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Health and Social Care Bill

moved Amendment No. 40: 40: Clause 57, page 28, line 26, at end insert— ““( ) Where a report has been published under subsection (2), the service provider shall display in a place accessible to the public on the premises of the service provider information taken from the inspection report, subject to the following provisions— (a) that the arrangements for, and location of, the display be agreed by the Commission; (b) that the information made available on the display be in a form prescribed by regulations; (c) that the inspection made available on display be from the most recent inspection report of the Commission; (d) that the service provider display any additional information which the Commission shall require.”” The noble Lord said: My Lords, the amendment gives me the opportunity once again to argue the principle of transparency in private care. It is one of a series of transparency amendments that I am moving to various Bills as they make their way through the House, and it stems directly from my own experience of having to place my mother in care—a matter which I dealt with at some length in Grand Committee. I should repeat that I do not have a background in social care. My background is in industry, so I come to this debate as a consumer. Like most people who are faced with placing a relative in care, I found myself submerged in glossy brochures from many providers. It was a particularly difficult decision to take, which was not helped by the unwillingness of social services departments to guide or advise on where a self-funder could find the best. It was also not helped by the fact that only one—a BUPA home—out of the 19 homes I visited volunteered the CSCI report. In Committee, I reported that I had visited 19 establishments. Some homes were a disgrace, some were very good and some stank of urine. One in central London was appalling and some others appeared cosmetically to be little better. I cannot imagine what was going on behind the scenes. As a Member of Parliament until 2001, I had been vaguely aware of an inspection regime. I should have been aware of the CSCI inspection report system, but I was not. Subsequently, I found out that that is the case for most others in my position. We all find out after placing someone in a home, but often that is too late. I am convinced that most relatives who are placing—certainly self-funders—have no idea how to choose. Thankfully, after many unannounced visits to homes, I found a first-class institution, with a first-class CSCI report, where my mother is very happy. However, I repeatedly ask myself how many others have been in a position to tour the south of England visiting homes unannounced like I did. I suspect that that would be a minority of people, yet they are paying fees of anything between £800 and £1,200 a week, which is equal to £100,000 per annum pre-tax annual income. That is a lot of money. There needs to be far easier access to independent information about homes and greater transparency. Some would argue that nursing home websites should carry or refer to the availability of their CSCI reports. Last week, if I recall correctly, my noble friend undertook to refer that matter to the new chairman of the Care Quality Commission, particularly the issue of the websites of homes being required to refer people to the CSCI report. Under Amendment No. 40, there would be a statutory responsibility on providers to provide information of an independent nature on home standards and conditions in an easily comprehendible form to prospective clients or their representatives. It would place on the home’s management a statutory obligation to provide that information in a place that is accessible to the public. It would help choice and create the conditions for raising standards. It would deal with the seven assessment headings set out under the national minimum standards for care using the scoring system, but it should also flag up in a more informative way information on kitchen cleanliness standards from local authority inspection reports under Section 32 of the Food Safety Act; information on staff turnover; staff-to-client ratios with benchmark guidance; weekend cover arrangements; the use of bank staff; access to outside recreational areas; the frequency of case reviews; the dates of previous CSCI inspections; the complaints procedure; the role of the key carer and named nurse; personal and room cleaning arrangements; the incidence of medication errors and of accidents; the number of individuals who make complaints; and information on sickness absence, all of which can indicate stress levels. I have gone into these areas in detail because these are the issues which arise. As I said in Committee, I placed my mum, but I have also been to many homes since that placement because I have found this area fascinating. Other professionals may have another view about what is important, but as a consumer I believe that these are important issues. The BUPA care home checklist system provides us with some guidance on what potential clients are looking for over and above the existing CSCI inspection report arrangements. What would be the effect on home management of being required to put the report in a place which was accessible to people coming in, where they could see it and be guided towards it? Staff would find themselves more openly accountable. Many carers are unaware of the availability of CSCI reports. I find that worrying because they do not realise the extent to which they are already accountable as individuals. I am talking about people who might be on £6 or £7 an hour, even less sometimes. Some people in these homes are incredibly poorly paid. Management would be ever conscious of the greater access to this information by potential clients and would be inclined to avoid poor scoring in a highly competitive market. In other words, standards would, in my view, inevitably rise. Relatives would have a checklist against which they could refer in times of concern without having to go to home managers which, in itself, can often be full of difficulties. I know this is controversial. I have discussed this with a number of home managers. Some believe it is a very good idea, because they know that the poorer homes avoid at all costs revealing the contents of these standard reports. Many homes would not want it. It might affect their ability to attract custom, but then, so be it. They would have to raise their standards to attract the custom. It would inevitably lead to higher standards and in the long run would make the task of inspecting homes far simpler for the inspectorate. I beg to move.