---

Health and Social Care Bill

moved Amendment No. 30: 30: Clause 41, page 20, line 23, at end insert— ““( ) The Secretary of State shall make provision for the adoption of minimum standards of frequency for the inspection of the premises of social care providers.”” The noble Lord said: My Lords, the amendment allows us to raise once again a concern from Committee; namely, resources available to the Care Quality Commission to deal with the inspections necessary for care facilities. It deals with the frequency of inspection. I place on record my total opposition to the recently introduced inspection regime, which I regard as Treasury-driven. It is opposed by many Members of the other House, including some on my side, particularly those who are aware of how it is working. It is also opposed by the unions, charities for the elderly, the Relatives & Residents Association and many of the inspectors involved. I quote Unison because it is closely connected with the inspection regimes: "““We are particularly worried about recent changes to social care inspection methodology and the reduction in frequency of inspections from annual or twice-yearly inspections to periodic reviews which could be carried out for some providers only every 3 years. In a recent survey of members working in CSCI conducted jointly by our unions, 76% of respondents said they believe this new reduced inspection methodology does not provide a robust assessment of risk to service users, and 81% believe that more frequent inspections are necessary. Our members are telling us that associated cutbacks have meant that inspectors no longer have time to follow up on problems and have far fewer opportunities to meet and listen to service users. We would question whether reducing the ‘burden’ of regulation is appropriate when it affects some of the most vulnerable people utilising health and social care services. This is even more critical at a time when the Government is encouraging a wider variety of providers to enter into the market””." I pay tribute to the many inspectors who, sometimes in very difficult circumstances, carry out the very sensitive work of inspection. It is a very difficult task, where too often one can stand accused of being far too subjective in judgment. However, many voices within the profession are expressing concern. The problem of reduced inspection is widely criticised. Some noble Lords may have heard, every morning last week on the ““Today”” programme, reports by Mr John Manell, a BBC journalist. In a very impressive piece of investigative journalism, he set out to expose conditions, both good and bad, in the social care sector. He drew directly on the comments of inspectors throughout the United Kingdom. His report showed that it was not the commitment of CSCI’s inspectors that was the problem but the ability of CSCI to fulfil its obligations with limited resources. One person interviewed by Mr Manell said: "““If a home is made poor, then there is a lot of work that needs to be done by CSCI. But Managers””—" that is, CSCI managers— "““know that due to the workforce reduction, everyone is under pressure to get the work done and meet targets. So if the home is made adequate inspectors have the time to undertake their planned schedule of inspections””." The same inspector went on to say, in relation to a particular inspection: "““I completed my report and sent it to my manager as required by the CSCI. My manager came back to me and suggested changes to the report. These were to change all the poor ratings to adequate. And the reason? ‘The care provider is a good provider, they can turn this problem around quickly. So make the overall rating adequate and we can keep them on our side and work with them.’ For me the issue was, the care is poor, and if it is poor we need to say it is. However, the pressure that I was under was huge. So against my own judgement, I made the rating adequate””." Another inspector said: "““I think my main concerns are that the homes aren’t inspected as frequently as they were before. We rely a lot on information given to us by the providers of a service to say how good that service is. When we actually go out to visit the homes they are completely different to what the proprietors have told us in their feedback to us. So, it may mean that we are not inspecting a home as frequently as we should do because of the information we are receiving about it or the lack of information we are receiving about it””." I was on the Public Accounts Committee throughout the 1980s and remember that sometimes National Audit Office reports that came before our committee at their earliest stage were prompted by whistleblowers; and also, that whistleblowers sometimes have a bad track record. I have no doubt that there are people in the care sector who make reports of malpractice for all sorts of reasons. Perhaps they were subject to a disciplinary procedure, are discontented in their place of work or have been in arguments with management. I recognise that that can be the case with some people who act as whistleblowers to draw the public’s attention to deficiencies in the places where they work. However, that cannot account for all reports in this case. Another inspector said: "““Providers are pleased to be left alone, some don’t even want to complete their own self-assessment””." Another said: "““The home was poor throughout and needed enforcement action to be taken but the Regulation Manager did not want this to happen—too many poor homes this year””." Yet another said: "““So that there is less conflict with home owner and to make our regional figures look better, i.e. less poor services—statistics then show false improvement of standards””." I repeat: there may be whistleblowers out there who have a grievance; however, I cannot believe that all these reports come from such people. There must be something wrong in the system, and I am sure that, with the right resources, all these matters could be dealt with. On the attitudes of the elderly, one inspector said: "““Elderly people may not see an inspector for two or three years. One lady recently said to me, ‘at least I knew if I had problems, you would visit the home in a few months. Now I know no one’s there to help me. I’m very frightened what might happen’””." Another said: "““Good homes can very easily slide when they know that it is likely to be 3 years before another inspection will be carried out””. " Changing regimes in a home was a matter we laboured over in Committee. One inspector was particularly critical when he said: "““To be honest, I wouldn’t leave my dog in 90 per cent of our care homes””." However, what I really found disturbing was this. The interviewer said: "““I was very concerned about what I was being told so I arranged a meeting with a number of inspectors. I assured them they would remain anonymous but they were becoming increasingly worried about the implications of talking to me. Our meeting was called off. Two other inspectors told me about what they described as a ‘witch hunt’ within the organisation””." It may be untrue, but this is what the journalist said he was told by an individual inspector: "““I was asked if I knew that the BBC were doing a programme and I said yes. I was then asked if I knew of any colleagues who were or had contemplated speaking to the press. I said no””." The journalist said: "““I needed to find out whether what I had been told reflected wider opinion within the Commission for Social Care Inspection. So, I wrote a questionnaire for its employees. Three unions—UNISON, the Royal College of Nursing and Prospect—agreed to allow me to send it to all their members within the Commission. The BBC’s Editor of political research helped ensure the questions were posed fairly and neutrally. More than half of the organisation’s employees would have received it. And 30 per cent of the questionnaires were returned to us. More significantly around a quarter of all inspectors responded—that’s more than 200 of them. Many of the comments we received were, again, disturbing””." I put it to my noble friend that something, somewhere, is wrong. In all these interviews, inspectors talk about the inadequacy of resources, which directly influences inspection. We know about the reduction in resources from a Written Answer to me by my noble friend. In Committee, the noble Baroness from the Liberal Benches and many Cross-Benchers referred specifically to their concern about the amalgamation of these three organisations into one. Everybody was concerned that this part of the budget, covering these areas of inspection, might suffer. Ministers should be equally disturbed at what is happening and what might become worse. We all know the reality: a good home today can be a bad home tomorrow. It can be due to a change of management, a change of proprietor, a sudden turnover in care staff—particularly in a sector which is notoriously low paid—even a change of chef or the arrival of a bully. CSCI itself tells us that there is a high volume of complaints, including those about shabby homes, incompetent management, bullying, unsafe facilities, clients locked in rooms, clients tied to beds, occasional violence, inadequate monitoring of food intake, shouting by staff through overwork, lack of help with toileting and inadequate medical cover. I am sure that these problems apply only to a minority of homes and that most are excellent, but many are not. That is why we need a regime that maintains the highest possible standard across the board. The care sector is crying out for greater regulation, not less. A reduction in frequency of inspection would inevitably lead to a reduction in standards. I believe that there needs to be a review of the whole inspectorate system’s resources following the amalgamation. We need a minimum frequency of unannounced visits that is considerably more than the current arrangement. In responding to this report, CSCI’s chief inspector, Paul Snell, said: "““The quality ratings, together with our more detailed inspection reports will give current and prospective users of care services and their families every opportunity to check up on the quality of care provided””." Well, I am very sorry, but if the reports are deficient in many areas because the resources are not available to carry out effective inspection, they will not be of much use to those of us who have to place our relatives in institutions of care. I beg to move.