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Health and Social Care Bill

My Lords, looking first at Amendment No. 33, I agree with the noble Baroness that assessing the quality of services provided is impossible without an assessment of the needs of the population that is being served. For local authorities, both individual needs assessments under Section 47 of the National Health Service and Community Care Act 1990 and joint strategic needs assessments carried out jointly with PCTs under Section 116 of the Local Government and Public Involvement in Health Act 2007 are relevant here. Joint strategic needs assessments relate to the needs where there is an overlap between what the PCT and local authority might provide and identify the current and future health and well-being needs of the local population. Local authorities are required to carry out individual needs assessments of those individuals who appear to them to require social services. Both of these functions are statutory duties of the local authority and play a crucial part in ensuring the effective provision of care, especially when one bears in mind that models of care, particularly adult social care, are changing very rapidly indeed. Both could therefore be encompassed within the commission’s reviews under Clause 42 or, indeed, Clause 44. Obviously, exactly what will be encompassed in those reviews will be dependent on the indicators that the commission will play an important role in developing. When reviewing the provision of adult social services by local authorities, the commission will assess performance by reference to a set of national indicators. These indicators will form part of the single set of national indicators to be reflected in local area agreements used in comprehensive area assessments. These indicators could therefore look at the assessment of needs as part of the assessment of the performance of a local authority. In addition, we have proposed that the registration requirements should include a requirement on providers of regulated activities to ensure that all people receiving services have their needs assessed, as we said in Grand Committee. In this way, not just those whose care is arranged or funded by the local authority are looked at by the Care Quality Commission, but all service users are covered. If a local authority as a provider is failing in this respect, the commission will be able to take direct action. I also reassure noble Lords that where the commission finds in its reviews that a local authority is failing in the performance of its adult social services functions, including the statutory duties to carry out needs assessments that I have mentioned, it will be obliged to inform the Secretary of State and can recommend any special measures that it considers that the Secretary of State should take under Clause 46. I turn to Amendment No. 24. In Grand Committee, my noble friend Lady Thornton explained that we agree with the noble Baroness, Lady Barker, on the importance of the General Social Care Council as the key body in relation to the registration of the social care workforce. I have considered the noble Baroness’s concerns carefully and hope to provide reassurances. I should perhaps make it clear that under Clause 85 we anyway intend to allow the commission to make information about enforcement action publicly available. Obviously, in cases where local authorities are commissioning social care from service providers against which the Care Quality Commission has taken enforcement action, noble Lords will agree that it will be crucial that the commissioning body should have notice of that enforcement action, so that it will be able to commission alternative services from other provider organisations, if necessary. The same would apply to a PCT. Therefore, we have specified those bodies in the Bill. For NHS organisations, Clause 35 specifically allows SHAs and Monitor also to be notified, and this will apply where they have performance management responsibilities regarding a particular body. We recognise that, in contrast to healthcare, a large proportion of social care services are provided by the independent sector and are self-funded. In many, if not in the majority of cases, the commission’s action will be against an organisation as a whole, rather than against a specific member of staff. In such cases, it is not necessary to require the commission to inform workforce-related bodies, such as the GSCC, as it would not fall to it to take any specific action. That said, when the Care Quality Commission has taken enforcement action against a specific person who is registered with the GSCC—for example, a registered manager who is also a registered social care worker—of course we would anticipate that the commission would inform the GSCC, as enabled by subsection (1)(d), which requires the commission to give notice of the actions specified to any other persons it considers appropriate. In recognition that there may well be such cases, and if the noble Baroness would find it helpful, we would be very happy to specify the General Social Care Council explicitly within the explanatory notes to Clause 35 as a particularly important example of a body that may need to be notified under subsection (1)(d). I believe it would be preferable to make this link clear but leave a certain amount of flexibility according to the circumstances rather than accept this amendment as it stands, which will require the commission to inform the GSCC about every enforcement action it takes, whether concerning a person registered with the GSCC or not. Given those reassurances, I hope that the noble Baroness, Lady Barker, will feel able to withdraw her amendment.