Mrs. Madeleine Moon (Bridgend) (Lab): It is a great pleasure to follow the hon. Member for Mid-Dorset and North Poole (Annette Brooke), and I agree with her that some areas of the Bill need clarification, particularly those relating to the public appointees office and the short-term playgroups to which she referred. As she will be aware, packages will have to be put together to accompany the regulatory bodies dealing with the many agencies working with groups that will need to understand this Bill. Groups such as the Commission for Social Care Inspection, the Nursing and Midwifery Council, the Care Standards Inspectorate for Wales and the general bodies that regulate chiropodists, physiotherapists and so forth have a critical role to play in ensuring that those whom the Bill will impact on are fully aware of what that impact will be. I am also particularly pleased to follow my hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), to whom I will always defer in this field, as her knowledge is second to none.

It is a particular pleasure to speak so soon after last week’s debate in this Chamber on the creation of a commissioner for older people. The Government are looking further to improve protection for older people in Wales by creating such a commissioner. That follows the creation of a commissioner for younger people and children in Wales—a role that has expanded to England—which has enabled additional safeguards to be put in place, and allowed new efforts to be madein examining and exploring additional ways of safeguarding children in Wales. I hope that this Bill and the creation of a commissioner for older people will have the same impact in Wales.

Before entering the House, I was an inspector with the Care Standards Inspectorate for Wales, so although my colleagues have referred to the work of CSCI in England, my experience is with CSIW and certainly not with CSCI in England. The Bill will support the regulatory agencies and local authorities in much of the work that they already do. It will also enable work that currently cannot be done in the public domain to be considered and to come into play.

I hope that the Bill will also allay some of the hysteria surrounding the question of who will and will not be reported for inappropriate behaviour towards children and vulnerable adults. My hon. Member for Blackpool, North and Fleetwood said that under the terms of the Bill, we are all vulnerable adults, in that we are all vulnerable at some point in our existence. That is true. We all want such protection at the point when we become a vulnerable adult, which often happens when, for example, we are in receipt of medical services.

Mrs. Maria Miller: Will the hon. Lady join me in expressing concern that the Bill terms pregnant and breastfeeding women as vulnerable people? Is not defining such women in that way a somewhat retrograde step?

Mrs. Moon: No, I would not join you in saying that, because we are all vulnerable adults at some point in our lives. If we are in receipt of care—of services from those whose duty it is to provide such care to a high quality—we should be covered by the Bill. It is perhaps unnecessary to single out such women, but pregnant women and nursing mothers are entitled to expect the same high-quality protection from those charged with their care—particularly their medical care—as any other person.

Hywel Williams: Does the hon. Lady agree that the Bill defines what a vulnerable adult is very broadly? There are 10 descriptions of such a person in clause 44, one of which is someone who

“requires assistance in the conduct of his own affairs”.

I frequently require assistance in the conduct of my affairs, but I do not regard myself as vulnerable. Does the hon. Lady not agree that there is a risk here of not seeing the wood for the trees?

Mrs. Moon: I have not had time to refer to the clause that you refer to. However, I think that you will find that the cover-all at the end—

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I wonder whether I can help the hon. Lady with her terminology. She should refer to any other hon. Member in the third person, rather than referring to them as “you”; and the customary expression for referring to someone else on her own side is “my hon. Friend”.

Mrs. Moon: I thank you for those corrections, Mr. Deputy Speaker.

I have not had an opportunity to look in detail at the clause referred to by the hon. Member for Caernarfon (Hywel Williams), so I am unable to respond fully to the suggestion that if someone required support and assistance when looking at their finances, for example, that would make them a vulnerable adult. My recollection is that more than an individual’s needing assistance with their finances would be required to make them a vulnerable adult.

I turn to a matter that causes me concern. Last week, I attended an excellent meeting in my constituency, at which I met carers to celebrate carers week and the vital role that they play. A lady whose husband is an active member of the scouting service talked to me about her fears. She has told her husband, who is involved in scout jamborees, that if a young child comes up to him and, for example, wants to hold his hand, he must not do so because that could be misconstrued, and that he must not put suntan lotion on the children when they go to camp for the same reason. The Bill will directly address some of the anxieties that people have about their activities being wrongly interpreted, perhaps leading to their being included on a barring list. I hope that it will alleviate some of the unnecessary fears and anxieties that have arisen.

I am especially pleased that parents will be able to check the status of those whom they are going to employ as private tutors. I raised that issue with the commissioner for children and young people in Wales, and with the previous Secretary of State, following an approach made to me by a constituent. She became very alarmed when she found out that a man who had been convicted of stalking her daughter was advertising his services as a private tutor to children, that he was not required to reveal his criminal past, and that there was no way in which someone employing him could find out about it. I am particularly pleased that the Bill removes that loophole.

I am pleased, too, that paragraphs (a) and (b) of clause 33(6) require people to be referred—and provide the capacity to be referred retrospectively—to the barring board. I am sure that people who have worked with the Protection of Children Act 1999 and the protection of vulnerable adults scheme, the regulatory agencies and bodies such as the Nursing and Midwifery Council will welcome that.

I remember a case in which the Nursing and Midwifery Council had issued a number of cautions about a person who had applied to be manager of a care home. The cautions were serious, involving the physical restraint of a service user with a duvet, using cigarettes to bribe a service user to misbehave when a colleague was on duty and other serious allegations that I shall not mention. In fact, the cautions had no status and could not be used to refuse registration to the individual concerned, but that will no longer be the case because the Bill will allow information about someone found to have behaved inappropriately by a regulatory body to be passed to the barring board.

In another case, I was involved with members of staff in a care home for nearly six months. Alongside the POVA co-ordinator of the local authority in which the home was based, I made regular unannounced visits to the care home. We gathered a huge amount of information about the abuse that was taking place there, but because of the nature of the service users in the home, no criminal prosecutions could be taken. The police were unable to take statements from the service users and could not put together a case that would stand up in court. Indeed, there was nowhere for us to go with that information. Now there will be somewhere to go—the barring board.

The members of staff involved in the abuse leftthe home, mostly before they were sacked, and subsequently applied for jobs in care homes elsewhere. As no criminal prosecution had been launched, the owner of the home felt very uncomfortable about refusing them a reference. When an application for a reference was made, she would always refer them on to the inspectorate, which mainly said that the person had been part of an investigation into abuse within the home. That was enough to warn people that they needed to explore problems further. Information that does not meet the required standard for a criminal prosecution—sometimes because the people who have been abused have a learning disability or lack capacity on account of dementia or age—is often held in POVA and POCA investigations or in the monitoring of procedures. Such information can now be sent to the barring board, which I am sure will prove invaluable in providing protection.

I accept the need for regulation to control how that information is passed on and to provide people with a means of appealing against it, but such information is likely to open up to challenge people who are unsuitable to work in care settings. They will now know that an investigation can have serious consequences.

Clause 11 is important, as it relates to the failure of residential homes to carry out checks. Members might be aware that the inspectorate can take only limited steps against homes that fail to carry out such checks. We know that checks are not being carried out because the inspectorate has highlighted and vigorously pursued the issue. It is not always easy to ensure that checks are rigorous and thorough.

Again, I cite the example of someone who applied for registration as a manager of a care home. They claimed to have provided full and thorough documentation of their qualifications to the care home’s manager, who subsequently left. The applicant had been operating in a lower-grade position at the home. When they applied to become the manager, they alleged that the documentation had been removed by the previous manager in an attempt to discredit them. It took a long time—I estimate that communications went back and forth for at least six months—before we categorically proved that the individual had none of the qualifications that they claimed and that none of the checks that they claimed had been carried out was undertaken.

There are limits to how far an inspectorate can go with a home that fails to meet the regulations. The inspectorate might apply to remove the registration from a home and ultimately seek to close the home by taking it to the tribunal, but if steps are put in place at the very last moment to rectify the failings and to meet the standards, the tribunal has no option but to allow the home to continue to operate. Again, it is hoped that clause 11 and the requirement in respect of failing in the duty to check will place another responsibility on care home owners to ensure that they carry out the necessary checks into qualifications and criminal records.

Annette Brooke: I should like to elicit from the hon. Lady whether she thinks, given her experience, that the additional requirements will cause care homes to feel under greater pressure. Will they perhaps make as many representations on the improved training and room-size requirements? I hope that we can work together with those in the sector, rather than letting them feel that this is a case of them against Government regulation.

Mrs. Moon: The hon. Lady makes a valuable point.

The Care Standards Act 2000 is clear in relation to the responsibility of care homes to carry out checks. When providing a service, it is important that the service is carried out to standards that are set down in legislation. It is only appropriate that those who are vulnerable and require the care and protection of agencies that are set up specifically to provide that care and protection should feel assured that the care setting, whether it is a care home, a domiciliary care setting or a day service provider, meets those minimum standards.

I hope that anyone who sought to register to provide those services would be fully aware of the requirements to register and of the legislation that they were required to comply with. I hope that they would seek to do their best to do so. It is only fair to say that the majority of providers do that. The hon. Lady will be aware that the majority of care providers seek to meet the highest standards. Indeed, they seek to exceed the national minimum standards. Those that do not are the ones we need to focus on to ensure that they carry through their responsibilities at least to check whether staff have criminal backgrounds and to have appropriate checks such as references in place. Those are not onerous expectations. They are minimum expectations and I hope that they will be met.

I have some questions for the Minister that I hope we will have get answers to. I would like reassurance that there will be one list for England and Wales. I support all those other hon. Members who have sought to ensure that those who are barred from working with children are also barred from working with adults.

Experience shows that abuse is often related to power and that, once a person has power over a vulnerable individual, that power is where the pleasure comes. The abuse can be transferred to another vulnerable individual. I have some concerns about clause 6(5) and clause 43 in relation to private arrangements where care is provided by a member of a family or friend. I ask the Minister at some point to clarify what protection will be available where it is known that the family member or friend has a history of abuse or a criminal record relating to abuse. For example, that information may have been passed to a POVA or POCA co-ordinating team in a local authority. Will they be able to share that information with the family? That will be vital because we know that, often, sexual abuse happens in families. The anxiety and fear are often about stranger danger but the reality is that the building of trust within families can lead to abuse. I would welcome clarification of clause 44(9)(b) and (c) and schedule 2, paragraph 9(1)(a) and (d), which relate to hon. Members’ concerns on vulnerable adults.

I have particular concerns about what happens when the condition of a patient in a hospital, as a result of the actions of staff, deteriorates. I cite an example that I raised in an Adjournment debate relating to Parkinson’s. If a Parkinson’s sufferer is not given their medication at the right time, the chemical balance in their brain is altered and disrupted. The disease becomes uncontrollable. With an uneven release of dopamine, a person may be suddenly unable to get out of their chair, to walk, or to get out of bed. Sleep can be disturbed. Bowel and kidney functions and digestion can be affected. The individual can suffer mood swings, hallucinations, anxiety and fear. What will be the implications for ward staff and for care homes if, as a result of their failure to provide medication on time, a person’s capacity to manage their life, to manage their bodily functions and to communicate is damaged? It can ultimately be destroyed for a number of months. From being someone who could rise out of bed and walk and talk, they can end up totally incapacitated purely as a result of the staff’s neglect and failure. That surely must be something that can be tackled under the Bill.

Half of care homes in England and Wales are not meeting minimum standards in relation to medication. A large number of patients entering hospital find their conditions deteriorate because medication is not provided on time. I have seen service users behaving bizarrely and becoming aggressive and anxious because their medication has not been provided on time. For me, that is creating a situation where a vulnerable person is being abused and neglected.

We have older people and people with learning difficulties going into hospital who, because of the poor quality of care they receive, develop bed sores. We have people going into hospital who, because of the poor quality of care and the poor quality of nursing staff making sure that they are regularly toileted, become incontinent. That is surely unacceptable and we should seek to utilise the capacity to refer people to the barring board for poor-quality care to stress the need to drive up standards.

I cite another example of a service user whom I worked with. It was felt that abuse had happened within one of the homes in my constituency. The service user had been lying on the floor with his head against a hot pipe. As a result, he had burns on the top of his head. It was thought that that had been a situation of abuse and neglect, where the staff had failed to move the service user and had ignored the fact that he was lying on the floor. As a result, they were suspended and their behaviour examined under protection of vulnerable adults legislation.

I carried out the inquiry into that matter, taking with me one of the directors of the company, who was horrified, when we went through all the documentation relating to what had been going on in that care home for six months, to discover that we had a severely mentally disturbed individual who, on two occasions, had held the entire home at knife point. He had prevented staff from leaving the room and other service users from getting access to care. The staff had failed to call for medical assistance for him even though he was begging for that help and support. In fact, the failure of medical staff to pick that service user up from the floor did not constitute abuse because lying on the floor was part of his normal behaviour pattern, but there was an overall failure to protect a vulnerable adult by not seeking the required medical assistance.

I am sure that I am not the only Member who receives regular visits at surgeries from constituents who express concerns about the care in homes where members of their family are resident. Mrs. Bartlett visited my surgery because she was concerned that appropriate care was not provided for her mother, who was not fed and had lost a lot of weight. I am also concerned about day centres for people with learning disabilities. We need checks on those who regularly provide day care for such people and who are not covered by the current regulations.

The independent barring board is not a name that trips off the tongue, but we need people to understand it. We must widen understanding of the implications of providing poor-quality care that leads to abuse and to vulnerable people having less protection and security than they should expect from those charged with their care and protection.

Members have been careful to emphasise the point that no legislation can remove personal responsibility. As parents, relatives or carers, we have responsibility to ensure that those for whom we care are looked after by professionals in a professional manner to the high standard that we would provide ourselves. Through the legislation, we can prevent a repetition of the physical and sexual abuse of children and vulnerable adults in care that happened in Wales in the 1970s and 1980s.

I hope that we shall also put a stop to a practice that is all too prevalent: English local authorities placing vulnerable people in care homes in Wales. In some cases that I came across, such vulnerable adults were not visited for more than 18 years. Local authorities do not follow through on their obligation to ensure that care is of the highest order.

It is important that we ensure that, alongside the Bill, there is a full educational regime so that people understand their rights. Two thirds of children tell no one when they are sexually abused; they do not know how to report that they are being inappropriately touched and abused by adults they trust. Behaviour easily becomes institutionalised in care homes. If a person sees others not being fed or toileted, why would they expect to be fed or toileted themselves? When older people and vulnerable adults do not have the advocates they need, it is easy for their families and friends to be afraid of expressing concern about the care their family member is receiving. They are afraid of being criticised and told to take them away from the institution.

It is important that local authorities take responsibility for their contracts with care homes. I had responsibility for a care home where a local authority was paying for five staff to provide care for one service user because a risk assessment showed that such a ratio was necessary for that person whenever they left the care home and went into the local community. The local authority carried out no checks until it was pointed out that, often, only three members of staff were on duty at the home so the service user rarely left it.

We need to make sure that legislation for vulnerable adults and the implications of the independent barring board are highlighted for bodies that we would not think were normally affected by such measures——in particular, local authority staff responsible for tendering. In my local authority, a tender was put out to taxi firms and a list that was seven years old, giving full details of names, addresses, dates of birth and medical conditions, as well as pick-up, drop-off and return-home times to a range of schools, was circulated to various taxi companies. Some of them no longer existed and some had moved offices, yet they were given access to extremely sensitive information about vulnerable people. It is important that even agencies that we would not normally think had a responsibility for protection are aware of their duties.

It is easy to express concern about a Bill such as this one and to point out that there are aspects that it does not cover. However, we have moved a long way in a short time to provide protection to vulnerable people and we should congratulate the agencies in local authorities, the providers of care and the hospitals and trusts that are working vigilantly and vigorously to raise standards and to ensure that much of the abuse that previously occurred no longer happens. We should welcome the fact that, thanks to the Criminal Records Bureau, 25,000 people who would otherwise have been working in care settings cannot do so.

There have been changes and improvements and the Bill will add to the protection arrangements that we are beginning to set up, but it is only a beginning. Those of us who work in this field are increasingly aware that we must always move on to find new ways of working with people to protect them. The Bill moves on to areas of protection that are needed, so I welcome it.