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Health and Social Care Bill

moved Amendment No. 3: 3: Clause 45, page 21, line 31, 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, it may take me longer to move this amendment than I had otherwise planned. It was not until yesterday that I thought that I would be moving this amendment, when I received from CSCI a briefing paper on my contribution last week to the House. I thought that I should not leave it without response, particularly because it deals with what I believe to be an issue that is at the heart of this whole debate; that is, the frequency of inspections in care homes. I remain utterly opposed to the regime that has been established in recent years, and which I believe is of increasing concern to those who know what is going on in this whole sector of care. CSCI sent out a briefing, which most noble Lords will have received, entitled, "““Health and Social Care Bill Third Reading, Tuesday 1 July. Briefing on the ‘Today’ programme on CSCI and the new approach to inspections””." Members will recall that the BBC transmitted a programme making a number of allegations about conditions within the inspectorate, drawing on the statements of people within the inspectorate. Those statements have been challenged by CSCI. I asked Unison, one of the unions, for its response to CSCI’s accusations against the unions, one of them being that they were aligned with the BBC in the formulation of the questions. CSCI’s response, in my view, questions the integrity not only of the four unions involved but also of the BBC, which will no doubt wish to respond directly to CSCI. The ““Today”” programme report on this vital issue—on the frequency of the ability of the inspectorate to carry out its work—was based on more than 200 questionnaire returns. The questionnaire was written and paid for by the BBC. The unions had no input; they simply sent it to their members. The wording in the questionnaire was approved by the director of political research within the BBC, who is a well respected individual in Westminster. The focus of the questionnaire was on the impact of inspection and regulation changes on service users. It was not to do with internal industrial relations issues, which is what CSCI said in its briefing. The report mirrors many of the findings of an earlier survey conducted by the joint unions, based on 250 responses. These concerns are widespread and cannot be dismissed as comments of one or two people. Again, CSCI’s report misrepresented the position in terms of the number of people who spoke to the BBC. The unions have been complaining since last year about the effects on service users of the new inspection methods. CSCI’s own 2007 staff survey, which had 1,200 responses, had a different focus. Nevertheless, some results backed the view that there are problems within the inspectorate that should be investigated. I have not had time to check this data: this is what the unions told me this morning. In CSCI’s own survey, only half the staff agreed that CSCI delivers a good quality of service to its customers; only 35 per cent agreed that CSCI could deliver what it has committed itself to; only 25 per cent had confidence in the senior management team; only 15 per cent agreed that change is well managed within CSCI; and only 15 per cent agreed that CSCI values its own employees. I have not seen the data, but that is what I have been told. I shall check the data myself if possible. The budget set by Government, and the Government’s blanket approach to deregulation, have shaped the inspection regime. CSCI has responded to these pressures, rather than designing a system that meets the particular and unique circumstances of the care sector. In other words, what is happening is Treasury-driven, and I object. The claim that the new methodology had widespread public support does not stand up to scrutiny. CSCI commissioned a MORI poll of service users for its 2004 report, When I Get Older. It showed that 79 per cent of respondents said that services should be inspected at least twice a year and that more than a third wanted monthly inspections, yet under the current system, many services are inspected only once every three years. Moreover, respondents said the best way for inspectors to judge the quality of care was to speak privately to service users and spend time observing what goes on. These practices were rated much more highly than talking to owners or checking paperwork. Yet we now have a system that relies on a service review, which is a desk exercise based on provider self-assessment. Yesterday’s CSCI briefing claims that its approach works, because two years ago there were 1,500 poor services, and now there are only 600. The concern of union members is that this reduction does not necessarily show that services are getting better; rather, it shows that CSCI is getting worse at identifying poor services. The claim is made that poor performers are inspected more often. This is doubtful. Under the new system, the default is twice a year for poor performers: the same as under the old system. The fundamental concern of union members is that the systems for assessing and monitoring providers are insufficiently robust. The frequency of inspection is determined by the service rating. The whole argument relies on being confident that a good or excellent rating, first, is justified, and, secondly, can be sustained for two or three years. It is this that concerns the members of the unions involved in these inspections. Poor or deteriorating services will slip through the net. The number of inspectors has dropped from 1,400 in 2004—I emphasise this—to just over 800 now. In addition to concerns about frequency of inspections, inspectors report that they do not have enough time to spend on each inspection visit. The pressure of meeting targets means that they no longer have time to follow up on concerns or issues. The CSCI briefing refers to evidence from a range of sources, including the provider self-assessment surveys. The unions say: "““We have raised repeatedly with CSCI that inspectors are reporting that providers are not returning these and staffing shortages mean they are not always chased up in time. Even where they are provided, there are doubts about how objective and reliable the evidence is””." A key feature of the new methodology was to have been a new IT system known as ICAP. Cuts in administrative staffing were made on the basis that the IT system would streamline systems. This was to have been introduced in 2007, yet it still has not been rolled out. There are some concerns about the overall rating methodology. A provider in breach of key standards, such as the safe administration of medicine, can still be rated as adequate. I do not know whether that is true but, if it is, I find that appalling. CSCI talked about unannounced inspections at any time—indeed, there was much emphasis in Committee and on Report about the need for such inspections—but it has to be asked how often they happen, given the staffing constraints. Furthermore, I emphasise that providers are tipped off about the scheduling of a key inspection by receiving the self-assessment questionnaire in advance. In the view of people involved in the inspectorate, the annual service review is a desk exercise. The briefing claims that a change of manager or owner automatically triggers a fresh key inspection, but those involved question whether that is automatically the case. The last time we debated these issues, I said to my noble friend that those who had replied to the BBC questionnaire were lying, telling the truth or exaggerating. The more I hear, the more I think that there is an element of truth in what they are alleging. I cannot see how it is possible to leave on the record accusations of this gravity without Ministers wanting to know precisely what is happening within the organisation. We know that very often those who lead any organisation simply push the party line, although I do not mean that in a political sense. They push the case for the organisation, very often knowing that complaints are occurring but, because of all sorts of considerations—relationships, budgets and whatever—they simply peddle the same old tune. I believe that there is something wrong within this organisation that should be addressed and that the department should send people in to find out whether there is any truth in these allegations. I hope that my noble friend will be able to deal with that specifically when she replies from the Dispatch Box. However, I say to the noble Baroness, Lady Young, who I know is taking on a huge responsibility here, that many of these things will be left for her to sort out. I am confident that she will do so but she should have the benefit of knowing that people from outside have gone into the organisation and are able to provide her with information over and above that which may be fed up the line but which, by the time it gets to her office, may not altogether reflect the reality. I beg to move.