---

Health and Social Care Bill

I was tempted to support the amendment tabled by the noble Baroness, Lady Jones of Whitchurch. I thought about it a lot because, with some notable exceptions, in my professional life I have come across the most downright harrowing incidents of treatment of older people in residential care. Because of that, I have arrived at the view that good organisations have absolutely nothing to fear from unannounced visits but bad organisations have everything to fear from them. Bad residential homes are often very good at passing inspection visits, because an inspection visit is only an inspection at a particular time. For example, an elderly person I know told me about a home in which a friend of hers was. She said: ““It is absolutely awful. Every older person in the area knows that it is awful. You know what? One day, they got up and everyone had brand-new sheets put on their bed. We all wondered whether the people coming round might wonder why everyone had brand-new sheets on the bed, but we are not sure whether they did””. I do not have an aversion to light touch in the sense that it is proportionate, so that bad homes get frequent inspections, but the key thing is that those inspections are unannounced. I do not question the intentions of the noble Baroness for a moment, but the second reason why I think that the amendment is wrong is that what passes for poor quality and bad practice in one home may not in another. They are people's homes; sometimes homes can be not exactly up to pristine scratch. Why? Because they are places where people live; there may be good reasons for that. The process of judging overall whether a home is, first, of good quality and, secondly, whether people are subject to abuse is quite subtle. What we really do not need is a replication of a very crude Ofsted tick-box approach. We are talking about people's lives. I do not think that a list is right because I have not seen any evidence that the transfer of ownership of a home is necessarily an indicator of a change in practice. I am willing to be persuaded otherwise, but I have not seen it. I want an inspection regime that is effective because it is a deterrent. I very much fear that if we take the approach proposed by the noble Baroness, we may end up with an inspection approach that is very predictable. That would not serve people well. The noble Earl, Lord Howe, is absolutely right to ask his question about the documents. This is probably one of the single most important aspects of the Bill, which will have an effect on people's lives. It is important that we have completely different inspection regimes for acute hospitals and small places; but it does not matter whether it is St Thomas’s or somewhere little, it is unannounced visits that are fundamental to and at the heart of all of this.