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House of Lords
Thursday, 22 February 2007.
The House met at eleven o’clock: the LORD SPEAKER on the Woolsack.
Prayers—Read by the Lord Bishop of Coventry.
Care Homes: Abuse
Lord Ashley of Stoke asked Her Majesty’s Government:
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, there are no comprehensive data on how many people are abused in care homes, but all cases of abuse are to be deplored. No Secrets, the statutory guidance issued in 2000, embraces multi-agency policies and procedures to protect vulnerable adults from abuse.
Lord Ashley of Stoke: My Lords, I thank my noble friend for that reply, but abuse has been reported, as he well knows. That abuse includes people being raped and people being tied to a wheelchair or a bed for up to 16 hours at a time, as well as routines being established for the convenience of staff rather than patients. Will my noble friend confirm that the Healthcare Commission reported as long ago as last June on some of these shocking cases and issued another report recently on yet another hospital where there has been further abuse? Can he tell us just how many more commissions, reports, inquiries, investigations and policy reviews are necessary before these patients can be treated in a civilised manner?
Lord Hunt of Kings Heath: My Lords, I said that there were no comprehensive data, but a number of reports by respected organisations, including Action on Elder Abuse, have detailed the kind of serious issues and incidents to which my noble friend referred and the recent shocking cases in Cornwall and in Sutton and Merton. No Secrets, the statutory guidance to local authorities, makes it absolutely clear that adult protection committees need to be established and multi-agency working needs to be adopted. The Commission for Social Care Inspection has very clearly been charged to investigate all potential cases and it takes decisive action against homes that are found to abuse people. Clearly, we must be ever vigilant in this area.
Lord Marsh: My Lords, does the Minister think that there is a relationship between this problem and the growth in the practice of contracting staff into the health service on short service contracts?
Lord Hunt of Kings Heath: My Lords, I am not aware of any hard evidence to that effect. Clearly, it is much better if organisations do not have to rely on
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Baroness Neuberger: My Lords, given that 91 per cent of care home places for older people are in the private or voluntary sector and that the Government know that it is important for the Human Rights Act to be widely interpreted, what are the Government going to do about the loophole after the Cheshire judgment in 2001 for privately run care homes? What will they do about the large number of vulnerable older people who lack the protection of the Human Rights Act in that regard?
Lord Hunt of Kings Heath: My Lords, the noble Baroness is right to refer to the large number of people in private care homes. Clearly, if there are gaps in the legislation, as she implies, that needs to be looked at. More generally, we very much rely on the Commission for Social Care Inspection inspecting standards. I remind noble Lords that, as a result of the action of the commission, in the past 12 months 69 homes were compulsorily closed. There is a wide variety of problems behind that but it shows that the enforcement agency has teeth.
Lord Tebbit: My Lords, in the opinion of Her Majesty’s Government, what is the cause of the unacceptable practices of which the noble Lord spoke?
Lord Hunt of Kings Heath: My Lords, that is a difficult question to answer. I suggest that there are a number of causes, which relate to poor training, a poor ethos of leadership and problems with the vulnerability of certain patients, but at the end of the day I put it down to poor leadership. If you do not have a proper ethos of caring in care homes, and you do not ensure that all staff know it, you will end up with problems.
Baroness Howe of Idlicote: My Lords, does the Minister accept that this certainly shocking but also very sad state of affairs reflects the lower value that we have all, perhaps subconsciously, placed on older people at the end of life? We seemingly place little value on the considerable contribution that they have made to family, the community and the well-being of the country. What plans do the Government have to address this aspect of the problem?
Lord Hunt of Kings Heath: My Lords, the noble Baroness raises a profound question, which covers attitudes in society towards older people. This House of all places knows the value of older people. I believe that our average age is 68. Noble Lords have evidence of the valuable role that people who might be regarded as older play in society. The passing of the
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Baroness Greengross: My Lords, does not the Minister agree that any abuse of people in care homes is quite unacceptable and very often horrific? Some of this occurs because the staff who do the direct caring are poorly, if at all, qualified to do the job that they need to do. Will the noble Lord assure me that the Government will take very seriously the efforts that are being made to produce qualifications and training for those low-level care staff so that they are recognised, and that the Government will take this up as a priority?
Lord Hunt of Kings Heath: My Lords, the simple answer to that is yes. Any act of abuse must be deplored, and we do so. I thoroughly agree with the noble Baroness about that. Thousands of people work in care homes. The great majority of them do a very good job indeed and we should acknowledge that. However, they need support, training and leadership. Clearly much more needs to be done, and the Government will address this in partnership with the regulatory bodies concerned.
Countryside and Rights of Way Act 2000
11.14 am
Lord Greaves asked Her Majesty’s Government:
What progress is being made on the implementation of Section 3 of the Countryside and Rights of Way Act 2000.
The Minister of State, Department for Environment, Food and Rural Affairs (Lord Rooker): My Lords, Natural England is due to report on ways of improving access to the English coast by the end of February, including the use of Section 3 of the Countryside and Rights of Way Act 2000. Once Natural England has provided its advice, the Government intend publicly to consult on options for improving coastal access and the costs and benefits of these.
Lord Greaves: My Lords, I welcome that factual Answer. I also welcome the decision of the board of Natural England, which met yesterday afternoon, to put to the Government what I consider to be very sensible proposals, and I look forward to their response.
This was a Labour Party manifesto commitment at the last election. Will the Minister confirm that the Government have a commitment to legislate for coastal access during the current Parliament? Will he
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Lord Rooker: My Lords, I am sorry, but I cannot confirm anything other than the Answer I gave and the fact that it was a manifesto commitment. The other questions go way beyond what I am able to commit to today.
Baroness Byford: My Lords, will the Minister clarify issues arising from recommendations made at the meeting yesterday? First, it was presumed that no compensation would be paid for the compulsory take-over of land. Secondly, although the CROW Act stated that access to the countryside should be opened up, it also stated that we should protect and conserve wildlife and the environment. The RSPB, for one, is very concerned that this corridor will be opened up willy-nilly, without considering certain exemptions.
Lord Rooker: My Lords, with due respect to the noble Baroness, we have not had the report of the meeting yesterday. The Government will receive it from Natural England by the end of this month. There have been press reports about what occurred, but I am not in a position to say that the Government have received the report. Whatever view is taken, there will be a consultation and there will be no attempt at confiscation. There must be a reasonable way of dealing with people who have private land on the coast, whether it is hotels or people owning beaches rather than the foreshore. Compensation is therefore some way down the road. We have got to look at the costs and the benefits of this proposal. One should not take literally the report by the excellent journalist Valerie Elliott in the Times today about an attempt to rush a Bill through Parliament “within a year”. I can assure the House, no way.
The Duke of Montrose: My Lords, no doubt the Minister is aware that Section 3 allows the Secretary of State to include coastal land for access by order. Does the approach of Natural England to look for further primary legislation have the Government’s approval?
Lord Rooker: My Lords, Section 3 is the power to extend to coastal land. In my original Answer, I said that Natural England was due to report on ways of improving access, including the use of Section 3, but Section 3 may not be the option taken to deal with this issue. As I understand it, there will be other options. It is just one of the options; it will not necessarily be the way forward.
Lord Clark of Windermere: My Lords, does my noble friend accept that walking is a growing and popular pastime in this country? Will the
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Lord Rooker: Yes, my Lords, that is absolutely the case. It is our intention to have as much land available to people as possible, whether countryside or costal access, other areas such as inland waterways, or along the Thames, as has happened in recent years. That, in principle, is that way to do it. However, one has to be practical and do it with consultation and in partnership in a way that allows you to get maximum benefit for everyone, and not go around deliberately trying to upset people.
Lord Greaves: My Lords, the noble Baroness suggested that there would be the compulsory take-over of land. Will the Minister confirm that under none of the proposals that has been put forward, or is being considered, will there be any compulsory take-over or confiscation of land? More than half of England’s coastline on the edge of farmland is already open to access and it works perfectly well. That kind of reasonable and sensible arrangement is being suggested for the rest of it.
Lord Rooker: My Lords, I look forward to receiving the report. The Government will take a view on it and then put out options for consultation, together with the benefits and the costs of each option. However, I agree with the noble Lord in principle.
Health: Sports Medicine
11.20 am
Lord Addington asked Her Majesty’s Government:
Whether the current level of expertise in sports medicine in the National Health Service is sufficient to guarantee adequate help to those who do not have access to private healthcare.
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, sport and exercise medicine is the newest medical specialty in the UK, and we are looking to expand it as part of workforce development across England. Local development plans will need to include action to recruit and develop the appropriate staff required to deliver those services.
Lord Addington: My Lords, I thank the noble Lord for that reply. Does he agree with Charles Galasko, president of the Faculty of Sport and Exercise Medicine, that not having sufficient doctors in the community means that those who have suffered, for instance, soft tissue injury end up going to casualty, having several weeks’ referral before they receive physiotherapy, and then having injuries that are more chronic and intractable, and thus cost the NHS considerably more money. That probably also interferes with their work patterns.
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Lord Hunt of Kings Heath: My Lords, that is a very persuasive argument, which is why we have taken the initiative in working with the medical profession to develop this new specialty. We should recognise that often GPs in primary care do an excellent job in relation to some sports injuries, and my understanding is that an increasing number of muscular-skeletal clinics have been set up to deal with the very issues that the noble Lord suggested, and in quick time.
Baroness Gardner of Parkes: My Lords, how many of those special clinics have been set up, given that the Minister said there was an increasing number? How many are in major regional hospitals?
Lord Hunt of Kings Heath: My Lords, the clinics that I am aware of are in St George’s London, Leeds, Sheffield, Colchester, Bath and Cardiff. There may be others and I would be happy to write to the noble Baroness about them. It clearly makes sense if you can set up specialist clinics that allow patients to be treated very quickly with early intervention, as the noble Lord suggested. That applies not just to sports injuries but, for instance, to occupational ill health—30 per cent of such cases are muscular-skeletal disease injuries and, again, early action can prevent people having to leave work and go on to incapacity benefit.
The Lord Bishop of Coventry: My Lords, can the Minister confirm that last summer fewer than 10 per cent of all the graduates on our physiotherapy courses managed to find a job within the NHS? Given that their training costs were in excess of £70 million, that many of those unemployed could well find their way into sports medicine, and that the hospital waiting lists in this area are getting worse, can he assure us that steps are being taken to address this matter? I probably need to declare an interest, in that my daughter runs a physiotherapy department in one of our training hospitals.
Lord Hunt of Kings Heath: Yes, my Lords; while I do not accept the figure given, I understand that there has been a particular challenge this year for newly qualified physiotherapists finding employment within the National Health Service. Only two weeks ago, NHS employers held a summit with various interested parties to discuss this issue. A range of actions have been agreed, including encouraging current basic-grade physiotherapists to apply for higher-graded jobs—thus releasing vacancies for basic-grade physiotherapists—more career advice for physiotherapists and the encouragement of joint appointments between the NHS and the independent sector.
Viscount Falkland: My Lords, is it not the case in National Health Service practices that an increasing burden of administration is falling on the doctor and that more and more treatment is in the hands of the practice nurse? That trend seems irreversible. Admirable though practice nurses are, if you have a
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Lord Hunt of Kings Heath: No, my Lords, that is not my experience, nor is it the experience of many patients. Yes, many staff in primary care are taking on new roles and responsibilities, which often means that patients do not have to go to hospitals because they can have checks in the surgery; but, due to the other changes being made in primary care, GPs actually have more time to deal with patients.
Baroness Masham of Ilton: My Lords, is the Minister aware of the danger of the community type of MRSA spreading in sports clubs? In the interest of public health, will he see that there are adequate hygiene facilities?
Lord Hunt of Kings Heath: Yes, my Lords. As the noble Baroness will know, the incidence of community-based MRSA is low in this country, but experience in the US certainly suggests that it can be spread in sports clubs. We have already issued guidance to the health service but we are looking at further guidance. I very much accept that her point is relevant to guidance and advice that should be given to the health service.
Baroness Neuberger: My Lords, given that as a society we actively encourage people to do more sport, for both public health and personal health reasons, should we not be rather concerned, as the Minister has already said, about people who get injured and need to be mobile for their jobs? Can he tell us how quickly the workforce development work will ensure that we get more physiotherapists in place and more specialist sports medicine in the NHS?
Lord Hunt of Kings Heath: My Lords, I anticipate that in the near future we will have 40 specialist doctors, in addition to 12 starting training each year. With regard to the recruitment of newly qualified physiotherapists, it is worth bearing in mind that the vacancy rate for physiotherapists has dropped dramatically because of the increase in the number of training places. I fully agree with the noble Baroness’s first point. She will know that the joint strategy between my department and the DWP on health, work and well-being takes as its premise that early intervention, good occupational health services and good support from the NHS will stop many people going off work in the first place, and that applies as much to sports injuries as it does to occupational injuries.
Lord Greaves: My Lords, does the Minister agree that the definition of sport and sports medicine in this context should apply not just to formal sports and games but to informal types of outdoor recreation, such as rock climbing and cycling?
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Lord Hunt of Kings Heath: Yes, my Lords. There should not be a theological dispute about the benefits of organised sport on the one hand and more general exercise on the other; in my view, the two go together. The more we can encourage young people in particular but the population as a whole to engage in exercise, the better it will be for their health and life outcomes.
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