My Lords, I will speak against government Amendments 145, 146 and 149, and speak at the same time to Amendment 147 in my name.
The government amendments would remove from the Bill a requirement for the CQC to conduct regular reviews of adult social care, as the noble Lord, Lord Warner, indicated. The Bill gives us an important opportunity to ensure that local government commissioning is effectively regulated. Last year’s EHRC homecare inquiry evidence pointed to serious concerns about some commissioning practices, which were found to put the human rights of older people in particular at risk. Accordingly, the EHRC’s recent review of the inquiry recommendations welcomed the fact that the Government had signalled their intention that the CQC should conduct regular reviews of adult social care commissioning.
Unamended, Clause 83 would reframe Section 46 of the Health and Social Care Act 2008 to empower the CQC to conduct periodic reviews of adult social care providers and English local authorities which provide or commission adult social care. It was very disappointing to see that the Government intend to remove clauses requiring the CQC to conduct these reviews through Amendments 145, 146 and 149, in the name of the noble Earl, Lord Howe. Taken together, these amendments would remove the proposed new requirements for the CQC to conduct regular performance assessments or periodic reviews of local authority social care commissioning, and amend existing provisions relating to special reviews and investigations by the CQC. That would leave it able to review providers and to ask the Secretary of State for permission to run special reviews when there has been a particular issue but unable to run ongoing reviews of how local authorities commission services. It seems counterproductive to be removing this power at the same time as committing to challenging bad commissioning from local authorities.
The proposals announced by Norman Lamb about CQC reviews the other day are very helpful. But, again, they seem to be focused solely on providers and what they are doing, not on the commissioners who have directed these providers. If the CQC is being made independent, should it be seeking approval for such reviews? I believe that the Government have tabled this amendment because they believe that the provisions in the Health and Social Care Act 2008 will be sufficient to keep local authority adult social care commissioning under scrutiny. However, my analysis is that the human rights of people receiving care would be better protected by retaining the requirement under the Care Bill as currently drafted so that the CQC should conduct regular periodic reviews of local authorities’ commissioning of adult social care.
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If this amendment is adopted, the CQC will only be able to conduct periodic routine reviews but not of commissioners, which will leave the central element of the social care delivery system without regular independent scrutiny. Routine reviews would raise the standards of adult social care commissioning and, in my view, would result in higher quality services which better protect the human rights of care service users. In the absence of routine scrutiny, the CQC would be unable to identify thematic trends or poor commissioning by individual authorities that indicate the need for a special review or investigation.
In summary, I am absolutely delighted that this has been recognised as a serious problem, but at the same time I am concerned that some of the Government’s amendments seem to be taking away some of the CQC’s power to act. I am not alone in this view. Leonard Cheshire Disability is worried that these amendments risk reducing the ability of the CQC to challenge poor quality commissioning. Therefore, I ask the Minister to reconsider. I leave him with a question because, from the tone of these amendments, it appears that the Government do not see a role for the CQC in improving local authority commissioning practices. If not the CQC, who does have this role?
I turn briefly to my Amendment 147. While I fully understand that Ministers do not wish to be too prescriptive in the Bill, I feel it cannot be left entirely up to them and the contingencies of the moment. The CQC’s remit covers a wide range of care delivery settings including hospitals, care homes, dental and GP surgeries and all other care services in England. It will have a wide range of quality domains to supervise and it would be very easy to migrate the quality standards for an acute hospital into elder care where both the conditionality and capacity of the patients may be widely different. I feel that the CQC should be mandated to include indicators of the quality of services provided for the identification and treatment of those conditions that most frequently occur in a particular care setting. For older people this would include those conditions from which they are most likely to be suffering such as dementia and continence issues.
Continence care should be established as an essential indicator of high-quality services across all care. I have declared my interests in the register—I am chair of the All-Party Parliamentary Group on Dementia and the All-Party Parliamentary Group for Continence Care. A number of recent assessments have demonstrated that continence care remains a low priority across NHS settings, with poor treatment resulting in escalated and more costly care needs and poorer patient outcomes. Indeed, the Francis inquiry included an entire chapter outlining the scale of failures in continence care. Given the expected rise in the prevalence of incontinence and the impact that poor care can have on patients and the NHS, continence care must be seen as a key indicator of high-quality care provision across care settings. An explicit requirement within the Care Bill for the CQC to assess providers for the quality of their continence care would directly respond to the failings in continence care identified by Francis, the stated purpose behind Part 2 of the Bill. This would encourage providers to
actively address how they manage incontinence by assessing their local protocols and policies about the condition, taking steps to improve awareness among staff about incontinence and undertaking internal audits to continuously improve care standards.