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Health and Social Care Bill

moved Amendment No. 19: 19: Clause 16, page 8, line 11, at end insert ““including, in particular, the handling of recommendations for remedial action arising out of such complaints or disputes”” The noble Earl said: My Lords, I shall speak also to Amendment No. 73, which brings us to the important issue of complaints made by service users, and in particular by residents of care homes. We had a useful series of debates in Grand Committee on this subject. Clause 16 says that the Secretary of State may impose requirements in regulations that those delivering regulated activities will have to meet in order to be registered by the CQC. Among other things, the regulations may make provision, "““as to the handling of complaints and disputes””." In other words, as I understand this provision, a service provider would need to demonstrate that it had systems in place to enable service users to make a formal complaint, and systems that enabled the complaint to be looked into and resolved. I am more than happy with that idea. However, it does not go quite far enough. We need to know that the CQC will not simply look at whether an establishment has a complaints procedure, but that it will also make sure that, if a complaint is made and a finding or recommendation emerges from the subsequent investigation—whether by the ombudsman or the provider itself—the recommendation is acted upon in an appropriate, timely and fair manner. In other words, it is not just the handling of the complaint that matters, but the handling of what comes out of the complaint. That point is of particular importance for the reasons given in Grand Committee by the noble Baroness, Lady Finlay, and my noble friend Lord Onslow. They highlighted the risk that someone in a care home, or receiving care in their own home, might be frightened to complain, in case their complaint rebounded on them in a vindictive fashion. The noble Countess, Lady Mar, told us about the very disturbing experience of her mother. The way in which a provider handles the follow-up to a complaint is every bit as important as the way in which it handles the complaint. The CQC should concern itself with that as well. The noble Baroness, Lady Thornton, promised to circulate a flow chart showing how complaints in each type of care setting will be processed under the new system. However, I am not aware that she has yet done so. I look forward to receiving it, if that is still possible. The other unresolved concern in this area is covered by Amendment No. 73. Those who fund their own care in a care home are particularly vulnerable. If they are aggrieved, they will not be able to turn to the CQC. Nor will they be able to turn to the ombudsman. They are not covered by the Human Rights Act. Therefore, if they make a complaint and are to have it resolved properly, they are totally reliant on the integrity and honesty of the management of the home. In my view, the position is one that leaves this vulnerable group of individuals unacceptably exposed. Up to now, the Government’s answer has been that self-funders are people who have entered into a private contractual arrangement. If they do not like the care they are getting, they can move. The noble Baroness, Lady Thornton, did not resort to saying that, but other Ministers have done so. When we hear that line of argument, we all share the same concern: it is a lawyer’s answer. The fact is that many elderly people in care have neither the emotional strength nor the intellectual capacity to make a complaint, let alone carry it through to a conclusion, and to expect them to be able to exercise their legal rights by moving to another home is often equally unrealistic. They are unable to countenance even the thought of moving. These are often frail and vulnerable people who simply cannot cope with tasks that younger people take in their stride. I believe that there is a strong case for giving those people an avenue through which they or their family and friends could pursue a grievance if the care provider has not resolved it satisfactorily. It is not possible to think in terms of the CQC providing such an avenue because of the scope of its statutory remit. That is why I am suggesting that local authorities should act in this capacity. The local authority has a role in the case of all elderly vulnerable people in so far as it is obliged to carry out a statutory needs assessment for all such individuals on request. It has that role even if the person ends up by paying for all of his or her own care. I appreciate that there are significant resource implications that need to be thought through, but many self-funders will be living in homes which are also occupied by people whose care is commissioned and funded by the local authority. In respect of those homes, there is an argument for saying that it is in the interests of local authorities as responsible commissioners to become aware of areas of concern, however they arise and whoever it is that brings those concerns to their notice. I hope that the Minister will at least think carefully about this proposal. I for one believe that it is too important an issue to be left hanging in the air. If we can resolve it during the passage of this Bill, we should certainly do so. I beg to move.