Health: Adult Pneumococcal Vaccination

Baroness Greengross Excerpts

Tuesday 8th December 2015 Lords Chamber

Asked by

[Baroness Greengross]

To ask Her Majesty’s Government what plans they have to improve the efficacy of the adult pneumococcal vaccination programme and to ensure optimal coverage of target populations in the United Kingdom.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, vaccination of children, adults and risk groups with pneumococcal and influenza vaccines has led to a significant reduction in pneumococcal disease in the UK. The Joint Committee on Vaccination and Immunisation published an interim statement on adult pneumococcal vaccination on 18 November. The JCVI statement is subject to stakeholder consultation before being finalised. The interim statement advises continuation of the existing adult pneumococcal vaccination programmes. The Government will respond fully once the advice is finalised.

[Baroness Greengross (CB)]

I thank the Minister for that reply. As he knows, this disease puts an enormous pressure on the NHS and on patients. The recent report that he mentioned from the ONS showed that pneumonia was the underlying cause in almost a fifth—19%—of the 43,900 excess deaths in England and Wales just last winter. The recent review by the Joint Committee mentioned by the Minister recommended no changes to the adult pneumococcal vaccination programme at this time, which is a bit surprising. The committee is currently consulting, as the Minister mentioned, and it acknowledged that there are weaknesses with the levels of protection offered to at-risk adults. Will the Minister look into this issue and work to make sure that the pneumococcal vaccination programme provides optimal protection for vulnerable adults?

[Lord Prior of Brampton]

My Lords, the report by the JCVI was very clear in its recommendation that the existing vaccination, PPV, was the most appropriate for those aged over 65 and that PCV 13, which is the vaccination used for young children, because it provides herd protection—that is, young people who are treated with it can no longer carry the disease—offered the best long-term protection for the elderly as well.

NHS: Health and Social Care Act 2012

Baroness Greengross Excerpts

Monday 16th March 2015 Lords Chamber

[Earl Howe]

If I had to single out two or three things from that Act which have been of enormous and incomparable benefit, one would be the enhancement and promotion of clinical leadership within the system, which has happened as a result of the creation of clinical commissioning groups. The second is the creation of Public Health England and the transformation of public health delivery in this country. The third is the separation of elected politicians from the running of the health service, which has enabled the NHS to free itself up to look at innovation in a more creative way

[Baroness Greengross (CB)]

My Lords, does the noble Earl not agree that if specialist secondary clinicians worked a more significant part of their time in primary settings in the community, this would be a welcome innovation across the country?

[Earl Howe]

I do agree. That idea is being taken up by a number of the vanguard sites, which are looking at the new models of care that were foreshadowed by the five-year forward view. It is, I think, the shape of things to come.

Meals on Wheels

Baroness Greengross Excerpts

Monday 19th January 2015 Lords Chamber

[Earl Howe]

My Lords, as I have indicated, there are a variety of reasons for this. The data collected by the information centre include only people who receive meals in their homes as part of a council-arranged formal package. They do not include informal arrangements such as the provision of meals at day centres or via daycare, or indeed those who pay the council for their meals, as many do.

[Baroness Greengross (CB)]

My Lords, I declare an interest as patron of the National Association of Care Catering. The association recently did some research that showed that, over 10 years, the numbers of people receiving meals on wheels has gone down from 40 million to half that number. That is really very worrying. Can the Government explain whether it would be better to have a statutory requirement for someone to provide these services to the huge numbers of older and vulnerable people within the community?

[Earl Howe]

My Lords, I do not recognise the figure of 40 million that the noble Baroness mentioned; perhaps she and I could confer after this Question. I think that what matters here is that those with eligible needs receive the service they require. It is up to local authorities to determine eligibility criteria, but the latest available data from ADASS show that all local authorities are setting their eligibility criteria to ensure that they meet at least critical and substantial levels of need.

Elderly People: Powers of Attorney and Living Wills

Baroness Greengross Excerpts

Monday 12th January 2015 Lords Chamber

[Baroness Greengross (CB)]

My Lords, it is a privilege to take part in this debate. I declare an interest—apart from my involvement in the International Longevity Centre—as chair, and now co-chair with a Member of the Commons, of the All-Party Parliamentary Group on Dementia, as ambassador for the Alzheimer’s Society and as a “dementia friend”. I congratulate the noble Baroness, Lady Bakewell, on initiating this debate. It is important and has covered a whole lot of areas. I very much agree with her and my noble friend Lady Flather, because one of the issues that the noble Baroness talked about was our unwillingness to face the issue of dying. We forget that dementia is a terminal illness and, if we are going to get things right, we have to be able to talk about dementia as we can now, thankfully, talk about cancer much more easily than we used to be able to.

Although we can talk about dementia a bit more, we do not all realise that there are more than 100 different types of dementia, and some of them are illnesses that enable people to slip in and out of mental capacity and spend a long time being at least partially capable of making decisions and planning their future—in other words, being mentally competent. We all have a certain amount of pride. We want to be sure that we are remembered with some dignity and that some of our dearest wishes will be complied with if we are unable to make sure ourselves that they happen.

It is understandable that everyone is frightened of dementia, because it is now the leading cause of death in women in this country, and the third leading cause of death in men. More than 80% of people in care homes have dementia or significant cognitive problems. It is not a minority issue but it affects so many people. It does not affect just the person with dementia; it affects particularly that person’s carer and sometimes many more people in the family and the immediate friends of that person. Carers do a most amazing job, and I congratulate the Government on having given carers more rights in the Care Act, which is important.

However, one of the most popular areas of advice sought from Carers UK is the Mental Capacity Act. Carers’ thoughts and wishes can be looked at much more easily if a lasting power of attorney has been appointed, because the carer and the person with dementia can rest more easily knowing that the plans for the future will be carried out in accordance with his or her wishes. Many people feel tremendous responsibility that, when they cannot manage their affairs by themselves, their children should not be faced with terrible decisions. They want—I want, and I am sure many noble Lords want—to be sure that there are plans in place so that our wishes can be carried out, and that we do not present our children with dreadful problems and responsibilities. If they have to make decisions, they must try to make sure that they correspond with our wishes.

We are quite accustomed to knowing about this when it comes to money. We know that we can, or have been able to for a long time, make decisions about our money, but very few people know that the lasting power of attorney now includes decision-making possibilities about our health plan. People would be hugely eased if this was better known—if the information was more available. In fact, the lasting power of attorney can deal with our health issues and our welfare issues, as well as our financial issues, and help us to feel relaxed about how our children are going to deal with the future, when we die. They can be carried out, but only if we are all clear about the procedures. It is very important that people do not forget to get things in place in time, as the noble Baroness, Lady Bakewell, made quite clear. The lasting power of attorney can make it very clear who is going to make decisions, which adds to the dignity of the person who has dementia and is going to die at some stage. It is that person’s wishes and advance decisions, not other people’s, which will be taken as read.

It is very important that those caring for people with dementia know that they can get the right advice. I would like to see an Admiral nurse available to every family dealing with dementia. That is not going to happen for a long time, but we need more Admiral nurses and more volunteers for the early stages, so that everybody who is diagnosed—and we need more than 50% of people to be diagnosed—has access to help and advice, either from a volunteer or, later on, from a person who knows enough about the situation to take someone’s hand, whether that is the carer’s or the person’s with dementia, and guide them through this very difficult maze of questions that require answers. If we can do that, we will make life better for people with dementia and those who are affected along with them.

I hope that the Minister will make sure that the Prime Minister’s and the Government’s wonderful achievement in getting a G8 discussion to focus on dementia happens and will be carried forward. It will happen: it will happen with the global envoy; with the national plan, which must be renewed; with the increase in money for research, which must be continued; and with a commitment from everybody in power in this country to make sure that dementia is in the forefront of our thoughts. It is very important and I am sure that the Minister feels the same way.

Elderly People: Abuse

Baroness Greengross Excerpts

Wednesday 14th May 2014 Lords Chamber

[Baroness Greengross (CB)]

My Lords, the noble Baroness, Lady Cumberlege, has given us the opportunity to consider a whole range of abuses of elderly people. In my very short time, I will concentrate on the rather hidden abuse of people in the community. Unfortunately, as we learnt from the Health and Social Care Information Centre, in just one year—2013—there was a 4% rise in cases of alleged abuse referred for investigation. Sadly, the hidden abuse is very likely not to be referred at all. I have been involved in this issue for many years and helped to establish Action on Elder Abuse because nobody took these issues as seriously as they need to be taken. I am really appalled that we still have to take into account the fact that most of this sort of community-based hidden abuse is not understood or reported.

There are reasons for this. An elderly woman, a mother, who is smashed up by her son will not report it because that makes her seem a very inadequate mother to produce that sort of son. There are other reasons, too. For example, a lot of elder abuse is the result of a whole history of domestic violence in a family that continues into the old age of one member of that family. Sometimes it is a question of revenge, such as for a daughter who was abused in some way in childhood by her father. There are other examples. There is a lot of fraud, which personalised budgets and choice can in fact increase very easily. It is very simple to extract money from benefits or pensions from somebody who is elderly, frail and confused.

Abuse is very hard to detect if a confused elderly person is cared for by a family who provide the basics of food and drink but then shut the door and leave that person in a room alone without any real contact with other human beings. We know that, worse, it is not difficult to use the personalised money they receive for the family’s other needs. I agree with the noble Baroness, Lady Barker, about deficiencies in the law in this country. I have also tried to argue with the noble Earl that some sort of easier method of gaining entry to someone’s home if there is a suspicion of abuse is needed because it is extremely difficult to detect what is going on if you wait until it is publicly recognised. Social workers—very specialist ones—need some way of investigating what is going on.

We know that the elderly people most likely to need care in their homes very often suffer from dementia. The noble Lord, Lord Turnberg, said how difficult it is to care for many years for somebody who has dementia and can be aggressive and difficult. People just do not always have the stamina to continue year after year doing that. We must do something to make sure that these people are better cared for and supported in their task.

Care: Financial Services Industry

Baroness Greengross Excerpts

Wednesday 26th February 2014 Lords Chamber

[Baroness Greengross (CB)]

My Lords, I add my congratulations to the noble Lord, Lord Lipsey, on securing this debate and pointing out so much that still needs to be done to fulfil the potential of the Dilnot recommendations. While we all regret the fact that it does not seem that long-term care products will be available for some time—perhaps that was predictable and perhaps we all knew that—we have been encouraged by the Government’s decision in its Care Bill largely to accept the Dilnot commission recommendations for a cap to be created for an individual’s lifetime contributions towards their social care costs. That represents an important starting point from which new care funding solutions can begin to emerge.

An important outcome from those reforms for the industry would be the long-term stability and sustainability of the social care funding framework. A stable state framework should give consumers the confidence to invest in solutions to pay for their share of care costs. It will also have a positive impact on providers’ willingness to enter the market. However, much of the detail around the operation of the cap, in particular the modus operandi of the benefit eligibility criteria, as the noble Lord, Lord Lipsey pointed out, will be clear only when the promised guidance finally emerges from the Department of Health. It would be helpful if we had a better idea about the timetable for the appearance of that guidance.

The legislation itself will not deliver a new care funding option unless it first creates the right environment in which new markets for care funding products can develop. Accordingly, I warmly welcome the new statement of intent between the Association of British Insurers and the Government. That is an important step in the process of helping people to plan and prepare for the costs of long-term care. From my perspective, an important element of that statement is the declaration that there will be a joint initiative to raise public awareness of the reforms in advance of 2015. In the absence of such an effective information and education campaign, possibly run in conjunction with a campaign on pensions awareness, low consumer understanding about the realities of care funding—as the noble Baroness, Lady Brinton, pointed out—will continue to reduce the demand for new care funding options, which the financial services industry could potentially develop products to meet.

Currently, for those who can afford them, immediate needs annuities are the only products dedicated to care fees funding. These guarantee an income for life to fund care costs in return for a one-off premium. In the continued absence of any form of pre-funded long-term care insurance products, it is to be hoped that products such as disability-linked annuities and vehicles that combined care insurance with other protection insurance options—the so-called care conversion and hybrid protection products—will emerge. We should do all we can to encourage such innovations.

Unless local authorities, as part of their mandate to establish a competent local information service, have effective processes in place to refer future consumers—who are already emerging and may require appropriate regulated financial advice—perhaps to members of SOLLA, who are reliable and can give them the correct information, not only will the information programme be wasted but many consumers will not get the outcome their sensible considerations and planning merit. Some reassurance from the Minister on both the information programme and service would be helpful. I hope that he can give that assurance to us.

For people with property assets, one of the routes to funding care fees that emerges may be based on the current equity release products, as we have heard. For example, only yesterday the think tank Demos launched a research report which explored the possibility of helping customers to ring-fence a proportion of their housing equity to help them to meet their long-term care costs in later life. It is also important to remember that, while the proposed extension of local authority deferred payment schemes is positive, these are complex financial arrangements with long-term consequences. In many ways they are very similar to fully FCA-regulated equity release products but without the accompanying consumer protection and redress features.

Therefore, first, an information and advice campaign must be aligned with that on pensions; secondly, the guidelines should be consulted upon, and eligibility criteria and the level of need should be thought about again—it is really important that we build in some protection for people—and, thirdly, eligibility criteria should, I think, be national rather than local so that minimum standards are guaranteed and could be exceeded locally but not lowered.

The older population has within it people of all different shapes and sizes with different aspirations and needs, and a one-size-fits-all solution is inappropriate. I end by echoing the aspirations of the statement of intent, in that all of us must continue to work together to help people to better plan, better prepare and better save for care costs. We must spare no effort in seeking to identify the best care funding solutions for all our different people of all ages and backgrounds.

Health: Dementia

Baroness Greengross Excerpts

Wednesday 22nd January 2014 Lords Chamber

[Baroness Greengross (CB)]

My Lords, I congratulate the noble Baronesses, Lady Gardner and Lady Turner, on their excellent and very moving speeches.

I start by saying that I have rarely been as proud of being British as I was recently when this country—or, rather, the Prime Minister, because of his personal commitment—secured here in London the G8 summit on dementia. That was an enormously important achievement. I say that with real pride because I chair the All-Party Group on Dementia. We are an extremely active all-party group that has produced a lot of reports on many areas of interest. We have looked at the fact that dementia patients stay longer in hospital when they go in for a fractured femur and we were part of the campaign to reduce the use of anti-psychotics. We have had many quite successful inquiries and policies have radically changed because of the work of colleagues on the all-party group. However, there is still a huge way to go.

Dementia is certainly the new cancer, as the noble Baroness, Lady Gardner, said. It is not very long ago that you could not really talk about it. The interest in, and commitment to, doing something about dementia now is really important and it is excellent that we have got that far. There are still, however, many problems. Dementia is a disaster if you are suddenly diagnosed. You have no idea how to cope with the diagnosis or where to go for help. You are absolutely struck by your inability to move forward. However, it should not be seen in that way because a lot can be done. Of course we do not have all the research that needs to be done—the G8 made that clear. As a result, however, some very hopeful research work is being undertaken in the United States and the money is beginning to flow in as well. But there is still a long way to go on research.

In this debate we are looking at what has to be done now to alleviate the situation of people when they receive a diagnosis or even before, when they suspect, because of memory loss, that something is going wrong. It is a progressive and a terminal disease which, at least at the beginning, attracts social care funding and not health service funding. Over much of their life course many of those who have the disease will experience problems in getting financial help so that they can live adequately. It can be a disaster and we need to do something now. The noble Earl is doing a great deal to ensure that the Care Bill, which has now gone to the Commons, will help many people with dementia. However, a huge amount needs to be done.

We have to see dementia as one element of the comorbidities that many older people face—and it is usually older people, as the noble Baroness said, who get a form of dementia. We have to concentrate on the fact that if people have dementia, the other conditions from which they suffer are sometimes ignored, or vice-versa. Dementia also has to be seen in the light of the huge stigma that still surrounds its diagnosis. For many people, even GPs, it is better to ignore it than to diagnose somebody when they do not feel that there is a great deal they can do to help. Many people try very hard to forget that it is happening, and if they forget it is happening, their quality of life will be reduced enormously.

Much can be done. We have to take into account that local commissioning is an excellent way of improving the situation as long as it works properly. I chaired a meeting this morning with commissioners to look at what can be done to improve the lives of people right at the beginning when they know that something is wrong, before they are diagnosed and immediately afterwards. As soon as they feel that there is some memory loss or they begin to worry they need to get help and not wait for a diagnosis. They need to get help and start the process of making a plan of action and support for that person, the family and the wider community where possible. Things can be done to improve the quality of life.

We know that much can be done in preventive care, particularly with vascular dementia. A change in lifestyle can help a great deal to delay the worst aspects of that dementia and, indeed, some of the others. However, not all can be helped in that way. What is necessary then is the coming together of support mechanisms—that is, people—who can really help.

We have to be certain that the good measures in the Care Bill are introduced so that we have a co-ordinated plan of action for anybody who is diagnosed eventually with some form of dementia. The right now of carers as well as of patients to a proper assessment leads to action, and this is not easy. It is not easy for local authorities and not easy for commissioners in healthcare, because there is a shortage of funds. However, we have to find the funds because dementia is a priority. It is a terminal disease, so it is extraordinary that it gets primarily social funding from local authorities rather than health funding. We have to integrate. That is what the Care Bill is aiming to do, so we have to give it our total support.

Memory clinics need to be the first place that people go to when they feel there is something wrong. That is when the support services need to be brought together to help somebody to find their way through the maze of services. They need to inform themselves about them and make sure they are available to them. That is where other people in the local community can do so much, as the noble Baroness, Lady Turner, said. When there are good services around that can be brought in early, we can get this as right as possible. Even before the memory clinic people have to start recognising that something is wrong, and then you need to have a co-ordinated approach to care. That is essential. We need to have a navigator/co-ordinator who can go in and advise that person and that person’s family how to get the best care that is available locally so that their quality of life does not deteriorate. When they are diagnosed, this is even more important, so we need a navigator/co-ordinator of all the services. The services need to be brought together so that they are not difficult to find.

We need people to understand that post-diagnosis, life can be very good. One of the participants at the meeting with about 30 commissioners this morning was an early-onset dementia patient. He was diagnosed at the age of 49—10 years ago, I think. He was still perfectly capable of taking a very active role in the debate we were having because he had the right support around him all the time. That is essential. You need one place where all the services are available, you need one navigator/co-ordinator to provide those services for somebody and you need to convince that person and the carers that life can be good for a very long time. We need to have contact with all the advisers straightaway, one service co-ordinator and a strategic service integration scheme. That is key. We need one location, one centre where all the services are brought together and, rather like when you have a baby, you need to have a list of the services given to you so that you know who to ask about everything. We can do that.

We can embed personalisation in what we do. We can look to the groups that really cannot cope, and which have no idea of local services, and to our minority groups, some of which do not even have a name for Alzheimer’s or dementia. There are huge problems there. We need to focus on those people. We really need above all to listen to, communicate with and involve people with dementia every step of the way because they have not lost their humanity and their ability to be part of society. We have to trust them to know what they need and want and bring the services close to them so that they can benefit from the many important new ways of delivering services which will be enhanced, I hope, by the Care Bill when it becomes part of our legislation.

G8 Summit on Dementia

Baroness Greengross Excerpts

Tuesday 17th December 2013 Lords Chamber

[Earl Howe]

My noble friend raises an important issue, because it is going to be increasingly necessary for not only health and care professionals but members of the public to be properly attuned to dementia and the needs of those who have the condition. We want to see all those who deal with the public trained in dementia, at least to a basic level, in a way that is appropriate to their level of engagement with those who suffer from dementia. Dementia training is now a key part of Health Education England’s mandate.

[Baroness Greengross (CB)]

My Lords, I would like to add my congratulations to the Government, and in particular to the Prime Minister on his personal commitment and on securing the summit focusing on dementia. I ask the Minister whether there are any commitments from other G8 countries, both for research and for the other side of this, which is care and how we help the growing number of people—it will be one in three of us in the near future—who are going to experience dementia, in all the G8 countries and beyond.

[Earl Howe]

My Lords, it is perhaps too soon to expect concrete proposals from other G8 countries, but I can tell the noble Baroness that the summit was not the end of the story. The G8 countries will be meeting throughout 2014 to build on and develop further agreements. We have agreed to host the first legacy event on social-impact investment in March next year. That will be followed by an event in Japan on what new care and prevention models could look like, and by an event hosted by Canada and France on how industry can harness academic research. There will then be a meeting in the United States in February 2015. We hope that the momentum generated by the summit will elicit the kind of commitments that the noble Baroness rightly seeks.

Care Bill [HL]

Baroness Greengross Excerpts

Tuesday 29th October 2013 Lords Chamber

[Baroness Greengross (CB)]

My Lords, I was the third member of the delegation, so to speak, with whom the noble Earl met and I thank him for the time he put in to clarifying the issue through our amendment and his response.

I was worried about the same points as those raised by the noble Lords, Lord Lipsey and Lord Sharkey, particularly for the people who need rather different kinds of advice from that which we take for granted in financial advice. I refer to those people who might need additional advice on their housing or other needs that are broader than or slightly different to pure financial advice. The word “facilitating” is key. Local authorities must enable people, as well as they possibly can, to get the correct financial advice they need for their particular circumstances. I believe that we have arrived there and I thank my colleagues, and in particular the noble Earl, for meeting our requirements so well.

[Lord Best (CB)]

My Lords, speaking as president of the Local Government Association, I can confirm that the LGA supports this amendment and underlines the importance of sound professional advice before people, particularly elder people with care needs, make major financial decisions, not least in relation to the use of their homes as a source of finance for meeting care costs.

Facilitating access to such advice, of course, will add to the duties and burdens on local authorities. That must be recognised, as with the implementation costs for the so-called Dilnot arrangements, in the financial settlement that central government makes with local government. The costs involved for local authorities may not be very great but they should nevertheless be acknowledged. With that point in mind, I am delighted to give firm support to the amendment. I am sure that, as always, the noble Earl will respond helpfully and wisely.

Care Bill [HL]

Baroness Greengross Excerpts

Monday 21st October 2013 Lords Chamber

[Lord Warner]

My Lords, I express my concern about the provisions of subsection (4) of the Government’s new clause on the independence of the CQC. My instincts are that this will do the absolute reverse of what the Government are seeking to do in terms of the CQC’s independence, which is why my Amendment 143A seeks to remove subsection (4). I do not disagree in any way with the other provisions in this set of government amendments and will explain my thinking. Subsection (4) effectively prevents the CQC investigating, of its own mere motion, the extent to which local authority commissioning practices and decisions on adult social care damage user interests and well-being.

In effect, if the CQC considers, after looking at the results of its work on providers of services, that there is a major stumbling block to good, sound provision of services that promote the well-being of users—the provision in Clause 1 of the Bill—it has to seek the approval of the Secretary of State before it can do any kind of generalised or thematic review of local authority commissioning of services. It has to seek the approval not only of the Health Secretary but of the Secretary of State for Communities and Local Government. That seems a step backwards from the position we have now, where the CQC, as I understand it, could actually undertake these kinds of reviews. I do not see how the new subsection (4) helps the CQC to get to the root of a problem that may be affecting thousands of users of services. We have already seen that the providers were not the instigators of the policy of 15-minute home visits—it was the commissioners of services who instigated that policy. They required the providers to do that; they almost drove them along the path of not paying for the travel costs of the healthcare assistants who were making those visits. The institutional behaviour that has grown up and caused so much concern among the public and in Parliament has been driven by commissioners.

I suspect that we will have other kinds of such issues as we move through a decade of austerity in public services. It ought to be possible for the CQC to take the initiative and try to get to the bottom of those issues by carrying out a thematic review of the commissioning practices. That is why we need to take out subsection (4), which seems to be incompatible with the rest of the provisions in this set of government amendments, which I thoroughly welcome. All credit to the Government for removing these requirements on the CQC, but why are they spoiling the ship for a ha’porth of tar? Why are we pushing back on the ability of the CQC to decide that it wants to carry out a review of commissioning practices, when that is not in the best public interest? The Government should think again about this.

[Baroness Greengross]

My Lords, I will speak against government Amendments 145, 146 and 149, and speak at the same time to Amendment 147 in my name.

The government amendments would remove from the Bill a requirement for the CQC to conduct regular reviews of adult social care, as the noble Lord, Lord Warner, indicated. The Bill gives us an important opportunity to ensure that local government commissioning is effectively regulated. Last year’s EHRC homecare inquiry evidence pointed to serious concerns about some commissioning practices, which were found to put the human rights of older people in particular at risk. Accordingly, the EHRC’s recent review of the inquiry recommendations welcomed the fact that the Government had signalled their intention that the CQC should conduct regular reviews of adult social care commissioning.

Unamended, Clause 83 would reframe Section 46 of the Health and Social Care Act 2008 to empower the CQC to conduct periodic reviews of adult social care providers and English local authorities which provide or commission adult social care. It was very disappointing to see that the Government intend to remove clauses requiring the CQC to conduct these reviews through Amendments 145, 146 and 149, in the name of the noble Earl, Lord Howe. Taken together, these amendments would remove the proposed new requirements for the CQC to conduct regular performance assessments or periodic reviews of local authority social care commissioning, and amend existing provisions relating to special reviews and investigations by the CQC. That would leave it able to review providers and to ask the Secretary of State for permission to run special reviews when there has been a particular issue but unable to run ongoing reviews of how local authorities commission services. It seems counterproductive to be removing this power at the same time as committing to challenging bad commissioning from local authorities.

The proposals announced by Norman Lamb about CQC reviews the other day are very helpful. But, again, they seem to be focused solely on providers and what they are doing, not on the commissioners who have directed these providers. If the CQC is being made independent, should it be seeking approval for such reviews? I believe that the Government have tabled this amendment because they believe that the provisions in the Health and Social Care Act 2008 will be sufficient to keep local authority adult social care commissioning under scrutiny. However, my analysis is that the human rights of people receiving care would be better protected by retaining the requirement under the Care Bill as currently drafted so that the CQC should conduct regular periodic reviews of local authorities’ commissioning of adult social care.