My Lords, I refer to the register and my charitable interests. I am also the named carer for an adult with a direct payments care package.
I support the amendment of the noble Baroness, Lady Greengross, although I must tell her that I have listened very carefully and I share some of the concerns about which is the right body. However, the argument for the principle of her amendment is well made.
The Bill gives Health Education England responsibilities for ensuring that the health workforce has the necessary skills to meet the needs of patients. That is valuable but there is a key omission concerning the registration of healthcare assistants and care assistants. Although those doing this work provide the vast majority of personal care to people receiving health and social care services and are fundamental to promoting and protecting service users’ dignity and respect, there have been—as we have debated on many occasions in this Chamber—far too many concerning reports in the recent past. These reports have indicated that something needs to be done at all levels and in all structures in healthcare, whether in hospitals, care homes or people’s own homes.
The Francis report clearly showed the failings at Mid Staffordshire Hospital and, while it identified the trust management as responsible for the shocking quality of care, it outlined incidences of poor care and inaction by healthcare assistants in reporting concerns. At Winterbourne View, people with severe learning disabilities were treated with an appalling lack of dignity by care assistants and nursing staff, some of whom have since been given prison sentences. A number of reports looking at dementia care in hospitals have found unacceptable variations in practice and high levels of dissatisfaction, alongside incidences of unacceptable care. A number of reports looking at home care provided to older people, including the Alzheimer’s Society reports Support. Stay. Save. and Home Truths, as well as an inquiry by the Equality and Human Rights Commission, indicate that care assistants lack the time to provide good-quality care to service users. There continue to be isolated incidences of reported poor care and abuse of older people in care homes. I shall not continue the list. Sadly, it goes on, and we see new reports in newspapers even today. It is so frustrating that we raise these issues and try to do things about them but they still continue.
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I say to the Minister that I understand that the Government do not like to be seen as a regulator, particularly an overregulator, but one of the beefs I have had with Governments of all political persuasions in the past decade has been that for some reason as legislators we often appear to legislate for things that we should actually leave well alone and that do not need regulating, but then there are glaring omissions, such as this, where there is an obvious need to regulate, yet we say that we do not want to be seen as regulators and therefore do not take the necessary action. I say “Courage” to my noble friend. The time is now to regulate in this area. We have talked about it long enough and I hope that he will have the courage to take this forward. He is the ideal person to do so. I have seen his courage in many other areas of healthcare over the years, so I am convinced that he could do it.
We tend to focus on the elderly, but more and more people look to have care packages within the environment of their own home. There are thousands of people who are not elderly but who are just as vulnerable. People with learning disabilities, autism, chronic mental health conditions or chronic physical conditions have packages of care in their home. The grey line between what is healthcare and what is social care merges even more as these packages become much more complex and as technology and medication enable more people to maintain a degree of supported independent living at home. We tend to think in boxes. When people living at home in these circumstances need to engage the help of care assistants, whether for healthcare or social care, those assistants come through the statutory services or through agencies, and we like to think—as a sort of comfort cushion—that all the checks have been made to ensure not only that these people have been trained but that they are fit to do such a job. There are also a lot of people and their carers who have to employ others directly to carry out these services for them.
In conclusion, we saw appalling cases at Winterbourne View and we know that some of those people are currently serving prison sentences. When they come out of prison, I want to know that if you are suddenly seeking for the first time to employ someone to look after your mother, father or adult child, although there are Criminal Records Bureau checks, you are not going to find that people who left the service for being cruel and carrying out illegal acts on previous patients are back in the system and that you and your loved ones are vulnerable to them. For that purpose, in particular, whether this amendment finds favour with Health Education England or another body—the Nursing and Midwifery Council, for example—I urge my noble friend to consider that now is the time for registration and regulation to ensure that people are safe in their own homes and in areas where they are feeling extremely vulnerable.