Private and Voluntary Health Care (England) and Care Home Regulations 2001

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Peter Bottomley: I can help my hon. Friend. Some of the regulations apply to that age group, but others including regulation 45 apply to adults.

Mr. Burns: I am grateful for that help, which confirms that some of the regulations deal with 14 to 25-year-olds. That is crucial, because in legal terms the crucial date is when someone turns 16. Some of the regulations deal with two client groups, 14 to 16-year-olds and 16 to 25-year-olds.

Jacqui Smith: I think that I can help the hon. Gentleman. The regulations apply to care homes for older people and younger adults, with a specific section for 16 and 17-year-olds. To that extent, they apply to care homes that accommodate people aged 16 and older.

Mr. Burns: I am extremely grateful to the Minister. So that there is no misunderstanding, let me ask this: Am I right to think that the regulations do not apply in any shape or form to homes in which there will be young children of 14 to 16?

Jacqui Smith: They do not.

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Peter Bottomley: No.

Mr. Burns: I am grateful to my hon. Friend and to the Minister. That is extremely helpful, as it invalidates the point that I was about to make about the changeover and dual registration.

As I said earlier, the Opposition support any sensible and rational ways to raise standards in care homes, and to ensure that they provide the highest standards of care and give the maximum quality of life and dignity to those who live in them. I am concerned that some of the regulations seem incomprehensible in terms of how they can be defined and enforced, and also that they sometimes seem over-prescriptive and nannyish in stating what one can or cannot do.

Unless there is good reason, I hope that the Minister will allay my fears on criminal records and the burdens that they will place on the aspect of social care that we are discussing. It provides vital care to several vulnerable client groups, despite the fact that she will never accept or admit the figures that show what goes on in the real world. During the past five years, that aspect of care has come under more and more relentless pressure. One would not want regulations designed to improve and enhance the quality of standards in care homes being taken too far and placing even more unnecessary and unacceptable burdens on them.

6.15 pm

Ms Shipley: I broadly welcome the regulations, which are not before time. I welcome the immense detail that has been criticised by some. We need this sort of detail to protect fully vulnerable people. However, I want to raise a series of questions, and if the Minister cannot answer them now, I would be grateful to receive a written response.

What monitoring of the procedures will be put in place? I note that the regulations will come into force on 1 April 2002, so there is some urgency about the matter. Who will carry out the monitoring, where will it be located, exactly how will it operate and through what channels will it be funded? In addition, when something goes wrong, what sanctions will exist for failure to comply and how will the operation of sanctions be phased in? Who will be responsible for implementing the sanctions and how will the monitoring of compliance with the sanctions take place?

6.16 pm

Dr. Harris: The Liberal Democrats welcome the fact that we now have clear regulations for care homes, just as we supported the Act that set out the requirement for the regulations, which are long overdue. However, there are worries that the cost of compliance with some of the regulations, especially in the case of older premises, which are more difficult to amend in order to comply, may create huge financial burdens for some providers and further threaten the availability of care homes. I think that the Government realise what

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difficulties they face in trying to strike a balance between suitable regulation and the need to ensure that there is adequate capacity in the care homes sector.

I want to raise a couple of specific points, the first of which relates to definitions. For the sake of previous and future discussions in other areas, I would be grateful for some clarification from the Minister. Regulation 2 states:

    ''references to 'spouse' in relation to any person include a former spouse and a person who is living with the person as husband and wife''.

It would be helpful if the Minister could give some background or clearer definition of the expression

    ''living with the person as husband and wife''

because, as she and her colleagues have previously said, people live in many different ways these days. Such people will have relatives living in care homes and it is not unreasonable to ask the Minister, as the publisher and writer of the regulations, to explain what she means by that because it must be interpreted by others.

Regulation 5, on the service user's guide, includes a provision that was included in the previous regulations that we discussed. It states:

    ''The registered person shall produce a written guide to the care home . . . which shall include . . .

    (b) the terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees''.

The Minister may be aware—as I am aware from correspondence with constituents—of care home residents who have been presented, out of the blue, with an increase in fees, sometimes related to the provision of free nursing care. I would be interested to know if the Minister expects that such a service user's guide will specify whether there should be a minimum time with regard to increases in residents' charges. Many residents of care homes do not like moving, or they might find it difficult or upsetting; it can be argued that it could be damaging to the well-being of some residents. An untrammelled market could not, and should not, exist in this area, because there is, effectively, a captive customer.

Two issues are at stake. First, I want the Minister to clarify whether she expects there to be some protection against increases in charges for people who are paying for themselves. Secondly, because of the financial position that some care home users find themselves in, is it right that they should pocket the extra funding that the Government are providing for free nursing care?

It is not necessary to get into a debate about whether the amounts that are being provided are adequate, or about the issue of the funding of personal care. That is an issue of limited importance. The Minister might have heard the media coverage of it on Monday morning. She might have been unable to respond to it then, but I wish her to do so now.

I turn to regulation 16, which addresses the facilities and services that need to be provided. The hon. Member for West Chelmsford made a valid point about the details of the regulations. The same question

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applies to the term ''wholesome'' in a discussion about food, as applied to the term ''offensive'' with regard to odours. Everyone understands what is ''suitable'' and ''nutritious'' food. The Minister probably thinks that she knows how ''wholesome'' refers to qualities that are not covered by ''suitable'' or ''nutritious''. However, I am unsure, in legal terms, what ''wholesome'' means that is not covered by ''suitable'' and ''nutritious''.

One might have thought that ''sufficient'' would be included as an adjective to describe food, because I could have a very small portion of suitable, wholesome and nutritious food. However, if it were inadequate in terms of calorific intake—I do not usually suffer that—I would be more concerned about that than about whether it was wholesome as well as nutritious. The Minister might wish to reconsider several of the adjectives that are—and are not—included in the regulations.

Regulation 16 (3) states:

    ''The registered person shall ensure that so far as practicable service users have the opportunity to attend religious services of their choice.''

That is an understandable point; many residents of care homes will wish to participate in religious services. Many of them will also wish to participate in what 16 (2)(m) describes as,

    ''local, social and community activities''.

However, many of them will also wish to participate in the democratic process. If anything needed to be specified, with regard to the requirement to ensure that there are adequate facilities for the engagement of residents so that they are not socially excluded, it should have been the provision for them to vote, in person if they wish to do so. That is as important as the provision to attend religious services, and to take part in community activities. Perhaps the Minister considers that that democratic right is included in the phrase,

    ''local, social and community activities''.

However, the political provision is so important, that it should be explicitly specified. I acknowledge that that opinion might be considered controversial, under certain circumstances.

I found the regulations difficult to understand, because the explanatory notes do not make it clear what age group they provide for. The hon. Member for West Chelmsford also found them difficult to understand. It would be helpful if the Minister would check with officials in her Department that they are capable of seeing the wood, rather than only the trees. I also wish them to recognise that, as some of us are approaching the regulations from the outside, it would be helpful if the explanatory note were longer than less than a page out of a 31-page document.

The explanatory notes should make it clear which areas are covered, as we are dealing with a complex matter. If children's homes and homes that provide services for children under the age of 16 are not covered, a title that refers to children and young persons could be considered misleading.

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I look forward to hearing the Minister's response to the points that I have raised.

6.25 pm

 
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