No return to regular ratings of council adults’ services, says minister

Earl Howe says Care Bill will allow Care Quality Commission to inspect councils only where there has been systematic failure, not on a regular basis

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There will be no return to regular assessments of local authority adults’ social services, the government has said.

Ministers will remove the existing duty on the Care Quality Commission to assess council adult services on a regular basis – which has not been enforced since 2010.

Instead, the Care Quality Commission will have the power, as now, to assess a local authority – with government approval – where there is evidence of “systematic failure”, health minister Earl Howe said week.

In April, care services minister Norman Lamb said he was considering reintroducing assessments of local authority commissioning to give the CQC a fuller picture of the quality of care and ensure failing authorities could be identified.

There is a statutory duty on the CQC to assess council adults’ services under the Health and Social Care Act 2008, but this has lain dormant since the government scrapped annual performance assessments in 2010.

The Care Bill had been originally drafted to oblige CQC to conduct regular checks on local authority adults’ services should regulations prescribe this, giving ministers the option of reintroducing regular performance assessments.

Performance assessment plan withdrawn

However, the government has now issued an amendment to repeal this section of the bill. A further amendment would enable the CQC to conduct a “special review” of a local authority with the approval of the secretaries of state for health and local government.

In last week’s debate on the Care Bill, Earl Howe said: “We are proposing in a later amendment to give the CQC powers to conduct special reviews where concerns have been raised about a particular local authority or NHS commissioner; there would not be periodic, regular reviews.”

He was responding to questions about the quality of local authority commissioning in the light of mounting concerns over the use of 15-minute visits to deliver personal care at home.

‘Systematic failures’

Howe said the second amendment would enable CQC to conduct a “special review” into the council in cases of systematic failure.

“Subsequent to any such review, CQC could issue an improvement notice in the event of a non-substantial failing and recommend special measures to the secretary of state in the event of substantial failings,” he added.

The government would also issue statutory guidance for councils on commissioning to highlight good and poor practice and influence decision-making, he added.

Howe’s comments came a day after the Equality and Human Rights Commission’s report reviewing progress against the recommendations of its 2011 inquiry into human rights in home care.

As well as warning that local authority commissioning practices – including the use of 15-minute visits – were putting older people’s human rights at risk, the EHRC welcomed what it saw as an “imminent” return to regular assessments of commissioning.

‘Assessing councils could improve human rights’

“We believe that the Care Quality Commission’s imminent resumption of this remit has the potential to improve the protection of older people’s human rights in home care,” said the report. The EHRC’s view was based on Lamb’s comments earlier in the year mooting a return to council performance assessments.

While Howe said that the special reviews amendment would increase government action to tackle poor commissioning, the post-Care Bill position would be similar to the current one.

As stands, the Health and Social Care Act 2008 permits the CQC to conduct special reviews into particular ones. And when annual performance assessments (APAs) were scrapped in 2010, the government left open the possibility that the CQC would inspect a council if it was found to be failing.

The APAs were replaced by a system of “sector-led improvement” under which councils take greater responsibility for their own performance and authorities support each other to improve through regional partnerships.

Concerns over sector-led improvement

In recent months, both Lamb and CQC chief executive David Behan have expressed concern at the ability of sector-led improvement to identify councils at risk of failure and ensure they were challenged to improve. While the government’s plans would allow for inspections of councils where failings had been identified, it would seemingly not make it easier to identify failing councils in the first place.

Howe also refused to lend government support to an amendment to the Care Bill to prevent councils from commissioning visits to deliver personal care of less than 30 minutes.

Crossbench peer Baroness Meacher – a former social worker – moved the amendment – because, she said, there was “nothing in the bill to prevent [15-minute personal care visits] from continuing, and indeed spreading further”.

No ban on 15-minute home care visits

However, Howe said some 15-minute visits were appropriate, banning them could have had unintended adverse consequences and setting a 30-minute minimum in law would reinforce a “time and task” approach to commissioning, rather than an outcomes-based one.

He pointed to a separate government amendment to require councils to consider, in their commissioning, the impact of their decisions on individuals’ well-being.

“This goes a long way towards achieving the objective we all share of tackling poor commissioning practices while maintaining local authorities’ ability to decide the most appropriate approach to commissioning services for the people in their area, and acknowledging that the underlying issues here are cultural and cannot be tackled by legislation alone.”

Though Meacher withdrew her amendment, the charity Leonard Cheshire Disability said it would continue its campaign for the bill to be amended to outlaw 15-minute personal care visits. Without it, older and disabled people would continue to receive “rushed and unkind care”, said the charity’s chief executive, Clare Pelham.

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