The Commission for Social Care Inspection (CSCI) is the nursing homes regulator
What it does
It gets the owners and managers of nursing homes to run homes according to published standards. If homes do not do as they are told then CSCI can issue an enforcement notice. Mike Rourke is their director of inspection regulation and review and he told us: "We are issuing far more enforcement notices than we have done in the past because they underpin, for those minority of reluctant providers, the seriousness of the situation and they recognise that it could lead to a criminal conviction." Ultimately CSCI can issue a closure notice, as they did in the case of The Haven, in Brighouse. But the home can appeal.
What it does not do
It does not operate as a sort of adult protection police force or even as an agency that pursues individuals' complaints. CSCI's corporate and regulatory complaints advisor, Suzannah Burden, wrote to a relative in December 2006: "The Care Standards Act confers no statutory duties or powers on the regulator (now CSCI) to act as a complaints investigation agency." She goes on to emphasise that: "Our powers of entry (to homes) do not provide for us to access regulated services in order to specifically investigate a complaint."
The Nursing and Midwifery Council (NMC)
What it does
It regulates the professional behaviour of nurses. Two nurses were removed from the nursing register in 2003 following the allegations of the neglect of Irene Hoyle, the mother of John Hoyle, at Heath Bank Nursing Home. They were the then owners Bridget Massey and Rose Anne Marshall. That investigation lasted nearly two years and by its conclusion the former owners had sold the home to its present owners. The present owners of Heath Bank have no connection with these events. The manager of Laurel Bank faces a Professional Conduct Committee hearing this year. This hearing relates to what took place between 2002 and 2004.
What it does not do
It does not consider itself to be the primary agency concerned with adult protection. The NMC declined our request to take part in this programme but wrote to us saying that: "The NMC is not an inspection authority. That duty falls to the Commission for Social Care Inspection (CSCI), the social care inspectorate and, in serious allegations of abuse or neglect, the police. The NMC's remit is to deal with nurses whose practice contravenes their code of professional conduct and puts patients at risk." They went on to say: "This can mean that it can take months, or even years, before an investigation runs it course and evidence is released for us to be able to consider the registration of a nurse (or nurses). However in the most serious cases, once an allegation has been reported, the NMC can and does impose an interim suspension or conditions of practice order to remove the nurse from practice until the outcome of the case is known."
What they do
They do investigate allegations of abuse, but require evidence of deliberate assault. The West Yorkshire police did make initial investigations into Laurel Bank and conducted interviews but did not proceed further, because they judged, as they wrote to a relative, that: "the facts do not suggest any criminal offences and therefore they fall outside our remit for investigation." They have told us that inquiries into an alleged assault by a member of staff upon a resident at The Haven, last September, are ongoing.
What they do not do
West Yorkshire Police declined our request for an interview. In December 2004 Calderdale Council published a report of the working group reviewing, supporting and safeguarding older people in care homes in Calderdale. Para 4.3.4 reads: "West Yorkshire Police reported that they do not keep specific data because it is not a huge concern. However they recognise it is a sensitive area and take any allegations very seriously and would gather evidence if necessary."
What they do
Social services has the prime responsibility for adult protection of individual residents in nursing homes. In Calderdale there is now a specific adult protection officer. There is an adult protection committee on which all the agencies involved in working with the elderly are represented. Social services also has another way of exercising pressure. Social services' clients form the majority of residents in many private nursing homes so the council has the weapon of contract compliance available, the threat that if things do not improve at a home its main income might dry up.
Social services in Calderdale now work much more closely with CSCI in investigating "problem" nursing homes than they did. In the case of Laurel Bank, CSCI conducted the main investigation and, we understand, only "broad brush" information was shared between the two. Social services did not see all the paperwork the investigation was producing. But now the cooperation is closer. In the case of The Haven we understand that a joint investigation took place.
What they don't do
They don't have the same legal powers that they do with children. Though vulnerable adults are of course entitled to the protection of the criminal law, social services told us that investigations that involve the police are a rarity. The elderly often make poor witnesses (to their own abuse). But the council itself lacks the powers (and the obligation) to intervene and "rescue" vulnerable adults from the risk of harm, as they do with children.
The newly arrived groupd director of health and social care in Calderdale, Jonathan Phillips, told us: "We do have powers under the legislation for children) and we can use them and in the main they work effectively. There aren't the same parallel powers (for adults) as there are with children's services in terms of investigating abuse, where that's in a family or whether it's in a care home."
But in his view it is not just that the law on the abuse of adults needs to catch up with that for children. It's also a matter of cultural attitudes towards the abuse of the elderly catching up as well: "I think the awareness of what happens to children in society is at a much higher level than what happens to older people," he told us, "we have to see them as citizens, they must be respected in a same way as you would respect somebody that you were walking past in the street or you met in any other environment. If we don't get that culture right, then we won't we won't eradicate abuse of people in care homes or any other setting."