Winterbourne View Care Home

Catherine McKinnell Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I would not want to give the impression that we would see that as a substitute for any of the other points that have been made on this urgent question today, but undoubtedly telecare, telemedicine and assisted technologies have their part to play, both in improving the quality of care and increasing independence for individuals. That is why the Government support that as part of the way in which we see the future for social care unfolding.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

A recent Tyne Tees television report uncovered cases of appalling abuse and neglect in the north-east that are now being investigated, and the staff in those cases reported dreadful treatment from their employers, not just losing their jobs but having their professional reputation smeared. Will the Minister please elaborate today as there will be workers who are aware of abuse but are in fear of their jobs, who could report abuse if they had some reassurance today of the changes that the Government are looking to make to protect vulnerable workers?

[Paul Burstow]

The first thing I would say is that if anyone sees criminal activity of the sort that took place at Winterbourne View, they should blow the whistle on it. There is no if or but about that. The Government have consulted and we are looking at the responses to the consultation on whistleblowing. I am not in a position to elaborate further, but it is absolutely vital that people feel able and safe enough to come forward if they have concerns about neglect, abuse or poor-quality care.

Social Care Services

Catherine McKinnell Excerpts

Tuesday 17th May 2011 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is a pleasure, Mr Brady, to serve under your chairmanship. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this morning’s debate, which concerns an incredibly challenging and complex matter.

I am concerned that few Government Members are here today, so I congratulate the hon. Member for Newton Abbot (Anne Marie Morris) on attending. That makes me think that we are not all in this together, and it seems that only Opposition Members wish to represent their constituents on this matter.

I wish to contribute to this debate specifically on the standard of care being provided to vulnerable elderly people. I recently participated in a series of hard-hitting reports by Tyne Tees Television’s “North East Tonight” programme. Tyne Tees’s findings on the standard of care provided in some care homes in the north-east were distressing and disturbing, and I am pleased to have the opportunity today—again, I thank my hon. Friend for securing the debate—to highlight some of those concerns and present them directly to the Minister.

I must point out that there are some fantastic care homes in the north-east and that they have some dedicated staff and carers. However, the “North East Tonight” reports were timely, being broadcast in the same week that a paper by Newcastle university’s institute for ageing and health predicted a care home crisis unless there is major investment in the care system to support the rapidly increasing number of elderly people.

In 2010, there were 2.6 million people aged over 80, but by 2030 that figure is expected almost to double to 4.8 million, with one in five needing regular care. The Newcastle university paper predicted that there will be an 82% increase in the number of care home places needed—that is 630,000 extra places between now and 2030 just to cope with the demands of an increasingly older population.

In its investigations, Tyne Tees uncovered reports of former care-home workers who were forced to leave their jobs. Those workers were given bad references, which make future employment in the sector difficult, because they had blown the whistle on the unacceptably poor standards of care. That included lifting the lid on cases of dangerously poor hygiene, of residents not being fed properly, of a lack of interaction between staff and residents and of a total lack of stimulus for the people living there. The investigation also uncovered cases of appalling neglect of vulnerable care-home residents—according to relatives, it was often because there were simply insufficient staff on duty to ensure that their loved ones’ needs could be properly taken care of.

Tyne Tees also reported that many relatives were afraid of reporting concerns about the quality of care being provided, because they thought that it might put their loved ones in greater danger. It is understandably difficult to complain about the poor standard of care being provided for a relative when, in the first instance, the complaint has to be made to the people who are providing it.

Tyne Tees invited me to view its findings. What immediately struck me, as a mother of young children, was the contrast between the standard of care provided to young children in child care settings and the standard of care provided to vulnerable elderly people in care homes. If Tyne Tees had uncovered similar cases of neglect and fear of whistleblowing in nurseries in the north-east, I am sure that there would have been a national outrage, and rightly so, yet the treatment of older people is too often shamefully brushed under the carpet.

The Tyne Tees series of reports received unprecedented feedback through e-mails and Facebook comments, and people wrote to Tyne Tees to back up its findings and report similar concerns. That shows the level of concern across the north-east—and, I am sure, across the country—about the situation.

I recently had to intervene in support of a family seeking help for Jessie Wiseman, an elderly constituent. She is 91 and blind, and she was found living in squalor after ambulance workers paid a routine visit to her property. Despite concerns having been raised by her GP and her son about Jessie’s deteriorating condition, social care workers failed or act and she rapidly declined. That is why I welcome the recommendations in the recently published Law Commission report to introduce a set of statutory principles, a statutory basis for adult safeguarding boards and a duty on councils to assess carers and investigate adult safeguarding cases.

[Mr David Anderson (Blaydon) (Lab)]

Is it not the case that the failings in adult care have gone on for a long time, because, unlike child care, it has never had a statutory basis? In arguing for such a basis to be put in place, we may find that the Government say that this is just more red tape and bureaucracy.

[Catherine McKinnell]

I agree that that is a great concern, which is why the Minister must take on board the deep concerns that are being expressed today. In any event, reforming the law will still not be enough.

I am pleased that, as a result of the Tyne Tees investigation, the Care Quality Commission has agreed to review its reports and to conduct unannounced assessments on the homes in question. However, I am concerned that it appears to have required a television programme to spur the Care Quality Commission into action. By placing their loved ones in residential care, people are putting huge amounts of trust in a service. They rightly expect that the Care Quality Commission is adequately monitoring, regulating and inspecting all care homes on a frequent basis.

[Anne Marie Morris]

The hon. Lady has made some extraordinarily good points, and the Care Quality Commission certainly needs more help to do an effective job. Now that we have an outcome-based set of performance criteria, homes need to be given guidance on how to comply with them. In my meetings with the Care Quality Commission, it says that it no longer gives advice, which means that it is an uphill battle for any home to ensure that it provides the quality of care that is needed and that it complies with the new criteria.

[Catherine McKinnell]

I agree that the Care Quality Commission should take a proactive approach to improving the quality of care in our adult services.

Another worrying statistic is that on-site inspections in care homes have fallen by 70% since the Care Quality Commission was introduced in October 2010. That must worry anyone who lives in a care home or who has a loved one in a care home.

Will the Minister consider the following issues because they are crucial to the future provision of social care services? What further steps can the Government take to ensure a much greater level of protection and safeguarding for vulnerable elderly people in residential care? What measures will he take to ensure that the culture of fear that was spoken about by people participating in the Tyne Tees reports is broken down, so that care workers, relatives and residents feel confident and safe in raising concerns about the standard of care? What steps is he taking to improve the status, pay and training of care home staff, who are doing an incredibly difficult and important job? How will he ensure that the swingeing cuts to local authority budgets over the coming years do not detrimentally impact further on the quality of social care being provided to elderly people, particularly at a time of ever-increasing demand?

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[Mr Anderson]

I agree with my hon. Friend. My own personal experience was in a purpose-built site that did just that. We took in people for a week at a time for respite and we also provided day care, but the individuals all lived in their own homes. Although that was cost-intensive in labour terms, the quality of care was good. We took care of not just the individual but the needs of the family, and we built very close working relationships with them. If we want to have quality care in this country, we must bite the bullet and accept the fact that we have to pay for it. The previous Government accepted that if we wanted quality health care, we had to increase the public payment into it.

[Catherine McKinnell]

In my contribution, I highlighted the worrying case in my constituency of Jessie Wiseman whose care at home was contracted out to a private care provider. Some 15 visits took place over eight weeks before she was discovered in an appalling state. However, the local authority took no responsibility for it. This story feeds into the debate on the worrying trends that can take place when services of this nature are put out to the private sector.

[Mr Anderson]

The privatisation of home care services in this country has been a complete failure and a nightmare. I have represented home care workers for many years and have seen the service deteriorate. We had a dedicated work force who had a set list of clients whom they went to see day in, day out. They built a relationship with that person and their family. When those jobs were contracted out, it was said, “We will send worker A on this day and worker B on that day.” The home care worker lost that direct link with not just the family but the wider team within the authority. That team would work together and take a holistic view and work better for the person concerned. It is clear that services are being contracted out to save money. If we save money, services will not be as good.

It is clear that we will see problems being stored up if we lose public sector capacity in home care services. At the moment, some 31,000 residents are being taken care of by Southern Cross Healthcare. Their homes now hang in the balance as a result of reckless business practices and local commissioning, which has allowed the organisation to become so dominant in the market. Southern Cross and Four Seasons—the big two in residential care—have operated casino-style finances, and both are now teetering on the brink of collapse. A toxic cloud, formed by irresponsible borrowing, weakening demand, council cuts, the slump in care home property values and the collapse of favourable credit facilities, now hangs over the heads of frail elderly people and their families at a time of insecurity and when they need real security.

How has it come to this? How has RBS, a state-owned bank, become the biggest shareholder in Four Seasons in exchange for writing off debts of £300 million? Would taxpayers’ money not be better spent directly on care homes run by democratically accountable councils, rather than being tied up in byzantine financing arrangements?

Across the social care market, research by Community Care suggests that one in five providers expect to go out of business in the next financial year. The regulator describes the home care market as a cottage industry of small, often barely viable providers alongside a few giants such as Care UK, whose chairman kindly provided £21,000 to fund the personal office of the Secretary of State for Health—perhaps that is one reason Care UK is doing so well.

If Southern Cross, Four Seasons or indeed local providers collapse, how will local authorities find new homes for people when they no longer run them? When home care providers default, as they often have and might in future, how will local authorities fill the gap if they have scrapped their own home care teams, which is happening up and down the country?

What about the quality? Care Quality Commission data show that privately provided care services are less likely to be rated “good” or “excellent” and five times more likely to be rated “poor”. I know that the Government do not like targets or standards, but when their own commission is saying such things its message should be listened to. Private providers consistently score lower on a range of indicators of quality and safety. When we look at the employment practices of some providers, we cannot be surprised that home care workers do not stay in their job. They are not paid for their travel time between visits, and they have to provide their own mobile phones and pay for their uniforms. They suffer from underpayments; they often have zero-hour contracts; and they sometimes have to pay towards the cost of administering their own time sheets. No wonder people do not see it as a job for the future or a career that it is worth investing their time and talents in. We need real regulation of employers to stamp out employment practices that have impacted so badly on home care users and, through them, on staff.

Where are we today? We have a Government who want more from staff for less; who want more work by fewer staff, because they are making 500,000 public sector workers unemployed; who want more pension contributions from less pay and for poorer pension provision; and who want people to spend more time at work by making, in particular, women work until they are 66 years old, with less time at home and in retirement.

What did we get last week? The Chancellor has a new red tape initiative. What is he going to do when people are losing their jobs? If there is a chance of redundancies being managed sensibly, what does he talk about? He wants more chances of people being sacked, with less chance of real support by limiting the time to consult. People will have more chance of being made redundant and less legal support to challenge decisions taken by their employer.

The CQC sees a vacuum in regulation and in the checking of safety and quality of care. The CQC’s risk-based approach is resulting in a dramatic drop in inspections. A freedom of information request by Community Care found a 70% drop in CQC site inspections in the past year alone, at a time when more people are in need of care.

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[Paul Burstow]

The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.

I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.

Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.

Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.

The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.

The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.

[Catherine McKinnell]

I want to reassert the point that, regardless of the changes put in place during the past 13 years under the previous Administration, we are moving into unprecedented territory in terms of the funding given to local authorities for supporting social care within the community. That is the context in which some of the changes that we are demanding and requesting today need to be considered.

[Paul Burstow]

I have rehearsed some of the findings from the ADASS survey, which shows that although the changes are tough, they are not as unprecedented as the past 13 years of experience would suggest.

The hon. Member for Blaydon talked about the mixed economy of provision in social care and lamented the passing of a time when a public service offer was the almost exclusive way in which social care was provided. He harked back to a golden age that has passed and that may never have truly existed. I am not certain whether I heard him describe a solution or route map that would get us back to the past that he hankers after. If he has one, perhaps he would share it on another occasion. He also talked about Southern Cross. As a Minister, I am, of course, only too well aware of the issues with which that company is currently grappling. Above all else, I am concerned to safeguard the interests of the residents who live in those homes. That should be on our minds whenever we talk about Southern Cross and its prospects. We need to ensure that we secure its future for its residents.

Health and Social Care Bill

Catherine McKinnell Excerpts

Monday 31st January 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

One thing is clear: from whatever perspective we consider the reforms in the Bill—whether from that of Charnwood or Holborn and St Pancras—there is a serious and worrying lack of evidence base for the Government’s proposals. These are proposals identified by the King’s Fund as without doubt

“the biggest shake up of the NHS since it was established”.

While the Health Secretary was the Conservative party’s shadow health spokesman—from June 2004 until he took office in May last year—he was coy about his real intentions towards the NHS, as indicated by my right hon. Friend the Member for South Shields (David Miliband). When the Government published the Bill, six major health unions and professional bodies wrote in a letter to The Times:

“There is clear evidence that price competition in healthcare is damaging. Furthermore the sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous.”

Labour Members welcome greater clinical involvement in commissioning, but GPs are not the sole font of knowledge in best practice and other areas.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Does my hon. Friend agree that in any one year some GPs will deal only with one or two patients with, in particular, a neurological condition? GPs might not be in the best position, therefore, to be the providers and commissioners of such services.

[Grahame M. Morris]

I agree completely with my hon. Friend’s point. According to evidence given to the Select Committee on Health, specialists in secondary care and the nursing and other professions could add their expertise to the commissioning process.

The shake-up of the NHS goes far beyond simply involving clinicians in spending decisions. GP commissioning is a red herring. We were told by the Secretary of State that these reforms are needed because productivity has fallen since Labour’s increased investment. However, after 18 years of mismanagement and under-investment under the Conservative party, it was obvious that on a crude measurement of productivity—inputs versus outputs—there was going to be a decline in supposed productivity, because obviously money had to be directed towards clearing up the mess left by the previous Tory government, to building new hospitals, accident and emergency units and maternity units, and to reducing waiting lists, which in many areas of the country were 18 months and longer.

The Secretary of State raised the satisfaction survey. Indeed, in December 2010, the National Centre for Social Research released its most recent report on British social attitudes. It found that public satisfaction with the NHS was at an all-time high, whereas in 1997, when Labour came to power, only 34% of people surveyed were satisfied with the NHS—the lowest level since the survey began in 1983. By 2009, satisfaction had nearly doubled to two thirds—to 64%. Given that most health unions, professional bodies, think tanks and the public did not call for such reforms, where did the Secretary of State’s motivation come from? These are not patient-led reforms; they are private health care-led reforms.

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[Nadine Dorries (Mid Bedfordshire) (Con)]

I rise to support a Bill that I believe is perhaps one of the most exciting, if controversial, Bills to have been put before Parliament in the 62 years since the NHS was established. It is a fact that a resident in this country today is twice as likely to die from a heart attack as a resident in France. In this country, we also fail to reach European averages for stroke care. In fact, 4,000 stroke victims a year lose their lives because our NHS is not up to European standards in stroke care. If we delivered trauma care slightly differently, we could also save 600 more lives a year, but we do not. Those figures alone show that it is now time, 62 years since it was established, for the NHS to be modernised.

In those 62 years, drug research and development have advanced hugely. Medical technologies have advanced in a way that could not even have been imagined 62 years ago. As a result of the internet and the information now available, patients expect and demand to have a say in how their condition is managed. They want more information and they want to discuss their care with their GPs. The Bill will put the patient right at the heart of the NHS, and that is why I so passionately support it. The central tenet of the Bill is: “No decision about me without me”. It will ensure that, for the first time, each and every patient can almost become their own lobbyist, sitting in front of their GP and discussing their condition and treatment in an open way, where they have information and the GP will have to engage with them. That does not happen today, and certainly not in hospitals.

I would like to give an example—something that I heard about this weekend from a patient—that clearly epitomises why the patient has become invisible in the NHS today. That patient was in hospital at the weekend when a doctor walked up to him, lifted his arm, took blood, put his arm back down and walked away without saying a single word to him.

[Catherine McKinnell]

It strikes me that despite what the hon. Lady is saying about the patient becoming the heart of the NHS, it will instead be the GP who becomes the heart of the NHS. Is she suggesting that the GP will be in the hospital with that patient to hold their hand at every stage of their treatment?

[Nadine Dorries]

I wish that that had been a more sensible question, because then I would have been delighted to give the hon. Lady an answer.

That patient was in hospital when the doctor walked up, took blood and put his arm back down without even a word of acknowledgment. A nurse then came and put his tray of food at the end of the bed. The patient was attached to a heart monitor and a drip, and could not reach the food. The patient was distressed, vulnerable and in pain, yet he was invisible to the health care professionals who were treating him. He was invisible because what is important in today’s NHS is the process—the management, not the patient. The humanity of the patient has almost been lost, and there is no way to put it back into the NHS other than to tip the understanding of who is important in the NHS on its head. The Bill does that in a way that has never been done before and which is now needed.

Public Health White Paper

Catherine McKinnell Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

The responsibility will be transferred to local authorities, and they will have the same obligation to consult their population as exists in the present legislation. In my view, local authorities are more accountable to the population that they serve than strategic health authorities have been in the past.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

The Secretary of State said in his statement that politicians need “to stop telling people to make healthy choices” and actually help them to do it. He said that they need to stop nannying people, but nudge them “to make healthy lifestyles easier”, and that “rather than lecturing people…we will give them the support they need to make their own choices”. Can he explain how failing to implement the tobacco display policy is forwarding those aims?

[Mr Lansley]

The hon. Lady does not seem to understand. We have made no announcement in relation to the tobacco display regulations—[Interruption.] They were approved by Parliament before the election. We have made it clear that we are looking at a tobacco control strategy. I made it clear just now at the Dispatch Box that, beyond anything done by the previous Government, I am considering the question of the plain packaging of cigarettes, which in itself could be a significant additional weapon in our armoury to reduce the initiation of smoking among young people and the visibility of cigarettes. When we publish a tobacco control strategy, we will weigh up the wide range of such factors.