The Care Quality Commission will be able to inspect councils over their commissioning of 15-minute care visits, a minister has insisted after the government removed the regulator’s duty to make routine checks on adults’ services departments.
Health minister Earl Howe said the CQC’s core role was to regulate providers, but the government would allow it to inspect councils where poor provision was caused by poor commissioning – as is often claimed with 15-minute home care visits.
The CQC is proposing to examine the impact of short visits and staff working conditions on the quality of home care from next year, care services minister Norman Lamb said last week.
However, following that announcement, campaigners against 15-minute visits warned its efforts would be blunted by the government’s removal of the CQC’s duty to make routine checks on council adult services.
Though this duty has not been enforced since 2010, the Care Bill as originally drafted would have retained it and Lamb had said earlier this year that he was considering reinstituting it in practice. However, the government tabled an amendment to the Care Bill that would remove the duty, which was passed in a House of Lords debate yesterday evening, despite several peers warning that it would undermine the CQC’s ability to challenge poor care.
CQC will be able to challenge councils on 15-minute care
In defending the government’s plans, Howe pointed to its decision to retain the current power for the CQC to conduct “special reviews” of councils’ adults’ services functions, saying this would enable it to challenge poor commissioning, including on 15-minute visits.
“The CQC will be able to carry out a special review of commissioning where there is evidence that commissioning practices are contributing to the provision of poor care for patients and service users,” said Howe. “A prime example of where the CQC could be tasked to conduct an investigation would be if it had evidence that 15-minute commissioning was taking place. That applies to any area where poor commissioning is identified as a contributory factor to the poor provision of care, either in terms of the quality of services or where access to services is raised as an issue by people who use them.”
Former Labour health minister challenged Norman Warner challenged Howe on the fact that the CQC would have to seek the approval of both the secretaries of state for health and local government in order to conduct a special review.
Warner said this would “put in place another hurdle to be got over, which is the approval of two secretaries of state, before the CQC can actually act in the area of commissioning”.
However, Howe said ministers would not stop the CQC from conducting a special review if there was a “good case” for doing so.
Though Warner pushed for an amendment to remove the requirement for the CQC to seek government approval, this was defeated by 220 votes to 194.
Regulator’s core role to inspect care providers
Howe added that allowing the CQC to routinely inspect council commissioning would reduce its capacity to undertake its core job of regulating providers.
While other peers warned that without CQC oversight of councils, their commissioning role would go unchecked, Howe claimed that local authorities would be subject to other forms of scrutiny, including:
- New statutory guidance on commissioning that will be issued following the passage of the Care Bill, which councils will be under a duty to follow;
- The provision of “comparable information on councils’ performance” through the Adult Social Care Outcomes Framework, to enable local people to challenge their authority;
- The ability of the local Healthwatch, which acts on behalf of service users and the public, to raise concerns about poor commissioning with Healthwatch England, a constituent part of the CQC.
Role of sector-led improvement ignored
Surprisingly, Howe did not mention the system of sector-led improvement, under which councils work together in regional partnerships to oversee commissioning performance and support improvement. This system – overseen by the Towards Excellence in Adult Social Care programme, based within the Local Government Association – was designed to replace the annual performance assessments of councils previously carried out by the CQC.
However, both Lamb – and CQC chief executive David Behan – have raised concerns that sector-led improvement will not identify and tackle failures in local authority commissioning.
Last week, Behan said there was “still a debate to be had” about the CQC’s role in monitoring councils and that national associations representing providers would see the removal of its duty in this area as a “retrograde step”.