AMENDMENTS RELATING TO THE CARE QUALITY
COMMISSION
Adoption of a human rights framework
1.25 We recommended that the proposed merged inspectorate
for health, social care and mental health should adopt a human
rights framework to underpin and inform the new inspectorate's
work and make it more effective in fulfilling its statutory duties.[20]
In its briefing paper on the Health and Social Care Bill, the
Commission for Social Care and Inspection has echoed our view,
stating that:[21]
The new regulator should take a strong rights based
approach towards the people who use health and social care services.
The new Commission should place the rights of the people who use
services and their carers at the heart of its work and they should
have clear rights of access to it. We would want to ensure that
this approach is reflected throughout the legislation.
1.26 The Government's response to our recommendation,
which we set out in full below, was deeply disappointing:[22]
The Department of Health will not be specifying the
precise work programme of the new regulator, but will expect compliance
with the Human Rights Act to form an important element of its
work, as it has for the regulatory bodies it supersedes.
1.27 There are three problems with the Government's
response to this recommendation. Firstly, putting the human rights
of health and social care users at the heart of the work of the
Care Quality Commission is not equivalent to "specifying
the precise work programme" of the new regulator. Secondly,
compliance with the Human Rights Act is a legal requirement, not
simply something for the Government to "expect" to happen.
Moreover, our concern is with ensuring that human rights influence
the work of the new Commission across the board, and are not simply
seen as a matter for 'tick box' compliance. Finally, in our
Report we concluded that "the Healthcare Commission should
not view the Human Rights Act as 'one of a large number of sets
of regulations' to which it is subject" but instead "should
regard the framework created by the Act as over-arching and fundamental
to all its work".[23]
We regret that the Department of Health has failed to address
this point and has resorted to restating the current position,
whereby the Human Rights Act is seen as just another statute applicable
to public bodies, demanding compliance rather than wholesale culture
change.
1.28 We propose that the following new clause should
be added, and amendments made, to the Bill to ensure that the
Care Quality Commission adopts a human rights based approach to
its work.
Human rights framework for Commission
To insert the following clause
'The protection and promotion of human rights
shall be central to the performance of the functions of the Commission.'.
Clause 2, Page 2, Line 26, after second "the"
insert "rights and".
Clause 42, Page 21, Line 2, after "quality"
insert "including, without limitation, respect for the rights
of any person"
Clause 90, Page 45, Line 12, at end insert
'"rights" includes human rights
under the Human Rights Act 1998 (c. 42).'
Functions of the Commission: information about
human rights
1.29 We recommended that the Department of Health,
the inspectorates, health care policy-makers and providers of
health care services should ensure that accessible information
on human rights, and how they can apply in healthcare settings,
should be provided to patients, care home residents, relatives,
carers and advocates, and the public as a whole.[24]
We were particularly concerned to ensure that such information
is presented in a manner appropriate to older people and we have
a similar view in relation to adults with learning disabilities,
following our recent inquiry into this issue.
1.30 The Government suggested that this would be
an issue for the Care Quality Commission to monitor.[25]
We were also told that the Government was commissioning a guide
to the effects of the Human Rights Act on service users, entitled
Promoting Dignity Within the Law, "aimed at staff
working in health and social care, as well as service users themselves".[26]
We have not yet had an opportunity to review this publication
to assess whether it provides useful and appropriate information,
in accessible formats, for both staff and service users.
1.31 Without clear and accessible information about
how human rights relate to hospitals and care homes, service users
may not be in a position to challenge the way in which they are
treated or know how to go about seeking redress. Consequently,
we propose the following amendment to the Care Quality Commission's
functions to ensure that the provision of information about human
rights is taken into account by the Commission.
Clause 2, Page 2, Line 16, at end insert
'(da) the need to improve the range and quality
of information provided by health care and social care services
to users of those services about their rights;'
Functions of the Commission: complaints
1.32 We recommended that the new health and social
care inspectorate should be empowered to investigate individual
complaints, as the Healthcare Commission is currently able to
do.[27] The Government
resisted this recommendation, arguing that it was more appropriate
for the Parliamentary and Health Service Ombudsman or the Local
Government Ombudsman to investigate complaints than the Care Quality
Commission.[28] In their
briefings on the Health and Social Care Bill, Help the Aged and
Age Concern have pointed to what they consider to be shortcomings
with the Ombudsmens' procedures for handling complaints and have
proposed amendments which aim to provide for the Care Quality
Commission to investigate individual complaints.[29]
1.33 We wish to recommend two distinct changes to
the Health and Social Care Bill to deal with complaints. Firstly,
we remain of the view that the Care Quality Commission should
be capable of dealing with individual complaints, as we recommended
in our report on older people in healthcare. A new clause, and
an amendment, to achieve this is set out below:
Handling and consideration of complaints by
the Care Quality Commission
To move the following clause:
'(1) Where a complainant is not satisfied with
the conduct or result of an investigation by a service provider
regulated under Part 1, he may request the Care Quality Commission
to consider the complaint in accordance with regulations made
under this section.
(2) Before making regulations under this section,
the Secretary of State must consult such persons as the Secretary
of State considers appropriate.'.
Clause 150, Page 101, Line 37, at end insert
"(e) regulations under section [Handling
and consideration of complaints by the Care Quality Commission]".
1.34 In addition, we recommend that the new Commission
should have a role in overseeing the adequacy of complaints procedures
throughout the health and social care sectors. This would be in
tune with the aim expressed by the Government in its reply to
our Report on older people in healthcare that the process of making
a complaint should be "easier, more user-friendly, more open
and transparent, and much more responsive to people's needs".[30]
We propose the following amendment to ensure that this aim is
reflected in the factors influencing how the Commission exercises
its functions.
Clause 2, Page 2, Line 11, at end insert
"(ba) the extent to which complaints
about the provision of health and social care by members of the
public, in particular users of health and social care services,
are adequately dealt with by the bodies it regulates,".
Functions of the Commission: advocacy
1.35 In our Report on older people in healthcare,
we recommended that the Department of Health should provide sufficient
independent advocacy services to older people, with particular
priority being afforded to older people with mental health problems
or those who are unable to communicate effectively in English.
We suggested that such advocates should have an understanding
of human rights principles and the positive duties of service
providers towards older people.[31]
1.36 The Government said it shared our view of the
important role advocacy could play in the relationship between
older people and service providers as well as in safeguarding
and promoting the human rights of older people. It pointed to
enhanced funding in the Comprehensive Spending Review for the
provision of advocacy and information services and to statutory
arrangements in the Mental Capacity Act 2005 and the Mental Health
Act 2007.[32]
1.37 We were pleased to note that the Government
shares our view of the importance of advocacy for older people
in healthcare, as well as in other contexts. The important role
advocacy can play in supporting older people in healthcare would
be reinforced by a statutory reference to advocacy as one of the
factors the Care Quality Commission must take into account in
undertaking its work. We propose the following amendment to the
Health and Social Care Bill to achieve this aim.
Clause 2, Page 2, Line 11, at end insert
"(bb) the availability and adequacy of
advocacy services relating to the bodies it regulates,"
Standards of Health and Social Care
1.38 We recommended that the new health and social
care inspectorate should apply one set of standards for health
and social care in relation to issues engaging the human rights
of service users. In particular, we called for:
- care standards which expressly
require compliance with human rights by all hospitals and care
homes, and state that service users have the legal right to respect
for, and protection of, their human rights;
- all staff working in health care to receive targeted
and regular training in human rights principles and positive duties,
and how they apply to day-to-day work;
- better information on human rights and the duties
of service providers under the Human Rights Act, including avenues
for making complaints, to be available in an accessible form when
people are admitted to hospital or enter a care home;
- all hospitals and care homes to have a policy
requiring their staff to report abuse or suspected abuse, with
protection for whistle-blowing and confidentiality;
- the Delayed Discharge Regulations to be amended
to provide for greater flexibility in applying the time period
for discharge, in order to protect patients' rights under Article
8 ECHR (right to respect for private, family and home life).
1.39 The Government said that it expected human rights
to be "an important feature" in the registration requirements
for health care and social care providers and in the regulator's
criteria for assessing compliance with those requirements. There
would also be "appropriate requirements governing the reporting
of suspected abuse".[33]
The registration requirements for care providers are currently
the subject of consultation and will be brought into force by
means of secondary legislation. The Care Quality Commission "will
devise the detailed criteria to judge compliance with registration
requirements".[34]
1.40 We recommend the following amendments to the
Bill in this area.
1.41 Firstly, we propose that the Secretary of State
should be under an obligation to prepare and publish care standards,
rather than have discretion in this area as is presently suggested.
Clause 41, Page 20, Line 5, leave out "may"
and insert "shall".
1.42 Secondly, we recommend that such standards should
relate to health and social care in their entirety.[35]
Clause 41, Page 20, Line 6, leave out "NHS"
and insert "health care and social".
1.43 Thirdly, the Bill currently gives no indication
of the content of any standards to be published by the Secretary
of State. We propose the following new clause to provide an indicative
list of matters which must be covered by health and social care
standards.
Health and social care standards: content
To insert the following clause
'(1) Standards set by the Secretary of State
under section 41 shall
(a) expressly state that all persons for whom
health or social care services are provided are entitled to respect
for their rights and that service providers (registered in accordance
with Chapter 2) have a responsibility to respect such rights;
(b) require that service providers respect
the rights of persons for whom health or social care services
are provided;
(c) require that service providers provide
their staff, whether employed directly or indirectly, with appropriate
education and training in relation to respecting the rights of
service users;
(d) require service providers to specify and
publish the procedures for making a complaint by any person about
a regulated activity;
(e) require service providers to put in place
appropriate procedures for ensuring that any person who is aware
of any failure to respect any other person's rights in relation
to a regulated activity being conducted by that service provider
to report such a failure to a designated person;
(f) require service providers to ensure that,
where any person is being discharged from a health care service
to a social care service regulated under this Part, the rights
of such persons are fully respected; and
(g) require service providers to disseminate
the standards set under this Part which are applicable to them
to users of their services.
(2) The Secretary of State may prepare and publish
statements of standards in relation to the provision of health
care and social care dealing with matters other than those listed
in subsection (1).
(3) In this section, a "designated person"
is a person designated by a provider of health or social care
services to receive and resolve complaints. '.
QUALIFICATIONS OF HEALTH AND SOCIAL
CARE PROFESSIONALS
1.44 We recommended that a "basic understanding
of how the Human Rights Act requires the protection of basic principles
such as dignity, fairness, respect and equality be included in
qualifications, accreditation and re-licensing of health professionals".[36]
The Government replied that "the regulatory bodies responsible
for the basic education curricula and codes of professional ethics
should consider how best to ensure an understanding of the healthcare
professional's responsibilities in this area" but implicitly
rejected taking a statutory approach.[37]
1.45 One means of putting our recommendation into
effect would be to insert references to this issue into the relevant
sections and Schedules in Part 2 of the Health and Social Care
Bill, which relate to the new Office of the Health Professions
Adjudicator, the Council for Healthcare Regulatory Excellence
and the education and training of mental health professionals.
Our recommendation could also be usefully extended to social care
workers, under clause 114 and schedule 9. We set out our proposed
amendments below.
Clause 105, Page 51, Line 34, after "safety,"
insert "rights".
Clause 116, Page 63, Line 6, at end insert
'(1A) The appropriate Minister shall by regulations
make provision in relation to awareness of, and training in, human
rights in accordance with this section.'.
Clause 118, Page 63, Line 37, at end insert
'"rights" include human rights
under the Human Rights Act 1998;'.
Schedule 6, Page 130, Line 24, at end insert
'(3A) The OHPA shall have regard to the desirability
of improving the awareness of, and training in, human rights of
its members.'.
Schedule 9, Page 154, Line 10, at end insert
'(ea) awareness of, and training in,
human rights;'
1 HL Bill 16-EN, paragraphs 570-588. Back
2
Appendices 1 to 3. Back
3
Eighteenth Report, Session 2006-07, The Human Rights of Older
People in Healthcare, HL Paper 156-I, HC 378-I (hereafter
OPH Report). Back
4
Seventh Report, Session 2003-04, The Meaning of Public Authority
under the Human Rights Act, HL Paper 39, HC 382 and Ninth
Report, Session 2006-07, The Meaning of Public Authority under
the Human Rights Act, HL Paper 77, HC 410 (hereafter 06-07
MPA Report). Back
5
Section 6(3)(b). Back
6
06-07 MPA Report, paragraph 2. Back
7
YL v Birmingham City Council and others [2007] UKHL 27.
For the majority: Lord Scott of Foscote, Lord Mance and Lord Neuberger
of Abbotsbury; Dissenting: Lord Bingham of Cornhill and Baroness
Hale of Richmond. Back
8
06-07 MPA Report, paragraph 150. Back
9
PBC Deb, 15 Jan 2008, c200. Back
10
HC Deb, 15 Jun 2007, c1045. Back
11
Ibid, c1047. Back
12
HC Deb, 26 Nov 2007, c105; PBC Deb, 15 Jan 2008, c202; JCHR, Oral
Evidence, 26 Nov 2007, HC132-i, Q40; App 3, paragraphs 63-4, 69. Back
13
06-07 MPA Report, paragraph 139. Back
14
Ibid, paragraph142. Back
15
PBC Deb, 15 Jan 2008, c193 (amendment moved by Kelvin Hopkins
MP). Back
16
Age Concern, JUSTICE, Liberty, British Institute of Human Rights
and Help the Aged. Back
17
Paragraph 1.43. Back
18
Annexes 4 and 5. Back
19
Annex 6. Back
20
OPH Report, paragraphs 184 and 189. Back
21
HC Library Research Paper 07/81, Health and Social Care Bill,
23 Nov 2007. Back
22
First Report, Session 2007-08, Government Response to the Committee's
Eighteenth Report of Session 2006-07: The Human Rights of Older
People in Healthcare, HL Paper 5, HC 72, (hereafter OPH
Reply) p14. Back
23
OPH Report, paragraph 184. Back
24
OPH Reply, p21. Back
25
Ibid, p21. Back
26
Ibid, p15. Back
27
OPH Report, paragraph 258. Back
28
OPH Reply, pp18-19. Back
29
Both briefings were released in November 2007. Back
30
OPH Reply, p18. Back
31
OPH Report, paragraph 249. Back
32
OPH Reply, pp17-18. Back
33
OPH Reply, pp 12, 16-17. Back
34
Ibid, p17. Back
35
For definitions of health and social care see clause 5. Back
36
OPH Report, paragraph 226. Back
37
OPH Reply, p16. Back