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I hope that the Minister can tell us what the options will be for those whose care is privately funded, and whether the Government have had any rethinking on this question as a result of the Joint Committee’s reports and amendments. I beg to move.

Baroness Meacher: I speak to Amendments Nos. 50 and 58 and, on behalf of the noble Baroness, Lady Jones, who is unfortunately detained elsewhere, Amendments Nos. 58A and 53B.

Amendment No. 50 says that regulations may make provision not only about the handling of complaints

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but about the implementation of recommendations arising from complaints. Amendment No. 48 has a more limited scope, but would enable the CQC to issue a warning notice if an organisation failed to implement recommendations arising from complaints upheld by the Health Service Ombudsman. Amendment No. 58A of the noble Baroness, Lady Jones, extends this provision further to include the Local Government Ombudsman. Together, all these amendments ensure that the Care Quality Commission has a power to deal effectively with an organisation that fails to deal with complaints properly and to implement fully recommendations arising from those complaints. The implementation of recommendations is the absolutely crucial point, and where so many trusts fail.

I am embarrassed to confess to the Committee that complaints are the one area of work on which the East London NHS Foundation Trust, which I chair, failed to meet the standard of the Healthcare Commission last year. It is perhaps ironic for me to stand here and propose that the regulatory authorities should have greater powers to ensure that people like me do a little better in future, but I have no hesitation in doing so. I shall say a word or two about our experience because it illustrates the value of the Healthcare Commission’s system. I will then go on to indicate why it is nevertheless inadequate. We were not able to meet the standard because of the long-term sickness of a member of staff that year. This public embarrassment in a single year has led to a complete change and the reorganisation of my department to make absolutely sure that we have proper back-up so that our complaints are dealt with properly and on time in future. Although we had done well in the past, we were running a system that was at risk and that exposed us to failure in the event of long-term sickness. We were lucky, until last year, and we are not the only culprits.

The Healthcare Commission’s report on complaints, which was issued on 7 April 2008, concluded that trusts have some way to go before they effectively resolve the complaints they receive and learn from the issues patients raise. Why is that so if the Healthcare Commission’s system is adequate? It is clearly not adequate. I accept that only by giving complaints a higher profile and putting more pressure on requiring the trust to do the job well will we ensure that sufficient priority is given to this vital customer care area of work. The reality at the moment is that some trusts’ recommendations simply get lost in the system—I have to tell the Committee that I am familiar with that—and they are not fully implemented. The same problems arise again and again. Clearly, that is entirely unacceptable.

Why is this so terribly important? Complaints systems are the safety valve for the public when things go wrong. If the safety valve goes wrong, public confidence in the whole system is threatened. I am acutely aware of that because of my work heading the police complaints system for a while. I often faced the fury of families and communities when the complaints system, for which I was responsible, failed, we had long delays in our investigations or we came out with results that were not satisfactory to the family or the community. Facing that fury was one of

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the most challenging areas of work with which I have ever had to deal. The anger that people feel if the system has gone wrong and the complaints system fails on top of that is incredible.

In the health service, these things are rather hidden. The fury is hidden because people cannot express it anywhere. Yet it is there and it is dangerous. I shall give an example of how terrible this can be. This example comes from Rethink. A young man suffering from a serious mental illness was given Clozapine. As my noble friend Lady Murphy will be well aware, people using medication such as Clozapine must have regular blood tests because they are susceptible to diabetes. In this case, blood tests were not offered until the mother of the man intervened and made multiple requests to the trust to test her son. By the time the tests were done, the son had diabetes. I find that absolutely shocking and terrible, and I am sure that other noble Lords do too. When the Healthcare Commission investigated, it found that the Clozapine clinic had simply not been running. A year later, when the mother raised with the trust what had happened as a result of the Healthcare Commission’s investigation, the staff had no recollection of the complaint or of the recommendations. Nothing had happened. The Healthcare Commission’s system is not ensuring that complaints are properly dealt with and that recommendations are implemented. I put it to the Minister that that has to improve. I think I have said enough about that to make the point.

I raise two related issues. Help the Aged has expressed a fear that the proposed loss of the investigative powers of the Healthcare Commission will leave a gap. I would be grateful if the Minister could give us an assurance that that gap will be filled. It is very important.

Amendment No. 53B, tabled by the noble Baroness, Lady Jones, is supported by Help the Aged and argues that existing complaints procedures are inadequate, particularly for people who fund their own care. My noble friend Lady Stern has already raised that point. Such people have no access to an independent complaints system beyond that available from the provider. Those funded by the local authority, as my noble friend said, have access to the local authority complaints system. Older people are very fearful of complaining to their provider for obvious reasons—there can be very unpleasant retribution.

The Minister in the other place stated that the Government are considering options for self-funders, but he also suggested that self-funders could take their custom elsewhere. I find it shocking that anyone could suggest that a 90 year-old woman could up sticks and take her custom elsewhere. Perhaps the Minister might raise this matter with his colleague in the other place. It is utterly cynical and completely unacceptable. I find it hard to think of any reason not to adopt these amendments. I hope the Minister will agree.

Baroness Murphy: I support these amendments. In particular, I support the comments of my noble friend Lady Stern on the implementation of the Human

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Rights Act in relation to care homes and how that could possibly be helped by the Care Quality Commission. I am anxious that the Government should bring forward provisions to address that in relation to privately funded, but also publicly funded, complainants in care homes.

I have recently experienced a very elderly relative being evicted from a care home as a result of becoming too dependent and frail. She was shipped off to hospital with a fractured femur, which is very common. I have experienced that professionally a million times, as have many other doctors, I am sure. She was evicted with no notice at all and we were told, “She is now in hospital, so it is up to you to find somewhere else because she is just too bad for us to take back, even if she recovers”. At the end of the rehabilitation process for the fractured femur, we as a family are faced with trekking around trying to find an alternative placement.

That kind of eviction happens often. Since I have made this case known, many people have written to me about similar instances. There is nowhere to complain to. Of course, I have complained to the group of homes where this occurred, but there is absolutely no come-back at all; no right to retain your home; no right to have an appropriate assessment of services; no right to have things talked through at all; and nowhere to complain about the manner in which such things are done.

I turn to the amendment of my noble friend Lady Meacher on the need for a power to follow up the recommendations that result from investigations of complaints. My noble friends Lord Patel and Lady Meacher will be endlessly aware of complaints that have been investigated by the Mental Health Act Commission, when one has had to go back time and time again to the same place to say, “What have you done about it?”, and nothing happens. You almost have to sit on the doorstep of the medical director, the senior nurse or the chief executive and say, “I am not leaving your office until you have given me a plan of what you are going to do about this problem”. I applaud the fact that yet again there is an emphasis on local resolution, but the NHS has been spectacularly bad at dealing with matters locally and is perhaps even worse than local authorities, although I am not so sure about their complaints procedures. The responses to complaints—when as chairman of the strategic health authority you sign the letters that finally reach you because they are so dreadful—embarrass you, because the responses are transparently ghastly. You can only send them back so often for a rewrite before you agree to sign them.

We must give someone powers—I cannot see who else it could be except the Care Quality Commission—to be able to go in and ask, “Have you achieved this, this and this, which were recommended as a result of this complaint?”, to ensure that trusts and other health service and social service bodies are faced with the threat that at least Big Brother will breathe down their neck if they do not do it. The Care Quality Commission is Big Brother in this respect.



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6.15 pm

Lord Harris of Haringey: I, too, support the amendments. I think back to my time in this area when most people who complained were not seeking personal redress; they wanted to see the system improved. Yes, it would be nice to get a proper apology, but they were really looking for some undertaking or some feeling that the lessons had been learnt from something that had gone wrong in their particular case.

When you return to an issue after a number of years, it is always interesting to see whether things have developed. I was talking to a business contact whom I had not seen for a while. He said, “I have had this terrible problem. Have you heard about my teeth?”. It turned out that he had been given the wrong medication and goodness only knows what in hospital. What was now driving him was not that this appalling mistake had happened and that he had been incapacitated for a period, but the quality of the response that he had had. It was, like all those apologies that I remember from when I was involved in community health councils, classically of the nature, “We are so sorry that you have found it necessary to complain”. That was it; there was no indication of what was going to be done about the particular complaint.

When he pressed for a further response, it was that the person involved was no longer with the trust. That might indicate that action has been taken, but it might indicate that the person was an agency worker who was no longer providing agency services in that trust. He was looking for some statement that said that a procedure had been implemented that would prevent that error in prescribing from arising again. Whether or not that was a sensible thing to do, he would have liked that issue to be addressed.

What concerns me, and the reason why I support the amendments, is that it is necessary to build in a requirement to learn lessons and to implement them where recommendations have been made following some major shortcoming. This group of amendments is about that. I come back to the point, which has already been made, that if this is not monitored or seen as part of the remit of the Care Quality Commission, whose responsibility is it and whose responsibility will it be to ensure that these matters are picked up and dealt with? My concern is that it will not happen in the absence of that responsibility. If the assumption is that it will be dealt with by someone else, no doubt by the Department of Health or whomever else it might be, why is that not a relevant factor for the Care Quality Commission in looking at the way in which these issues are dealt with by the bodies that it regulates? That is an essential part of assessing whether the management is good and learns from the things that go wrong.

Lord Campbell-Savours: I want to make it clear at the outset that I am not referring to the home, which is a BUPA home, where my mother has been placed by me. I want to make it absolutely clear that my comments have no relevance whatever to the circumstances in which my mother now finds herself.

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I am sure that noble Lords will understand why I am saying that. My comments are based on conversations that I have had with others.

I shall concentrate my remarks on the reference made by the noble Baroness, Lady Stern, to self-funders.

The financial bottom line in London is that you will get nothing for under £1,000 a week, which is £50,000 a year. If you want something reasonable, it will cost you £1,200 a week, which is £60,000 a year, or £100,000 a year of taxable income to fund it. We are talking about a very expensive service, and people who pay that kind of money for their care—that includes my mother, to whom I refer only because there are others like her in other institutions—demand certain standards. At the moment, self-funders are in an impossible position in nursing homes. They can say and do nothing, and have to put up with it, unless they or a relative are prepared to place themselves on the line and take a risk that there will be no retribution inside the home. As I say, this has nothing to do with my mother’s situation. I must keep emphasising that because I do not want my comments to be misrepresented in any way.

I thought long and hard about the solution. I shall quote selectively from the amendment of the noble Baroness, Lady Stern, because the following words are the nub of the amendment so far as I am concerned. They are:

Those are the key words. There is a way of dealing with this. As I say, I am an engineer and a trader by background and not a professional in this area, so I look at this more as part of the client group. Many of the complaints are not hugely important to us, but they are to the people who are in these institutions. They can be very small. They can be about the variety of the diet; the arrangements for cleaning people; the people, such as the nurses, who have been allocated to them; at what time they are required to get out of bed in the morning and be put to bed in the evening; at what time the television is turned off; and whether they are allowed to circulate within the home. There are all kinds of minor things that cannot necessarily be dealt with in a conversation with the home manager, because the information can somehow feed its way down the line and the client—that is to say, the resident—may well feel that they will somehow suffer as a result.

There is a need for someone between the client, the home management and the nursing staff who is utterly independent and can be relied on to receive information and deal with complaints effectively by raising them directly with the home management without identifying the person who has made the complaint or the relatives who represent that person. I do not know what the position is in homes that are in essence funded by local authorities and where the entire intake might well consist of people who are funded publicly; I am talking about self-funders. We can find these people, and one function of the commission should be to establish a structure that can identify people in communities who are in a position

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to act in this independent role. They do not deal with major complaints; they deal with the minor things that people as residents find impossible to raise in the home. Many such issues arise.

I talked to a resident of a home in the north of England that is very near my former constituency. That person had a catalogue of complaints that were not hugely important, but it was quite clear that they were causing them immense frustration and concern. Even I felt it difficult to raise the issue with the management in the home for fear that they might communicate what I had said to the nursing staff. It might be fed back to a member of the nursing staff and to a particular resident to whom I had been seen talking. So you are in an utterly impossible position.

Therefore, all I am asking for is a structure which allows for an independent person. Perhaps it could be linked to the LINks, to which my noble friend referred when speaking to his amendment. I do not know whether that is the answer, but I simply would ask that it is considered. At present, the position is utterly impossible for people who are paying out annually a very large amount of money.

Baroness Greengross: I support these amendments and should like to make two points. On self-funders, the Minister with responsibility for care in another place has said publicly on many occasions that this is the total unintended consequence. It was never intended that self-funders should be treated in this way and not be given the help and advice that they need. I very much hope that the Government will do something about that very soon—certainly, in the Green Paper which will shortly be brought forward. At the moment, it is an absolute disaster for self-funders. We all know that it is very difficult to have a home worth £21,000 or less in this country. Therefore, to be a self-funder you do not have to be particularly wealthy.

As regards complaints and human rights, one of the obvious places to go is the Equality and Human Rights Commission, on which I am a commissioner. But there are severe limitations to what the commission can do on human rights. It is absolutely essential that the Care Quality Commission takes up these cases of complaint. The EHRC can comment, hold inquiries and be an advocate on issues such as dealing with policies, but individual cases cannot be taken up in same way as equality cases. Therefore, the CQC must take on this role very thoroughly, with gusto, and really sort out these problems. As the noble Lord, Lord Campbell-Savours, has said, some of these issues may be minor but, in many cases, they are major issues, which affect people’s lives and, sometimes, cost them their lives.

Baroness Masham of Ilton: I, too, support these amendments. The complaints procedure has been talked about for years with no satisfactory solution. Surely, with all the expertise that there is in your Lordships' House, now is the time to get this right.

Baroness Barker: I should like to make two points which I hope the Minister might pick up in his response. First, the Government have indicated that

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they want to introduce an independent element into complaints procedures for people who fund their own care. I would welcome further details of what that will mean. Can the Minister clarify whether the 40,000 people or their families who partly self-fund through top-up payments are included in the definition of self-funders? That is important.

Secondly, when the current investigatory powers are removed from the Healthcare Commission, does the Minister believe that the Health Service Ombudsman will be able to pick up the anticipated volume of complaints? If so, what is the basis of this understanding?

Finally, the CQC will be a joint health and social care regulatory body. Complaints in the two systems are handled very differently. I cannot be the only Member of this Committee who has had reason to make a complaint within the NHS on behalf of someone who was not a relative but with whom I was concerned, only to have patient confidentiality thrown straight back at me as a reason for not doing anything at all. I would have thought that one of the big things that the Care Quality Commission would have to do early on would be to establish the underlying principles by which one regulates two currently completely different complaints systems. It is not unusual for those who are most active in raising complaints in social care not to be recipients of the services, but they know what goes on and they have a heavy interest in them. I would welcome the Minister addressing those matters in his response.

6.30 pm

Lord Darzi of Denham: This group of amendments focuses on the role of the new commission in ensuring that providers handle complaints effectively. I applaud the intention behind these amendments, which is to ensure that providers learn from complaints, because that is exactly what we are seeking to achieve. I welcome the opportunity to reinforce that.

Amendment No. 18, tabled on behalf of the Joint Committee on Human Rights, would require the commission to have regard to the level of satisfaction with complaints handling. The noble Baroness, Lady Meacher, and my noble friend Lady Jones have taken a different approach. Amendments Nos. 50 and 53B build on existing provisions in Clause 16 to make it explicit that registration requirements could cover the steps which registered providers should take to act on any recommendations resulting from complaints. Amendment No. 53B also addresses a different point, specifying that registration requirements could, in particular, cover the handling of complaints made by those service users who do not currently have recourse to a second-stage complaints process. Finally, Amendments Nos. 58 and 58A would enable the commission to issue warning notices where providers are failing to implement recommendations of the Health Service Ombudsman and Local Government Ombudsman.

I hope Members of the Committee would all agree that the onus must be on care providers, wherever possible, to resolve complaints themselves. I reassure the Committee that the Bill provides mechanisms to

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help achieve that. Clause 16 enables the Secretary of State for Health to set, in regulations, the essential registration requirements that providers will need to meet in order to become, and remain, registered with the Care Quality Commission. Clause 16 already enables regulations to make provision for the handling of complaints and disputes.


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