John Austin

Labour Party | Erith and Thamesmead

Elder Abuse

John Austin (Erith and Thamesmead) (Lab): I apologise at the outset for the absence of my hon. Friend the Member for Wakefield (Mr. Hinchliffe), the Chair of the Health Committee. All those who serve on the Committee and hon. Members generally will recognise that my hon. Friend is passionate in his concern for vulnerable people and has demonstrated that in both his political and professional career. He is very sorry not to be here, but he has an important speaking engagement with the Health Development Agency in Leeds and is unable to be with us.

This has been a short inquiry. The Health Committee has now decided that, as a matter of policy and in addition to its major inquiries such as that on obesity and the one on which it is about to embark on pharmaceutical services, it will conduct a series of short inquiries on important topics of the day. That puts an additional burden on members and also the staff of the Select Committee. On behalf of the Committee, I extend our thanks to the staff for the additional work that we have put their way and for the excellent quality of service that has resulted in an excellent report. It is also important to thank our advisers, Melanie Kenwood and Chris Vellenoweth, who have served the inquiry well.

In our introduction to the report, we refer to the death of Margaret Panting, a 78-year-old woman who died after suffering unbelievable cruelty while living with relatives, but that event cannot be dismissed as an isolated incident. During our inquiry, we heard horrific stories of various forms of abuse by positive and deliberate acts and by neglect.

In my local newspaper this week I read about the coroner's verdict on the case of 78-year-old Jean Bore who died in a private care home in a constituency neighbouring mine. Mrs. Bore had been admitted to hospital following a stroke in May last year, and in September was transferred to the care home. The following month, her condition had deteriorated and she was re-admitted to Queen Mary's hospital, Sidcup where staff were surprised at the extent and size of her bedsores and the consultant was shocked by her condition. During her five-month stay in hospital, staff had been able to prevent any bedsores developing, but during a short period in a care home she developed bedsores that were so horrendous that the coroner said that they had contributed to her death. He said in his verdict:

"The development of and delay in diagnosis and treatment of sacral pressure sore contributed to Jean Bore's death."

No wonder her son is calling for better monitoring of private care homes and regular checks on their residents. BUPA, which runs the home, said that the care fell short of the standards that it expects. Mr Bore was right when he said that

"if this could happen to my mother, there's every chance others have been treated in the same way".

All of us know of incidents of elder abuse in our constituencies. I know that my right hon. Friend the Member for Manchester, Withington (Mr. Bradley) will want to comment on the Rowan ward in the Manchester mental health care trust.

That is why we must raise awareness of elder abuse and why we need effective systems in place to prevent abuse from occurring. The Committee has received evidence of various forms of abuse: physical abuse, such as slapping, hitting, burning, scalding, pushing, inappropriate restraint, inappropriate use of medicine, withholding medicine as punishment, lack of consideration, roughness when handling or treating people or helping them to the toilet, changing dressings and so on; psychological abuse, such as shouting, swearing, frightening, threatening, withholding or damaging something with emotional importance, and failing to deal with elderly people with the respect and dignity that they deserve; financial abuse, including stealing and fraud; sexual abuse; neglect, including failure to provide food, heating, adequate care or bathing; and neglecting care, such as the example that I gave of Mrs Bore.

In some extreme cases there should have been criminal prosecutions, but that is rare and some witnesses referred in evidence to the lack of effort on the part of the Crown Prosecution Service. I hope that hon. Members will raise some of those issues during their routine meetings with their local police and criminal justice boards, and their regional CPS offices. I hope that the Minister will raise those concerns with my right hon. and learned Friend the Solicitor-General.

Our evidence showed that most abuse—67 per cent. was the figure quoted to us—occurs within the home. That is not such a surprising figure given that the majority of older people live at home. Other research suggested that almost half the abuse within the home is by relatives or friends and about one third by paid workers. Abuse in the home is difficult to tackle, and more often than not it goes unreported. In some cases the abuser, possibly a partner or sibling, may themselves be elderly. Research by Help the Aged showed that three quarters of older people who live with the person for whom they care receive no regular visits from health or social services and only one in 10 older carers receives regular home care.

Action on Elder Abuse told us that figures from its helpline suggest that 13 per cent. of abuse is carried out by care staff, domiciliary carers and home helps. Over the past 10 to 15 years, the nature of domiciliary care has changed considerably as local authorities have been required to stimulate the private market and encourage the growth of private sector provision. It has resulted in an explosion of small, often locally based agencies with little by way of regulations or statutory standards.

It is easy to see how abuse can take place within the home and not be seen. Part of the evidence from Action on Elder Abuse puts it better than I can:

"Domiciliary care by its nature is based upon one-to-one relationships between (often) single workers and isolated, dependent individuals. Many of these workers provide excellent services and are valued and respected by the older people in receipt of their support and it would be wrong not to acknowledge this reality.

However, it is intrinsic to this service that such relationships are difficult to manage within professional parameters, and are certainly difficult to monitor and inspect. Home care staff who subscribe to good practices, whether as a consequence of training or supervision or personal values, are statistically in the majority. However, the very nature of the home care service lends itself to the potential for abuse because of the relationships that are established, the opportunities that present, and the isolated one-to-one relationships that are inevitably created."

That is why we need adequate training, support and supervision of the domiciliary care market.

The vast majority of workers and voluntary care providers provide a good service that is valued by those who receive it. However, we must recognise the personal toll and stress that it puts on informal carers, who often neglect their own health and suffer financial loss. We must not lose sight of the need for care and support for the carers, too.

What we have seen with domiciliary care is what we saw with residential care in the 1980s—an explosion of small private homes, some excellent but some providing poor quality of care with untrained staff and little stimulating activity. The hon. Member for Wakefield described it at one conference as "wall-to-wall geriatrica". That sector has changed over the years with increased regulation and inspection, and I hope that the new Commission for Social Care and Inspection will build on the work of the National Care Standards Commission and lead to more improvements that are long overdue.

Despite these regulatory controls, the Select Committee was shocked to hear evidence of serious abuse in many homes. It included the inappropriate use of medication, often used not for the benefit of the elderly but to provide a quiet life for the staff. We should not ignore the dedication, commitment and concern of many professional care staff providing high-quality care services, but the new regulatory agencies, local government, the Government and local authorities' health trusts must do much more to raise awareness of the problem of elder abuse.

We have been in denial for too long. It is only in the past 20 years that we have spoken openly and acknowledged the existence and extent of domestic violence and child abuse. There is a growing awareness that such things take place, and often in the least suspected places. Teachers, nurses, general practitioners and staff in accident and emergency departments, as well as those working in voluntary organisations, neighbours and friends, are getting better at recognising the tell-tale signs of abuse in children and—mostly female—younger adults. We need to create the same awareness about elder abuse, and I believe that our report will assist in that process.

We need the Government to act, and many of our recommendations are aimed at them. However, we need action at a local level, too, and in this case Members of Parliament have a role to play. Our report can be used locally to raise awareness. My constituency is served by two local authorities and two primary care trusts. One is a first-wave care trust, and I discussed the report with it, as I know other Committee members will have done in their areas. In both boroughs in my constituency there is a well-established multi-agency adult protection working group, which was set up following the publication of "No Secrets" in 1999, and after the Government's White Paper, "Modernising Social Services", which highlighted the issue of protection.

The role of the working groups is to ensure that all agencies work together to establish a robust system for monitoring and for investigating complaints, and to provide training in adult protection awareness and multi-agency training in investigating abuse. I examined the last report of the Bexley adult protection monitoring group. In the past year, it investigated 38 instances of alleged abuse—a considerable increase on the 29 instances of the previous year. The allegations related to several different conditions involving vulnerable adults. Of the cases of abuse investigated, 24 were of physical abuse, two were of physical neglect, five were of psychological abuse, three were of financial abuse and four were of sexual abuse. Eighteen of those cases occurred in the individual's home, four occurred in someone else's home and 13 occurred in a residential or nursing care situation.

The potential vulnerability of people in their own homes confirms the importance of the training offered to domiciliary agencies. The fact that 13 of the instances were alleged to have taken place in residential or day-care settings suggests that the strategy of providing awareness training to staff in such settings is also of great importance. I hope that the Department will encourage all MPs to engage with their local agencies in promoting the recommendations in our report. The report is timely because it comes on the eve of the introduction of the new protection of vulnerable adults guidelines and changes in the legal regulations.

I come to the recommendations of our report and the Government's response, which, in the main, has been positive. I hope that the Minister will understand if I concentrate on the parts of the response that I regard as negative. I am sure that my colleagues on the Committee will want to expand on my points. I am sorry that the Minister felt unable to accept our suggestion that the no secrets definition of elder abuse should be extended to include those who do not require community care services. Such persons can still be isolated and vulnerable to abuse.

The Government's response to recommendation 3 about the need for multi-disciplinary research is welcome but I am concerned that the Minister has reservations about the figure of 500,000 elderly people experiencing abuse at any point in time. Despite the measures that the Government have taken since the 1992 study, my guess is that this is an underestimate and not an overestimate. I believe that the figure will rise, and continue to do so. That is not necessarily due to higher incidences but heightened awareness, systems for reporting and monitoring and more reporting in general, as we have seen in cases of child abuse, domestic violence and hate crimes.

Regarding recommendation 6, I welcome the continued funding for the Action on Elder Abuse helpline, and the recent TV and press coverage of the problem. On recommendation 7, we look forward to the outcome of the Commission for Social Care Inspection's consultation.

I welcome the acceptance of the need to train care staff as set out in our recommendation 8, but I feel that the response to recommendation 21 is rather too neutral. I appreciate that the Minister is not responsible for the content of nursing training, but I would have hoped that the Department would be in discussion with the Nursing and Midwifery Council on that issue.

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman) : It may help my hon. Friend to know that we have an appointment with the Nursing and Midwifery Council in two weeks to discuss that very issue.

John Austin : I am grateful for that comment. If care assistants need training in identifying abuse and how to deal with it, so do other carers such as nurses.

On recommendation 11, I regret that the Government are not able to accept our suggestion for more frequent reviews of medication. On recommendation 22, I am sorry that the Minister does not share our view that the formal complaints procedures may be inadequate to support older people and enable them to complain. Personally, I regret the Government's rejection of our suggestion that the proposed equality and human rights commission should be given enforcement powers as well as powers to assist, and act on behalf of, abused individuals.

On recommendation 26, I regret that the Minister does not seem willing at this stage to consider amending the national service framework for older people in line with our thinking. I hope he gives that further consideration. I had also hoped for a more positive response to recommendation 30 and the urgent need for registration of domiciliary and other care workers, which is one of the key ways of improving the quality of care.

On the whole, I hope that the Minister sees the report as positive; in the main, the Government's response has been positive, which I welcome. I have raised the issues of concern to me and my fellow members of the Committee, and those concerns are shared by a number of organisations. I understand that he had a meeting earlier this week with Age Concern, Help the Aged, Action on Elder Abuse, the Prevention of Professional Abuse Network and the Community and District Nursing Association. Certainly, the latter has echoed to me the concerns about the more negative responses that I have highlighted. I hope he will share with us the discussions that he has had with those bodies and the outcome of that meeting.