Care Homes for Older People

Baroness Blackwood of North Oxford Excerpts

Thursday 3rd November 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I thank my hon. Friend the Member for North Devon (Peter Heaton-Jones) for securing this important debate. He is a doughty campaigner. As he said, it is almost a year to the day since he last raised the issue in the House and he has taken much action since. I pay tribute to my predecessor, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), for his work. He has laid great foundations for the work we are doing now. As he said, care homes play a vital role in our society, but the decision to move into a care setting or place a family member there can be exceedingly stressful. It is essential that the public have confidence in the quality of care that they seek. Poor care, abuse and neglect are completely unacceptable at all times, whatever the cause, and we are determined to stamp them out.

My hon. Friend the Member for Horsham (Jeremy Quin) is right that we must learn from the mistakes of the past. That is why in October 2014 we introduced a tougher CQC inspection regime based on the five important questions that matter most to people: are services safe, caring, effective, well led and responsive to people’s needs? It is why we brought in a new criminal offence of ill treatment and wilful neglect, and why a fit and proper person test has been introduced to ensure that providers do not recruit directors who are known to have been responsible for unacceptable standards of care.

The CQC can and does take robust action against providers that breach regulations and standards, from issuing warning notices and fines, through imposing conditions on a provider’s registration, to cancelling that registration altogether. During 2015-16, the CQC took 901 enforcement actions in adult social care, ranging from warning notices to prosecuting providers.

The CQC now has specialist inspection teams, which under the leadership of the chief inspector of adult social care include people who have personal experience of care. Inspections are required to take into account the views of service users and their families. Furthermore, the great majority of its adult social care inspections are now unannounced. The timing of inspections is based on assessment of provider risk, but their frequency in usual circumstances can be expected to be at least every 24 months.

The CQC’s fundamental standards that registered providers are required to meet include two very important registration requirements. The first is the duty of candour, which requires providers to be open with service users about all aspects of their care and to inform service users where their failures are in their care. The second is, as I have said, a fit and proper person requirement for directors that ensures that accountability for poor care can be traced all the way to the boardroom if necessary. These standards now give the CQC an effective power to prosecute providers in cases where a failure to meet standards results in avoidable harm or a significant risk of such harm.

[Jeremy Quin]

Will my hon. Friend or one of her ministerial colleagues kindly meet me and my hon. Friend the Member for Crawley (Henry Smith) specifically on that point in relation to Orchid View? We would be most grateful if that was possible.

--- Later in debate ---

[Nicola Blackwood]

I am absolutely sure that the Minister with responsibility for this area will do so.

The point I am making is that together we now have a more robust inspection standard and the fundamental standards to ensure greater accountability for providers of unacceptable standards of care. The CQC now has a much stronger baseline of information that tells us about the quality of adult social care across the country. From October 2014 to the end of July 2016, it inspected and published ratings for more than 16,000 adult social care services, out of a total of some 25,000.

As my hon. Friend the Member for North Devon highlighted, I recognise that delivering this more comprehensive inspection programme has taken longer than originally planned. The National Audit Office itself acknowledged that the CQC would have been hard pressed to have been aware of the amount of work needed to complete the initial round of inspections and re-inspections. The CQC acknowledged that it experienced early difficulties in recruiting sufficient inspectors with the right specialty and calibre. These problems are now resolved and the Department agreed with the CQC that it should consider the quality and rigour of inspections, and having the staff to carry them out, as the most important issue. The CQC is now on track to complete adult social care inspections by their published deadline of March 2017. We are closely monitoring its progress towards that delivery date.

We should be pleased that this work is starting to bear fruit. We have seen improvements since the observation that

“four in ten establishments are not reaching a required standard.”

At the end of July 2016, 72% of all adult social care services were rated good or outstanding, compared with 60% when the CQC published its findings in the 2014-15 “State of Care” report. The 2015-16 report shows that about 70% of care homes were rated good or outstanding, and 2% of all adult and social care services were inadequate at the end of July 2016, compared with 7% when the CQC published its last report. These quality ratings matter, because they are an important starting point for driving improvements. They are an encouraging early sign that this is happening.

The regulation of adult social care has three key roles to play: to identify poor practice and to take action to protect service users from the risk of harm; to encourage improvement by identifying areas of weakness; and to highlight and share good practice and success. All those roles are built on the foundations of effective use of data and rigorous inspection. The evidence shows that this is now happening. I would like to quote the National Audit Office, which confirms that the

“CQC has made substantial progress since 2011 and its new regulatory model strengthens the way it monitors and inspects hospitals, adult social care providers and GPs”.

We are by no means complacent, and we recognise the work that needs to be done to ensure that we are exactly where we want to be. Care homes look after some of the frailest people in society, and if there is a possibility of a home closing, or of other serious problems, it is completely understandable and reasonable for the families to have the reassurance that it will end up in the position they want it to be.

In recognition of the wider social care challenges, the Government are giving local authorities access to £3.5 billion of new support for social care by 2019-20. Since April, councils have been able to introduce a new social care precept, enabling them to increase council tax by 2% over the existing thresholds. This could raise up to £2 billion a year for social care by 2019-20. In addition, from April 2017, the spending review will make social care funds available for local government, rising to £1.5 billion by 2019-20 and to be included in the better care fund. Together, the new precepts and the additional better care fund contribution means that social care spending will increase in real terms by the end of the Parliament. Funding issues, however, are no excuse for poor care or—worse—abusive treatment. It does not cost any more to treat someone with kindness and compassion and to respect their dignity.

Finally, I want to address the important concerns around complaints that have been raised this evening. I know my hon. Friend is due to meet the Minister with responsibility for community health and care shortly on this matter and that he has previously met the Minister with responsibility for care services, the local government ombudsman and the CQC’s chief inspector. On the earlier point that he raised, I want to assure him that there is a statutory requirement for care home providers to operate a complaints system. Care homes are held to account for the effectiveness of the complaints process by the CQC.

We know from discussions we have had that the system is not working perfectly. Despite the progress we are making, we still hear too many stories that highlight people’s real concerns about quality and safety in social care—and we are determined to do better. We also hear that those receiving care or their families can be reluctant to make a complaint for fear of the consequences, especially if it is about a care home where someone is living. Indeed, only this week there was a story on the “Victoria Derbyshire” show about care homes banning relatives who made a complaint about the quality of care. We find that completely unacceptable. It is right that people and their families should feel able to raise concerns without fear of reprisals.

Ministers and the sector are looking to develop an adult social care quality strategy that will look at complaints and the culture of why people fear speaking up, as well as how we can improve the system to make it easier for them to complain. Care homes must have a complaints procedure, and if people are not happy with the response they receive the local government ombudsman can investigate complaints on their behalf. It is clear that everyone—not just the Government, and the CQC in its role as regulator, has a part to play in bringing about improvements in the quality of adult social care.

The Government are committed to improving the quality of social care, because care homes play a vital role in our society. There are many good and even outstanding homes, and we need to encourage them to share best practice so that it becomes the norm everywhere. We know that while a robust regulation and inspection regime is a key part of encouraging providers to improve, it is not the only influence. Sustained quality demands a commitment from everyone—from staff and providers to commissioners, funders and regulators—to make adult social care the best it can be. We are committed to working with all parts of the care system to make sure that we achieve just that, because our constituents deserve no less.

Question put and agreed to.