Care Homes: Safety Ratings

Question

15:37:00

Asked by

To ask His Majesty’s Government what assessment they have made of the remarks by Sir Julian Hartley, the new chief executive of the Care Quality Commission, that the public can no longer trust the safety ratings given to care homes.

My Lords, the CQC has assured the department that Sir Julian Hartley, the new chief executive, did not use the exact words attributed to him in the interview with the Sunday Times recently. However, the chief executive gave a very honest assessment of the Care Quality Commission’s operational failings as a regulator and the challenges that face it in regaining public confidence. We welcome his candour, as well as his actions.

My Lords, it seems that available reports about care homes, which are needed, may be four years out of date, which is a serious shortcoming. At a time when the pressure is on to discharge people who need social care, as opposed to medical care, does my noble friend agree that the serious problems in the inspection regime are a barrier to any kind of progress with hospital discharge, and that the aim must be to make the CQC the trusted organisation it once was, on which families can rely when arranging care for their loved ones?

My noble friend is quite right in her observations. Indeed, serious shortcomings are at play. As for the age of the assessments, to which she refers, that is of scant help to those who are seeking to make decisions for either themselves or those who they care for. The CQC, under its new leadership, is prioritising tackling the oldest assessments. The first order of priority is to reduce the registration backlog, which at present is over 10 weeks, and address issues with the registration portal. An independent review has been commissioned to look specifically at the technology that will help reduce the backlog and provide the very necessary up-to-date assessments.

My Lords, can the Minister say what urgent steps are being taken to restore public confidence in the CQC’s ratings, and, in particular, what measures are being taken to ensure that the voice of both the patient and their families is given far greater weight in the way that these judgments and ratings are made by the regulator?

I agree that public confidence is absolutely crucial. That is why honesty is very important and why the Secretary of State accepted in full the recommendations of Dr Dash’s review into the CQC, which was published in October. In addition to new executive leadership, a recruitment process is under way for new non-executive leadership, including the chair, which is very important. I agree with the noble Baroness on the importance of the patient voice, because that will lead to greater confidence. There is a long road to go down, but I am absolutely confident that we are well on the way.

My Lords, organisations such as the Medical Defence Union report that new healthcare providers are facing severe delays registering with the Care Quality Commission. These delays are slowing down the process of registering new patients to access services. Can my noble friend the Minister outline what discussions the Government have had, or will have, with the Care Quality Commission to resolve this issue?

I assure my noble friend that the department has discussions with the CQC at fortnightly meetings. Those discussions are about performance, including clearing the backlog of registration of new providers, and this will continue in order to make the necessary improvements that my noble friend seeks.

My Lords, does the Minister agree that a lot of the problems in care homes would be alleviated if becoming a carer in a care home required certified training, supervision and a defined career path, rather than it being a job of last resort for itinerant job seekers, as it seems to be in many homes at the moment?

I certainly agree with the noble Baroness that the workforce is absolutely crucial, and I very much value the contribution that is made by those who work in care homes. Perhaps it would be helpful to say that, just last month, we announced that the care workforce pathway, a new national career structure for adult social care, will be expanding to support opportunities for career progression and development. This is the direction of travel that we want to take.

My Lords, whether or not the newspapers were correct in reporting what the CEO said, I am sure we would agree that the Care Quality Commission has been found deficient in its performance. With particular reference to the reports on maternity services, which are now in crisis, what are the Government going to do about properly evaluating maternity services?

I absolutely agree that the CQC has been deficient in its performance. We can look back to 2023 for the roots of that, when a new single assessment framework for assessing providers, coupled with a new IT system and changes in the CQC’s staffing model, were all brought into play. That produced a stark reduction in its inspection activity, as well as causing huge problems in the time taken to carry out re-inspections. In all of the ways that I have already mentioned, in addition to discussions on reducing the backlog and looking at the technology, staffing structure and improving governance within the CQC, this will be a root-and-branch change and will greatly improve inspection for maternity units and others.

My Lords, Sir Julian Hartley, in the Health and Social Care Committee hearing, said that the new IT system introduced by the regulator had been a complete failure. What steps will His Majesty’s Government take to ensure that public bodies, not just the CQC, have adequate and effective rollouts of digital systems, so that they can deliver on their performance targets? On 6 January, the Secretary of State announced that the Government were launching an independent commission on social care reform, with the intention of forming a national care service. Can the Minister please update the House on the progress made towards this commission?

To take the second question first, the commission will start its work in April. The noble Baroness, Lady Casey, has agreed to lead that review. The terms of reference will be published, and the first report will be with us next year. On the important point about IT, as I mentioned in response to the noble Lord, Lord Patel, that problem arose in 2023. The CQC has acknowledged, as we have, that there have been huge challenges with the provider portal and the regulatory platform. The Dash review talked about poorly performing systems hampering ability. This is not how the system should work. As we move towards the 10-year plan, and from analogue to digital, we will have that front and centre in how we work.

My Lords, the Secretary of State in July said that “the CQC is not fit for purpose”. Given the systematic failings still within that organisation, what timescale have the Government given the CQC to become fit for purpose?

The Secretary of State did indeed say that, and he was right to do so, in the spirit of transparency. The fortnightly meetings which I mentioned will be a constant assessment until we have met the necessary timeframes that are only reasonable to assist people in making decisions. All of that—how might I put it?—deep focus on the CQC will continue. I do not think this will be quick, but it will be thorough.

My Lords, 30% to 40% of public money given to corporate-owned care homes vanishes in profits, leaving little for front-line services. Almost all care homes forcibly closed between 2011 and 2023 were operated by for-profit companies. The Government’s promised crackdown on care home profiteering probably will not even be as effective as that on water companies. What will it take for the Government to recognise that profit and care cannot easily be combined?

The independent sector, which is not just the private sector but the charitable sector, is an important part of the provider framework. We will continue to work with it to provide the right quality of services for those who need them.