The government may reintroduce assessments of the quality of council adult social services less than three years after abolishing them, care services minister Norman Lamb has said.
Lamb said today he was considering asking the Care Quality Commission to resume assessing the quality of councils’ commissioning of adult care, a role it and predecessor regulators held until October 2010 when the government scrapped annual performance assessments.
These were replaced by a system of sector-led improvement, overseen by the Local Government Association and Association of Directors of Adult Social Services, under which councils support each other to improve but are not required to participate.
CQC chief’s warning over under-performing councils
Last week, CQC chief inspector David Behan said sector-led improvement served middle-ranking and top councils well, but that he feared it would not root out under-performance as councils were too competitive with each other.
Lamb said he was considering whether the chief inspector of social care, who will be appointed by the CQC later this year, should oversee commissioners as well as providers, on the basis that the quality of care was dependent on both. He also suggested it could help tackle poor-quality commissioning, citing the contracting of home care in 15-minute appointments, a practice the government has vowed to end to the extent that it compromises service users’ dignity.
“It seems to be that if we have a commissioner-provider divide you only get good results if both parts of the divide are working effectively,” he said. “As a local resident in Norfolk how much do I know about the quality of commissioning by the local authority? Probably not very much. I’m looking at whether the chief inspector of social care should have an interest in the quality of commissioning as well as the quality of provision, and I think there’s quite a strong case that that has some logic to it.”
However, the LGA warned that reintroducing inspections of councils would not achieve good-quality care.
“Instead it could lead to a closed-doors, tick-box mentality that merely requires services to meet minimum standards and fail to improve the vital services that older and disabled people have come to rely on,” said LGA community well-being board chair David Rogers.
“We are concerned that re-introducing inspection could also risk diverting energy away from those who are on the front line improving the quality of services for older and disabled people, particularly when the care system is about to face a time of significant change.”
Backing from providers
However, providers overwhelmingly welcomed Lamb’s comments. The Voluntary Organisations Disability Group (VODG) said it would “welcome the chief inspector providing an independent view on the quality of commissioning”. VODG general secretary John Adams said councils would have significant new duties under the forthcoming Care and Support Bill “but it’s not clear how they will be held to account for these responsibilities”.
The National Care Forum, which also represents voluntary sector care providers, said it too was supportive of extending the CQC’s remit to assessing commissioning, as did the United Kingdom Homecare Association (UKHCA).
“Currently, the regulator is only able to assess part of the picture,” said UKHCA director of policy and campaigns Colin Angel. “Empowering a chief inspector to address commissioning will finally enable CQC influence all the factors which ensure the best outcomes for people who use social care, including the link between adequate funding and quality.”
Lamb was speaking to Community Care after hosting an event at the Department of Health to showcase good practice in supporting people with learning disabilities or autism and additional mental health problems, as part of the government’s programme to improve support in the wake of Winterbourne View.
Lamb has set NHS commissioners – now the new clinical commissioning groups (CCGs) – a target of identifying all people with learning disabilities or autism placed in NHS-funded hospital settings, particularly assessment and treatment units, by April of this year. By June, CCGs and councils should have reviewed the needs of this group and provided each person with a personal care plan identifying how they can be moved to community-based settings within the following 12 months.
Threat to name and shame over Winterbourne targets
Lamb warned that he would “name and shame” councils and CCGs who failed to meet these targets.
“If people fail to step up to the plate on this they have to be exposed, ” he said. “Just as we want to applaud the places that are going great things, I will very readily condemn commissioners who fail to end unacceptable practices.”
The government has commissioned the LGA and NHS England, the new body that oversees NHS commissioning, to run a joint improvement programme to help commissioners redesign services so that they can move people out of institutions into appropriate community-based settings. This is led by former senior sector manager Chris Bull.
Lamb is meeting with Bull and others in two weeks’ time for an update on progress. The minister wants to produce a report in July detailing which areas have met targets and which have not.
Lamb said he wanted to know that the number of people placed in assessment and treatment units was going down, adding: “I have no idea if that’s the case.” He warned that people should not be moved out of assessment and treatment units, only for another group of people to be admitted into them; he also said there was a risk that people could be placed in inappropriate community-based settings if commissioners did not follow good practice.
Failing social services may be going unchallenged, warns Behan