Wills (Lab)
My Lords, I hope that it is acceptable for me to speak very briefly in the gap. This is an important issue, and the noble Baroness has done your Lordships’ House a great service by enabling it to be discussed. I support everything that she said about the abuse of powers of attorney—I have examples that I could add to hers.
I should also like the Government specifically to address one way in which elderly people are deprived of their property by the unscrupulous. That is when cold callers, usually on the telephone, persuade the confused elderly to buy goods and services that they simply do not need. It is difficult to detect, and even when it is detected, it can be difficult to put right. It is a serious issue which I came across regularly when I was a Member of Parliament. It is deeply distressing for the families involved and for the elderly person who has signed up to that sort of deal. It is not easy to find solutions, but I hope that the Minister can at least reassure me that the Government are looking at ways to increase protection for the elderly at risk of such exploitation.
Lord Hunt of Kings Heath (Lab)
My Lords, I, too, thank the noble Baroness, Lady Cumberlege, and also pay tribute to the noble Baroness, Lady Greengross, who many years ago first alerted the nation to the problem of abuse of older people. It is fantastic that she is here battling away on that most important issue.
I acknowledge that we have made progress in recent years, with the changes in the Care Bill—perhaps not as much as we wanted but definite progress—strengthening the CQC regulatory framework and the requirement for local authorities to submit returns on incidents of abuse of vulnerable adults. What will happen when those returns come to the Health and Social Care Information Centre? Can one then expect that to form the basis of government policy changes?
I turn to the question of regulation, which the noble Baroness raised. The noble Earl and I have argued about the regulation of care workers; we will not solve that this afternoon. The noble Baroness also raised the question of the Law Commission’s work. Until a few weeks ago, we fully expected, in the fifth year of this Parliament, to have a Bill from the Government. It became known among the regulatory bodies that in fact the Government were not now going to produce a proper Bill but were going to produce a draft Bill for pre-legislative scrutiny. There is another rumour that the Government are not even going to bring a draft Bill in the next Session. I do not think that it needs a draft Bill. It is quite clear that the work undertaken by the Law Commission is perfectly ready for a Bill to be prepared and put into the Queen’s Speech.
The great danger—this is the main point I want to make—is that if we do not have a proper Bill, I should have thought that there is absolutely no chance of a Government in 2015 bringing forward a substantive Bill in the first two terms, so it could be quite a long time before we get a substantive Bill. The noble Earl’s department is doing no work on the Section 60 orders that we currently use. There could be incredible blight among the regulatory bodies unless the Government begin to get a grip. Of course, the noble Earl will not respond to me on this point, but even at this late stage, I would hope that the Government would reconsider why we cannot have a substantive Bill in the next Session.
On financial abuse, is the noble Earl ready to say a little more about what we can do about the abuse of the power of attorney and the point raised by my noble friend Lord Wills on cold callers?
I also ask the noble Earl about the comments of the noble Lord, Lord Mawson. It seems to me that one reason for the lack of co-ordination between agencies is the normal organisational resistance to working together. The second is obviously cost shifting between different bodies, which we know happens at local level. Does the noble Earl agree that a third reason is that people are being very defensive? The reason for filling the forms in is not for the benefit of the older person; it is to prove, when an inquiry happens, when an investigation takes place, that the staff have done what is right. What will the Government do to move away from the current blame culture into one in which staff are encouraged to work together, not just fill in these ridiculous forms, which are no good to anyone?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I cannot hope to do justice in the short time available to the excellent contributions from noble Lords to this debate. However, I express my gratitude to my noble friend Lady Cumberlege for enabling us to discuss such an important subject.
We have stated in no uncertain terms that it is the right of every citizen to live in safety, free from abuse and neglect. Everyone is entitled to receive care delivered by well trained, properly managed and compassionate staff. We are determined to make this a reality. Despite this, cases continue to come to light of abuse and neglect, particularly of older people. We have only to look to the truly abhorrent and sickening cases uncovered at Winterbourne View and by the recent “Panorama” programme, which exposed appalling abuse and neglect at two care homes.
It is important that we also recognise that abuse and neglect is not limited to care provided in residential settings; it can take place anywhere, including someone’s own home, and be carried out by anyone, not just those paid to provide care. Nor is abuse limited to just the physical kind. It takes many forms including the psychological, exploitation and financial. Time and again we hear of targeted fraud on older people, as the noble Lord, Lord Wills, explained, but more often than not the person responsible for the abuse is in a position of trust and power. Everyone should be vigilant in helping to identify those experiencing abuse and neglect or at risk of it. They could be people working in health, social care, policing, banking, trading standards, leisure services, faith groups and housing—the list goes on. As made clear in the Care Bill, sharing of information is crucial. Findings from serious case reviews have sometimes stated that if professionals or others had acted upon their concerns or sought more information, death or serious harm might have been prevented.
We have a growing ageing population, which is to be celebrated, but there needs to be a sharp focus on the quality of life. Radical reform is needed of how health and social care are delivered. The Care Bill starts this process by providing the legal framework to achieve this. It places the well-being principle, prevention and early intervention at its heart. However, we are under no illusion that legislation will eradicate the type of behaviour that leaves people feeling distressed, frightened and fearful.
As many noble Lords emphasised, including the right reverend Prelate, my noble friend Lord Willis and the noble Lord, Lord Griffiths, eradication of these practices and behaviours can be realised only through a collective change in culture—one that leaves no place for abuse and neglect of any kind; one that shares an individual and collective responsibility for spotting when abuse is taking place and identifying those most at risk of experiencing it; and one that works in a collaborative way to challenge and address those corrosive practices.
It is right that people are held to account for the quality of care that they provide. Measures are being implemented to ensure that company directors who are complicit or turn a blind eye to poor care will be liable to prosecution. In future, they and provider organisations could face unlimited fines if found guilty. This should provide additional incentives for effective management and support of staff. There are already systems and processes in place to provide public assurance, including Care Quality Commission registration requirements and the Disclosure and Barring Service. These alone though do not go far enough.
The noble Lord, Lord Turnberg, referred to poor commissioning services. We will be working with the Association of Directors of Adult Social Services and the Local Government Association to develop a set of commissioning standards for local authorities that focus on quality care and support for individuals.
However, following the publication of the Francis report into the failings of Mid Staffordshire NHS Foundation Trust, Camilla Cavendish was asked to review how healthcare assistants and support workers in health and care settings were valued and supported. She proposed, among other measures, the introduction of a certificate of fundamental care, now known as the care certificate. This will give evidence to employers, patients and service users that the person in front of them has been trained to a specific set of standards and knows how to act with compassion and respect. I think that it will also raise the standing and prestige of that person, an issue rightly raised by the right reverend Prelate and the noble Lord, Lord Turnberg. Health Education England, working alongside key partners, has already begun piloting the care certificate across England, as my noble friend Lord Willis mentioned. Subject to evaluation, there will soon be a standard national approach to training on the skills and values needed to be an effective healthcare assistant or social care support worker. It is planned to roll this out in March next year.
I say to the noble Lord, Lord Turnberg, that “I care” ambassadors are uniquely placed as qualified and experienced care workers to promote the image of social care and act as role models. We are fully committed to ensuring that social care services employ people with the right values and skills by introducing a fit and proper person test for directors and a care certificate for front-line staff. Where a director is deemed unfit for the role by the CQC, it will be able to insist on their removal.
In addition, the system of regulation and inspection needs to improve. The CQC is currently introducing a new system of inspection of social care providers, based on much tougher fundamental standards of care, that clearly has the individual at its heart. It will be structured around five key questions that matter most to people—are services safe, caring, effective, well led and responsive to people’s needs? New inspections will draw on the views of people and their family who are experts by their experiences of the services that they see and use. The inspections will be carried out by people who deliver the type of care. CQC has been piloting this new approach in more than 200 social care providers since April this year. It will begin to inspect and rate all providers against the new standards from this October.
New measures in the Care Bill make clear local authorities’ responsibilities and those of key partners, such as the lead commissioner and local police, in safeguarding adults. This is vital in ensuring clear accountability, roles and responsibilities for helping and protecting adults who are experiencing, or at risk of, abuse and neglect.
Every local authority must establish a safeguarding adults board. These boards will be responsible for managing and co-ordinating arrangements that exist to prevent and respond to adult abuse and neglect. They will also have a duty to make inquiries or require another agency to do so. These inquiries will establish whether any action needs to be taken and, if so, by whom.
To make new legislative duties effective, services need to combine efforts to ensure that those who need to be cared for are protected. Strong professional relationships with those staff working in housing, the NHS, community pharmacists and local police will ensure that when concerns are raised they are firmly addressed, while never forgetting the person at the centre of those concerns and ensuring that they are a part of the discussion.
My noble friend Lady Cumberlege asked me about the Government’s response to the Law Commission’s report, a topic also raised by the noble Lord, Lord Hunt of Kings Heath. It is right for me to place on record our gratitude to the Law Commission for the significant time and effort that have been put into developing a detailed and thorough analysis. The department is considering the proposals very carefully and will produce a formal response in due course. It is not possible for me to comment on next steps at this stage until the contents of the Queen’s Speech are known after 4 June.
My noble friend Lady Cumberlege cited a graphic case of an individual who was abused by her daughters. I would say to her that the Office of the Public Guardian should be informed where abuse of a power of attorney is suspected, and it will investigate the claims and work closely with the police where appropriate. The Government have commissioned a practical legal guide for front-line practitioners to support them in using the law where it is necessary to gain access to someone where it is being prevented.
My noble friend also referred to the instance of abusive workers being dismissed from one employer and then going to work elsewhere. If care home or home care employers sack an employee for abusive practice, they are under a legal obligation to refer the person to the Disclosure and Barring Service. When employers are recruiting, they must make robust and rigorous checks and adopt a value-based approach to appointing staff.
Time prevents me covering more subjects. I will write to noble Lords whose questions I have not answered, but I hope my response today leaves no doubt in anyone’s minds about our position on this. We have zero tolerance of abuse or neglect of anyone living in our society. We have taken firm steps to challenge and address those people who do so and organisations that turn a blind eye to poor practices. We will continue to make improvements as part of the response to the Francis report and the Berwick review. We agreed to develop a new criminal offence for individuals and organisations of ill treatment or wilful neglect of users of care services. Following consultation on the proposals for the new offences, we are now carefully considering all the responses. We remain committed to legislating for the new offences as soon as parliamentary time allows.