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Question agreed to.


European Scrutiny


12 Nov 2001 : Column 685

12 Nov 2001 : Column 686

Care Homes (Avon)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. McNulty.]

10.53 pm

Mr. Steve Webb (Northavon): As you will be aware, Mr. Speaker, there has been much discussion in recent months about the effects of the proposed care standards on elderly people, nursing homes and elderly residents in residential homes. However, a group that has, not for the first time, been paid rather less attention is people who are under pension age but also live in residential care. For brevity, I shall refer to them as young residents, although they span the age range. They can be anything up to pension age, but include younger adults and some children.

I bring that group to the House's attention because many younger people may spend many years, and possibly the rest of their lives, in care. They need security and stability, but I fear that they do not have that. I seek assurances from the Minister that she will consider the Government's proposals and ascertain whether that insecurity is justified and whether the anxieties can be tackled. The debate refers especially to younger people in care homes in the Avon area, which covers more than 2,000 young people in the independent sector alone. However, the issue obviously has a nationwide relevance.

I do not want to imply that the Minister or the Department have anything other than the best intentions. I do not suppose for a moment that they support anything other than the best care for residents of the homes that we are considering. That is also my objective. My purpose tonight is merely to ascertain whether the Government will achieve their objectives through their proposed standards. The debate is not party political, and I hope that the Minister will gather from my tone that I am worried about some of my constituents who live in care homes and about whether the proposals are in their best interests.

Many of my comments are coloured by a visit to one care home, the Manor House, in my constituency. It cares for adults with learning disabilities from a variety of age groups. I want to raise two specific issues. First, I am worried that, in some cases, the proposed standards may close homes, especially those in the smallish category, with perhaps nine to 15 residents. The standards suggest that those homes might have to shrink to eight residents or that the required structural changes will cost them one or two bedrooms. Consequently, homes that provide a relatively homely environment, which we all want, may be jeopardised.

The sort of proposals that will cause the problems that I mentioned include a requirement for one toilet for every two clients next to their bedroom, one bathroom for every three clients, no more than eight people sharing a staff group or a dining area, respite care with separate facilities from long-stay residents, and no double rooms after 2004. The case for each standard is understandable, but together, they could mean the end of the road for homes such as the Manor House.

Why would the Manor House face problems? It is a listed building. Many buildings in which people are cared for are old, and the Manor House has specific problems. Any structural change takes twice as long and costs twice

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as much. We all support higher standards, but how will they be financed? The list of standards that we can improve for free is probably short. Most of the proposed care standards have a price tag. For example, different staff for different groups, and more toilets for fewer residents have a price tag. That also applies to management time spent on many of the aspects that we have discussed.

Many care home places are barely adequately funded through local authorities. With the best will in the world, it is unlikely that there will be an increase in local authority fees to care homes to pay for the improvements. Those running the homes believe that they will lose revenue and not have the money to pay for the changes. I fear that some will simply close.

What would be the effects of closure? I have received dozens of letters from parents and other relatives of residents at the Manor House. I have brought one with me that gives a flavour of the anxieties that are being raised. It was written by constituents who have a grandchild in her late teens, to whom I shall refer as Mary. The grandparents state:

There is no question of this being a bad home or an exploitative one. It has emerged in letter after letter from relatives of the residents that this is a good home. The grandparents make this interesting observation:

This proprietor and their family have been in the business for decades; they know what is needed and provide a good quality of service. In the context of whether people are getting a good enough standard of service at the moment, the grandparents say that their granddaughter

That is going to be part of the problem.

In all the letters that I have received, this part of the grandparents' letter jumped out at me the most. They say:

If my fears are unjustified, and if the Manor House can carry on, I will be delighted to write back to the grandparents, and to many others who have written to me, to say, "You need not worry. Your fear is that you may not be around for much longer, but your granddaughter will be properly looked after in a place where she is happy." I would love to be able to say that, but I have the anxiety that I may not be able to. I would be grateful for the Minister's reassurance on that. If places such as the Manor House close, I am not convinced that suitable alternative provision is likely to be in place in the foreseeable future.

I want to raise another specific concern about the regulations, with reference to the case of another resident at the Manor House, of which I became aware in the last

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few days. A lady in my constituency contacted me about her son, Mark, who is 15 and has a mental age of three. In the past week, she has been told by the local social services that homes will not be able to have dual registration for adults and children, and Mark is the only under-18-year-old in the building.

If I have misunderstood this, I have done so in all innocence, but I believe that Mark's mother is worried and has rung me to say that her 15-year-old may not be able to stay there if the new rules come in straight away. I am unclear about when and how they will come in. She says that the Manor House is the right place for him. He has been there for about five years, and it took him three years to settle. She says that he is not " a change person"; he likes stability, and to be in one place. Any disruption, any change, even to somewhere brand spanking new and apparently brilliant, would be a serious problem for this family.

Mark's mother says that, yes, some of his peers in the home are 18 or 19, but many of them have similar mental ages—chronological age is not the acid test here—and get on very well and are well suited to each other. She also says that some of the slightly older or more mature residents are good role models for him. Saying that he should not mix with those people is not in his interests. His mother would not believe anyone who said that it was in Mark's interest to be moved out.

I understand the argument that says we should not house teenagers with 60-year-olds and try to claim that we can cater for those two very different groups with the same sort of provision. I understand the thinking behind that, but my theme is that, when we apply these generalities to specific cases, we have to ask whether such sweeping generalisations work in every case. When they do not work, how much scope is there for flexibility?

I have raised this issue with the Minister, and responded to the consultation process. The Minister wrote back to me in mid-October; I am sure she has a copy of the letter to hand. The one slightly bitter comment that I might make is that one of the sentences in her reply states that

The providers to whom I have talked take great exception to that sentence, because they say that the homes that go under will be the ones that are on the brink financially. They will be the ones that cannot afford the alterations; the ones that will lose some of their fee income when they lose a bedroom; the ones that simply cannot make ends meet. They say, "If I go out of business, it will not mean that I ran a bad home." If the Manor House closes, it will not be because it was a bad home; it will be because it could not make ends meet, perhaps because it was a listed building and could not afford the structural changes. Any suggestion that the homes that go under because of the regulations are bad homes would be bitterly resented. I hope that that was not what the Minister was saying.

The Minister also says in her letter that it will be for the Care Standards Commission to decide

I must stress that although I talk about the care home owners—with whom I have had dialogue—we are concerned about the residents; the owners are the intermediaries. The key question is how much discretion

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or flexibility the inspectors will have. If a home meets 90 or 95 per cent. of the standards, but fails on two or three of the long list, will the inspector be able to say that, having talked to the residents, he has found that it is a good home, providing good quality care? If so, will he be able to allow the home to continue? Or will the inspector have to say that the home fails to meet the standards and that unless it meets them within a specified time, it cannot carry on? There is a danger that in the laudable attempt to raise standards, we are over-prescriptive.

For example, shared rooms are to be phased out. However, what if brothers want to be in a shared room, and their family and social workers think it works for them? Will the standards stipulate not merely that nobody should be forced to be in a shared room, but that nobody may be in a shared room? Is the system being too prescriptive when what works for the individual might be something different from the national model?

The Minister may ask what I would do, and one day I might get the chance. However, for the moment, I offer a suggestion. When we build new homes, we could build in the structural features that make sense. With existing homes, I envisage a situation in which every home that does not meet every standard has to report that fact in all the literature it produces, or whenever its staff talk to new or existing residents. The home would have to list any standard that it did not meet and say when it would meet it, and if it thought that it could. If the home could not meet the required standard, it would have to say why not, and why it did not think that that failure would be detrimental to the care it provided.

From the inspection point of view, I would argue that people who go into the homes should be asking, "What works?" The Government have been known to say on occasion that what matters is what works. What works in the Manor House may be an evolution of the present set-up towards ever-higher standards, but not a step change. If the sums do not add up now, they probably will not add up in 2007 either. However, inspectors will need to exercise some discretion.

There are very good homes throughout Avon, such as the Manor House at Frenchay, that risk closure because the Government's best intentions may have unintended consequences. I would be grateful if the Minister clarified the areas of uncertainty to which I have referred and perhaps offered some reassurance that the Government are still thinking these things through. I hope that she may be able to offer some flexibility on the interpretation of the standards.

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