I beg to move amendment 49, in clause 88, page 79, line 18, leave out subsection (4).

This amendment is one of a number intended, collectively, to restore the powers of the Care Quality Commission to review or investigate local authority social care provision or commissioning without first securing, singular or joint, Ministerial approval.

With this it will be convenient to discuss the following:

Amendment 126, in clause 89, page 80, line 20, at end insert—

‘(2A) The Commission must, in respect of such English local authorities as may be prescribed—

(a) conduct reviews of the provision of such adult social services provided or commissioned by the authorities as may be prescribed;

(b) assess the performance of the authorities following each such review; and

(c) publish a report of its assessment.

(2B) Regulations under subsection (3) may prescribe—

(a) all adult social services or adult social services of a particular description; and

(b) all local authorities or particular local authorities.’.

Amendment 127, in clause 89, page 80, line 21, after ‘provider’, insert—

‘other than the provision of adult social services’.

Amendment 128, in clause 89, page 80, line 23, at end add—

‘(3A) The assessment of the performance of a provider of adult social services, in respect of that provision, is to be by reference to a quality standards framework, and indicators therein, to be developed jointly by the English local authorities and the Commission under arrangements to be established by regulations under this Act.’.

Government amendment 154.

Amendment 51, in clause 89, page 81, line 19, leave out ‘(5) Omit subsection (1A) of that section.’.

This amendment is one of a number intended, collectively, to restore the powers of the Care Quality Commission to review or investigate local authority social care provision or commissioning without first securing, singular or joint, Ministerial approval.

Amendment 50, in clause 89, page 81, leave out lines 16 to 18.

This amendment is one of a number intended, collectively, to restore the powers of the Care Quality Commission to review or investigate local authority social care provision or commissioning without first securing, singular or joint, Ministerial approval.

The amendments relate to issues that have come up throughout the Bill’s consideration, in particular when we debated part 1. They pertain to the quality of the commissioning and how the public can be satisfied that it is doing what it is intended to do. They would ensure that people received good quality service and outcomes, in terms of the care delivered, the support provided and the arrangements made to secure their well-being under clause 1.

In the care and support White Paper, a number of organisations outside this House raised concerns about the Government’s view of the CQC’s role in ensuring that the quality of commissioning is maintained and, where it is poor, improved. There is a problem of fly-by-night, 15-minute contracting, where the focus is on task and finish, and on watching the clock because there is not enough time to do the job adequately. That has been a characteristic of poor commissioning practice for a long time. We in this place should make it absolutely clear that that is unacceptable and empower the Care Quality Commission to pursue commissioners who think that such practices are acceptable.

The Joint Committee raised concerns about that issue, which the Government took on board. They tabled amendments in the House of Lords to clarify that commissioners should take well-being into account, which was a helpful step in the right direction. It is therefore curious that during the consideration of the Bill in the Lords, the Government removed the backstop powers to undertake regular inspections. I think they did that because they took the view that the sector-led improvement processes that have been put in place are sufficient and that periodic reviews against a rating system are, to some extent, a tick-box approach that creates reaction and response by rote. They took the view that we need the inspectorate to genuinely engage with the way in which commissioning really works, which does not require a regular inspection of everyone, but targeted inspections of the commissioners who are clearly not doing the job well. I tabled the amendments because we need to ensure that the CQC has the power and independence of action to make decisions on the basis of evidence that it gathers from inspections of providers that the problems in a particular set of providers are caused by bad commissioning practice or poor procurement arrangements.

I am pleased that the right hon. Gentleman tabled the amendments. I share his concerns about the changes made to the Bill in the other place, because I have personal experience of the fact that we need to ensure that commissioners are held to account. I agree that limiting the CQC’s capacity to intervene to circumstances where the Secretary of State gives permission does not give it the necessary rigour. I share the right hon. Gentleman’s concern that the improvements in the system will not be enough.

I am grateful to the hon. Lady. She has been clear about her concerns throughout the Committee, and I welcome her support for this group of amendments.

Let me quickly talk about what the amendments would do. Amendment 49 would restore the CQC’s ability to investigate social care provision from the perspective of the local authority without the agreement  of the Secretary of State. Amendment 50 would restore the Care Quality Commission’s powers to instigate special reviews of local authority practices with regard to social care provision without the agreement of the Secretary of State, which would place it on a par with the powers that apply to health provision. Amendment 51 would restore the Care Quality Commission’s powers to conduct special reviews of local authority practices in regard to social care when it considers there to be

“a risk to the health, safety or welfare of persons receiving health or social care”,

without seeking the permission of the Secretary of State. The amendments would ensure that the CQC has the right range of powers to deal with flaws in commissioning.

Will the right hon. Gentleman assure me and others that the amendment will mean that the families who report their concerns will have them considered by the body responsible? I am always conscious that whenever people come to deliver care to elderly relatives in their homes, there are things they neglect to do. One example would be the making of beds for someone with problems with both hands who cannot do so themselves. There are wee, small things that families can see, but others cannot. Will those concerns be considered?

This group of amendments does not speak directly to that issue, but the hon. Gentleman is absolutely right to question the extent to which the concerns—not just of family members, but of whistle- blowing members of staff—are taken into account and acted upon by the Care Quality Commission. The CQC was rocked to its foundations by Winterbourne View and the lack of focus on whistleblowing and so on. Subsequent to Winterbourne View, the CQC established a much bigger team in its offices in Newcastle to enable it to be much better and more sensitive to calls of that sort. I hope that is the case, although I look forward to the Minister’s reassurance—it is him we want to reassure us, not me.

This debate gives me the opportunity to pay tribute to Leonard Cheshire Disability, the charity that has been drawing attention to this issue. It conducted the survey that found that 60% of local authorities commission flying visits of 15 minutes or less and that the proportion of such visits had risen by 15% over the last five years, so there is an unacceptable trend. I hope the Minister can say something about that. I know that both the Minister and the chief executive of the Care Quality Commission are concerned about this, because they have made clear on the record their desire to challenge such practices.

Finally, I put it to the Minister that at the very least we need the Care Quality Commission to conduct a themed inspection of sector-led improvement, to satisfy ourselves that sector-led improvement is working. I say that as the former Minister who took the decision to put resources behind the establishment of sector-led improvement. If I were a Minister now, I would want to be satisfied that that was working and I would want the public to be satisfied. A themed inspection would be a good way to establish whether the programme was working well and, where it worked well, to ensure that that good practice was transferred to places where it  was working less well. That is what a good themed inspection should do. I also hope that the Minister can take this opportunity to reassure the Committee and the many organisations in the Care and Support Alliance and others that the Government want the CQC to play a role in this area and that he will set out how that role is to be fulfilled.

My amendments are in a similar vein to those I tabled to clause 27. Their purpose is to strengthen safeguarding, based on my personal and practical experience. Amendment 126 would reinsert subsections of the Bill which were unfortunately removed on Report in the other place. Those subsections required the Care Quality Commission to review and assess local authorities and their provision of adult social care.

A number of peers in the other place expressed their disappointment at the removal of these subsections, as did charities such as Leonard Cheshire Disability, as they believed that their removal weakened the CQC’s ability to challenge poor commissioning and delivery of care. As was rightly pointed out at the time, this should be an essential function of the CQC. I am concerned that, without regular monitoring by the CQC, more and more examples of inadequate care, neglect and abuse will go undetected.

The current culture in adult social care is one of sector-led improvement, with CQC oversight having been played down since 2010, when the Government announced the cessation of annual performance assessments. What that means in practice is that the CQC no longer inspects local authorities’ commissioning practices, even though the legislation remains in place for it to do so.

The last annual performance assessment process undertaken in my local authority was in 2009. For four years, we have operated under sector-led improvement, a model in which local authorities on a regional basis voluntarily subject themselves to peer reviews to assess each other and work supportively and collaboratively. Although that approach may have some advantages, accountability is not one of them. The fact is that local authorities feel vulnerable, which has fostered collusion. If a local authority is alerted to poor practice in another local authority with which it has been working closely and collaboratively, it is highly unlikely to expose that poor practice. Local authorities are more likely to give each other leniency when it comes to making improvements—leniency that the CQC would not have given them—and such leniency may lead to harm. I would be grateful if the Minister would inform me how many local authorities have been subject to a peer review since the change was announced.

Another negative result of sector-led improvement was highlighted only last year by the chief executive of the CQC. Although he acknowledged that sharing and learning can help to improve a service, he queried how open local authorities that were failing, or on the cusp of failing, would be to volunteering themselves for review. Either way, I believe that sector-led improvement is fraught with problems. Because the CQC has not been allowed to inspect and assess local authorities and  their commissioning practices, an unaccountable sector has emerged in which failure is swept under the rug and whistleblowers feel unable to come forward.

My hon. Friend is making a powerful speech, because she has such recent experience of the matter. Does she agree that when it comes to the care and protection of vulnerable people, any delays in dealing with a situation are of concern, and that governance and accountability are fundamental in reassuring families and other carers that vulnerable people will be properly looked after?

I agree entirely with my hon. Friend. I have experienced situations in which there has been delay, which has caused harm and distress not only to those receiving care, but to their families. In addition, 15-minute visits for personal care are becoming the norm, and poor treatment is going unchecked. Ultimately, those who receive care are the ones who suffer. I am puzzled about why the Government saw fit to remove those subsections of the Bill, which they appeared to support when they introduced them. In April last year, the Minister of State in the Department of Health suggested that he supported the reintroduction of CQC monitoring for councils’ commissioning practices. I would be grateful if the Minister could explain in his response what has changed the Government’s thinking.

The Bill now allows the CQC to conduct reviews only under special circumstances with the permission of the Secretary of State. Although that power is welcome in cases where widespread and systematic failure has been identified, it means that low-level or isolated cases of failure are unlikely to be picked up on. Without the prospect of routine inspection, local authorities may well become complacent and allow standards to fall.

Amendments 127 and 128 are essentially probing amendments that relate to the monitoring of care homes. As we know, the CQC has only so much capacity to inspect services. That has been seen with cases such as Winterbourne View, where abuse went undetected. When CQC inspections take place, they are often desktop exercises, because the CQC does not have the capacity to conduct thorough and in-depth inspections. The amendments would require local authorities to develop a robust and thorough quality standards framework for monitoring the care homes in their areas. In my borough of South Tyneside, I implemented such a model and it drastically improved the quality of care in our homes. The care home services commissioned were monitored by an in-house quality contracts control team, which regularly checked that providers were meeting their obligations, inclusive of service user feedback. Our model ensured that care homes were subject to much closer scrutiny than had previously been the case. The CQC cannot be expected to carry out comprehensive annual inspections of all care homes across the country, and local authorities need to assume some responsibility.

The hon. Lady says she has concerns about the Care Quality Commission not having the capacity to undertake proper inspection of providers, yet at the same time she argues the case for an enormous amount of extra work for the Care Quality Commission  in undertaking periodic continuous reviews of local authorities. I do not understand how both can be right. Surely the best thing is to ensure that the Care Quality Commission has time to focus on rigorous inspections of providers.

I am explaining that the Care Quality Commission can do reviews of local authority care homes but cannot do in-depth reviews. The model I propose is one we have used in my local authority and which gave an extra layer on top of the Care Quality Commission.

I recognise that there may be a concern about bias, but the CQC oversight outlined in amendment 126 would create a further layer of accountability which would motivate local authorities to be appropriately rigorous in their checks and tackle internal failings. It is of course in a local authority’s own interest to ensure that the services they commission are good value for money and to avoid expensive and reputationally damaging safeguarding investigations. This in itself should be a powerful motivator for authorities to deal with inadequate services, but in the event that this does not happen, the threat of CQC inspection provides a further check.

Our model only covered those we commissioned with, but that was because we commissioned with every care home in the area. The quality monitoring was going to be rolled out to learning disability, mental health and physical disability residential homes as well as domiciliary care. There is no reason why local authorities cannot provide this monitoring for all homes in their area regardless of commissioning. It would be worth their investment if safeguarding alerts were minimised and scandals avoided. This structure has proved very successful in my local authority, where in the past we experienced safeguarding scandals such as the one at St Michael’s View care home.

The hon. Lady gave a detailed example of how this has been working in her constituency. Will she give us an idea of the costs involved? Obviously, any extra system comes with additional burdens and costs.

I do not know the exact cost because different authorities have copied this model, taken it on and used existing teams or existing contract monitoring teams. It varies from area to area so I would not like to give a cost.

Although I understand that we have to look at the cost issue, I understand from my hon. Friend’s explanation that being proactive in ensuring good care stops the process of things getting worse and scandals occurring. In my experience, when something that has gone wrong is investigated it takes an enormous time. It has to be done and it takes away from having that work done up front. I am not saying that there might not be an additional cost, but I think that this is both the right thing to do and likely to have cost savings too.

My hon. Friend’s intervention leads nicely on to what I was going to explain. If this model had been in place in one of our care homes where  16 residents died, those deaths could have been avoided. Whatever the cost of that safeguarding investigation, it is surely in a local authority’s best interest to have some checks and safeguards in place. As I said, this has dramatically improved care services in my constituency. I believe that this needs to be taken forward, as do other local authorities that have developed the model and report its benefits. The problem is that the implementation is piecemeal and it depends on which area of the country people are in. I hope that the Minister will agree that the model is worthy of some consideration and debate.

In my authority, people died from horrendous and sustained abuse before the service was overhauled. I do not want other authorities to wait until then to do something. I do not want anyone to have to suffer in the way those 16 residents did. I know that the Minister cares deeply about safeguarding and I welcome the steps taken thus far in the Bill, but, for me, it simply does not go far enough. I know that the Government and the Minister do not want to be too prescriptive, but we owe it to all those who have suffered or are suffering harm to make the system as foolproof as possible. I would welcome the Minister’s comments and views on the amendments.

Given that the Opposition’s amendments seek to achieve the same ends as those tabled by the right hon. Member for Sutton and Cheam, members of the Committee will not be surprised to hear that I agree with a substantial amount of what he has had to say on the matter.

To ensure that no detail is left out, I will speak about the clause generally—the principles behind it—and I assure the Committee, and indeed the Government, of the Opposition’s support before speaking about each individual amendment. I find that, where legislative scrutiny is concerned, it is always better to err on the side of thoroughness. I am sure members of the Committee will appreciate that, given today’s schedule and the groupings on the amendment paper.

A strong effective regulator is as essential in the health care system as it is in any other sector. Only through thorough and effective monitoring and enforcement can patients have confidence in the services they receive. That is why, in the Health and Social Care Act 2008, the Labour Government legislated for the formation of the Care Quality Commission, which was brought into being in the year after the first ever independent regulation in the national health service.

Under section 3 of the Health and Social Care Act, the main function of the CQC is,

“to protect and promote the health, safety and welfare of people who use health and social care services.”

That aim that should underpin everything that we all aspire to achieve in Committee. I am sure that the principle behind ensuring the regulator’s independence receives the Committee’s full support. However, there are anomalies in the Bill and obvious omissions, on which the Opposition seek clarification. The amendments would further ensure the independence of the CQC, as well as go some way towards improving health and social care provision. There are glaring examples in clause 88, which some of the amendments seek to amend, and there are further examples in clause 89 that we will get on to later.

On amendment 49, the Opposition clearly share the concern of the right hon. Member for Sutton and Cheam regarding the place that aspects of the clause would leave the Care Quality Commission in with regard to the inspection of local authority provision for social care. It cannot be right for the Government to introduce a Bill that they claim will improve integration between health and social care services and strengthen the independence of the CQC, while legislating that the health regulator cannot review or investigate local authority social care provision or commissioning without first securing ministerial approval.

I want to be absolutely clear that, when the Care Quality Commission wants to inspect local authority provision of social care where it is a registered activity, there is absolutely no need for Secretary of State approval. It can inspect a local authority provided service just as it can inspect any other service. Perhaps the hon. Gentleman misunderstands the provision, but there is no need for such approval when inspecting local authority provision.

I am grateful for that useful clarification, but I am afraid that I share the view of the right hon. Member for Sutton and Cheam that the omissions in the clause move in the opposite direction to the stated aims in clause 1 and part 1. Such a course of legislative action makes integrated commissioning harder and weakens the principle of regulatory independence. I hope that, when the Minister responds, he can give further assurances that that will be rectified.

Amendments 126 and 127 would take the same remedial action in respect of the counter-intuitive prescription that is apparent in the clause as it stands. Amendment 128 would go a long way towards improving the inspection process for local authority social care provision. It would ensure that local authorities and the Care Quality Commission could work in partnership to bring forward a quality standards framework and the indicators that that would be judged by. The fact that those would be developed through strong communication would ensure a much higher chance of universal support and more committed buy-in for the system.

Will the Minister explain how the Bill encourages strong communication? Why does he believe that the Care Quality Commission’s needing to get ministerial approval to inspect local authority provision will help achieve the aim of my hon. Friend the Member for South Shields, notwithstanding his previous clarification? The idea that the Care Quality Commission is becoming independent in how it assesses, reviews and rates hospitals does not chime with the shackle placed on it with regard to local authority provision of social care. The Care Quality Commission must be free to inspect what it deems right to inspect. If it decides that it needs to review social care provision under a local authority, the Secretary of State or other Ministers should not have a legal right to stop them. If that is the intention of this part of the Bill, will the Minister explain why?

I hope that the right hon. Member for Sutton and Cheam will test the will of Committee—I have tried this tactic several times—because it is clear that he has cross-party support for his position. However, my main  hope is that the Minister will provide robust reassurances that the clause will not inadvertently impede the actions of the CQC or its ability to inspect what it needs to inspect, where it needs to inspect, and to determine its reasons for inspecting.

I want to start by addressing a comment made by the hon. Member for South Shields. She said that her fear was that there would be “more examples of poor care” going undetected. If that was the case, it would obviously be of enormous concern. However, the whole purpose of what the Government are doing is to make that much less likely to happen, by introducing much more robust inspections of providers—whether in social or health care—with teams of inspectors who have expertise rather than generalists. That is a massively important reform, including the introduction of a chief inspector of social care and ratings of providers. I therefore think that the risk of poor care going undetected diminishes rather than increases as a result of the steps that the Government are taking.

Earlier, we talked about the importance of developing a culture of improving quality. Surely my hon. Friend the Member for South Shields is suggesting a parallel measure to the internal clinical audit processes that we already have in health. We cannot rely on external inspections. Inspection has to be seen as a requirement and part of the culture-changing process that we want in health and social care organisations.

I completely agree with that. We are doing nothing to stop that. It should absolutely be the culture that there is a sense of constant, continuous internal improvement. I encourage all providers of care to engage in that. The risk is that, if they do not, they will end up with a poor rating and lose customers if they are private or local authority providers. The whole design of the regime is to provide incentives to drive up standards, contrary to the suggestion feared by the hon. Member for South Shields.

The amendments in this group are about the way in which the Care Quality Commission regulates and reviews adult social care. The three amendments tabled by my right hon. Friend the Member for Sutton and Cheam seek to remove the requirement that the CQC seek the approval of the Secretary of State before carrying out a review of local authority commissioning of adult social services. Amendment 126, which the Opposition tabled, has a similar end point in seeking to establish the CQC’s power to carry out periodic performance assessments of local authority commissioning of adult social services. Amendments 127 and 128 would require the Care Quality Commission to develop its methodology for performance assessment of adult social services jointly with local authorities.

I will explain our approach in the Bill to CQC reviews of health and adult social care. The thinking behind several amendments is that the quality of commissioning can and does impact on the quality of care. I do not take issue with that. I agree with the points made by Opposition Members and my right hon. Friend the Member for Sutton and Cheam. I have frequently spoken about the importance of improving the quality of commissioning.

That is why, as my right hon. Friend said, we have amended the Bill to ensure that, when local authorities undertake commissioning, they have to consider the well-being of the individuals who will receive care. It is important that commissioning can be reviewed by the CQC, but I want the CQC’s main focus to be on the quality of care provided to patients and service users. If we think about it, that must be the most important thing. Let us focus first on the care that individuals receive, and ensure that that is of the highest possible standard.

I am slightly puzzled by that. Surely the point of commissioning is that it specifies what should be provided, but what if the specification is not correct? I agree that monitoring day-to-day interactions is important but it is not the whole story. Is the Minister not missing a large chunk out?

I do not think that I am missing a large chunk. I will try to explain my argument as I develop the theme. While I have the chance, I omitted to say at the start of my contribution that I join hon. Members in congratulating the hon. Member for Sheffield, Heeley on all that she has achieved while an MP. There is life after this place, as she is about to discover. I wish her all the best. It has been a pleasure to work with her on this Committee and elsewhere. She can be very proud of what she has achieved in this place.

The Bill restricts the duty to carry out performance assessments to providers of regulated activities. The Government made changes to that effect in the other place. The amendment I have tabled today is consequential on those changes. It is minor and technical and will remove a single remaining reference to local authorities from what will become new section 46 of the Health and Social Care Act 2008.

For reviews of providers, the CQC will not be under any obligation to seek the approval of Ministers. I repeat the point I made to the shadow Minister: when local authorities provide a service, there is no need to seek the authority of Ministers. Following consultation with key stakeholders, it will develop the method of performance assessment under clause 89 as it sees fit. While local authorities are, of course, key stakeholders that I am sure the CQC will consult in developing its assessment model, I am clear that responsibility for the development of the model has to be with the CQC. As we have sought to reinforce, it is an independent body with responsibility for undertaking inspections.

It will also want to consider other organisations with a keen interest, such as providers themselves and the Association of Directors of Adult Social Services and Care England. It would not be appropriate to require the CQC to develop its performance assessment model jointly with local authorities, as amendments 127 and 128 would do, when the CQC alone is ultimately responsible for that system.

Alongside restricting performance assessments to providers, we are making an important further change to make it clear that the CQC, importantly, can carry out special reviews of commissioning in both health and adult social care. Under the changes we are making, it will have the power to conduct special reviews of  commissioning by local authorities, clinical commissioning groups—that is really important—and NHS England, in exceptional circumstances. It will do so with the approval of the Secretary of State when there is evidence that commissioning practice is resulting in poor care for service users. That deals with the point made by the hon. Member for Sheffield, Heeley. When there is a link that poor commissioning leads to poor care is when the inspection of the commissioning process becomes so important.

It is helpful that the intention that the CQC can do this has been set out so clearly. Given that some of our earlier discussions have been about the ability to respond quickly, and that there are so many welcome steps in the Bill to grant more independence of action to the CQC, will my hon. Friend explain why it still seems to be necessary for the commission to get approval from a Minister before conducting its inspections?

I will come to that in due course.

The point is the pressure on the CQC. We expect a lot from the CQC, as the hon. Member for Leicester West has said. The CQC will be under pressure to achieve its objectives, so it makes a lot of sense to focus its activities on what is most important, which is surely the provision of care. Its central focus should surely be the provision of care, but my point is about when it is clear that the commissioning of care could be leading to poor care by providers.

That will not always be the case. There may be good commissioning in some areas and just very poor provision, in which case the sole focus should be on the provision. For example, my right hon. Friend the Member for Sutton and Cheam made the point that too often commissioning has been carried out on a time basis, rather than being commissioning for quality. I know that he recently visited Wiltshire to see how commissioners can change the approach on commissioning by providing incentives to providers to drive up the quality of care and to focus on outcomes for those being cared for. The whole focus of what we wish to do is to shift commissioning in that direction. However, if local authorities stubbornly refuse to shift to that sort of commissioning and focus on only commissioning on a time basis, which results in short visits and poor employment conditions for workers, with the result of all that being poor care, the focus should absolutely be on the commissioning of care. In those cases, we have the power to require the Care Quality Commission to do the inspection.

That is absolutely the point at which the Care Quality Commission should take the action that the Minister has just described. The only question that remains for me is why that cannot be made clear through guidance to the CQC, rather than requiring the CQC to make a submission to the Department before the Minister says yes or no. I do not understand why that process is needed when, in a sense, it is possible through guidance to give CQC the necessary scope to exercise its discretion and conduct such an inquiry.

This comes back to the point about the CQC’s absolute focus being on driving up standards of care and on the provision of care. If it had the  authority to pursue commissioning without any other requirement or condition attached, it would be constantly under pressure to widen its scope, which might diffuse the effectiveness of its work.

It is in all our interests, in times of acute financial constraints, that we try to focus the work of the Care Quality Commission on where that is most important, and to look at commissioning only when there is clear evidence of failure. As we have all been saying, one could carry out the tick-box exercise of constantly going back to local authorities that may be performing very well, but what on earth would be the point of that? We would be heating the atmosphere, incurring cost to the local authority and taking money away from care provision. That would be crazy. Let us focus on a more targeted approach in which we undertake the inspection of commissioning when there is clear evidence of a significant problem. I hope that I have reassured the Committee.

I am after a bit of clarification. If monitoring commissioning is not standard in the first place, how will we know that a special review is needed? Who will spark that and say, “Okay, let’s have a special review,” if nobody is monitoring in the first place? I am a bit confused.

If we think about this, it is actually quite clear. Let us say that the Care Quality Commission is undertaking inspections of domiciliary care providers in South Shields and it becomes apparent that all its domiciliary care is being undertaken through very short 15-minute visits, and that there is insufficient attention to the care of the individuals and no focus on their well-being, contrary to the requirements of the Bill. It thus becomes clear that there is a problem that goes beyond the individual provider and seems systemic in that local area. The CQC would then have clear evidence of a potential failure of commissioning. When those concerns were raised in discussion between the Care Quality Commission and Government—concerns about commissioning failures may emerge in other ways as well—there would be an opportunity to go in and undertake an inspection.

While I am responding to the hon. Lady, I also want to address her points about the work of local authorities to reinforce CQC inspections. I am absolutely sure that in the work that she did in her local authority, her objective was to provide more reassurance about the quality of care but, ultimately, I suspect that we all want a single inspector to be undertaking the job effectively. We must be concerned—providers often raise this concern—about repeat visits by the Care Quality Commission and local authorities, with a duplication of inspection by two different bodies. The more close collaboration we can have between local authorities and the Care Quality Commission to ensure that there is a single inspection process in which everyone has confidence, the better. Ultimately, we want to use no more resource on inspection than is necessary so that available resources are used to provide great care.

I understand that the intention is to reduce the need for the inspection of commissioning when everything seems okay, but why it is necessary for  the Care Quality Commission to speak to the Government about that and to get the approval of the Secretary of State? Secondly—I have no doubt that my hon. Friend the Member for South Shields will be able to explain this more clearly—I disagree with the idea about a single point for inspection. Inspection takes place after the fact. Surely building on work done locally is more likely to achieve good-quality care than just waiting for somebody to come along and check things.

I fully understand that if a local authority is commissioning and paying for care in local care homes or from domiciliary care providers, it will want to assure itself that it is spending money appropriately and that the individuals are receiving good-quality care. I am just pleading for much closer co-ordination and collaboration between local authorities and the CQC so that they do not duplicate their work. It really frustrates providers when they are subject to endless inspections that cover the same ground as a previous group of inspectors. We must simplify the process so that we reduce the unnecessary regulatory burden on providers while being assured that a single inspector is doing an effective job.

For clarification, the inspection model that I was talking about would sit on top of CQC inspection. I have spoken to numerous providers, social workers and families, and they have all said that that model drives up standards. It is aspirational and it actually improves care. There is a reason why other local authorities have copied the model: it works, it saves lives and it makes everyone feel more comfortable about the care offered in their locality.

I would be interested in having a further chat with the hon. Lady about the model in due course. I am concerned about duplication of activity. In some areas, that sort of approach has happened because there has not been confidence in rather generic CQC inspections. The model introduced with the CQC back in 2008, which I must say I think was a mistake, was based on generalist teams of inspectors. One week they might have been inspecting dental practices, the next an acute hospital or a mental health facility. It seems much more sensible to have specialist inspectors, particularly including clinicians, where appropriate, and users of services. In that way we can achieve much more robust, thorough inspections. If those are combined with an objective assessment through the rating of a provider, we will start to get a much better understanding of the quality of care and create an incentive to drive up standards.

I want some clarification, because the care homes that I have spoken to tell me that the CQC comes in and just does a straightforward desktop exercise, where, basically, they look at a few files, make an assessment and disappear again. The model I am talking about is three days’ worth of in-depth, thorough assessment of absolutely everything that goes on in a particular home. I am curious as to whether the Minister is going to try to strengthen how the CQC carries out its inspections. If not, it is vital that the model I am referring to is in place as that extra safeguard.

That is absolutely the point. I am now beginning to understand why the hon. Lady talks about the need for something in addition to what has traditionally been the case. Her description of the traditional CQC inspection gives no one any confidence. She described a paper, tick-box exercise, which is hopeless in terms of reassuring anyone about the quality of care. That is the change we are seeking to achieve.

The new leadership of the CQC is totally committed to a different approach, where the inspection, whether of a care home, an acute hospital or a mental health facility, is much more robust and actually looks at the quality of the service provided. Inspectors will talk to members of staff, for goodness’ sake—bizarrely, that has not been a significant feature of the regime until now. They will talk to service users and perhaps to relatives who visit the care home. In that way, we can get a thorough, robust inspection and an outcome that will feed into providers’ ratings.

I think the hon. Lady might agree that if we can achieve that robust process, that will give reassurance and avoid the need for any duplication of effort between the local authority and the CQC. She is absolutely right that the local authority should reassure itself of the quality of care if it believes that the CQC process is a tick-box exercise. We want to eradicate such exercises so that people have confidence in the CQC and the work that it does.

Meg Munn rose—

I am stuck on paragraph 9 but determined to get beyond it. I will give way to the hon. Lady, but I will not then give way again.

With respect, the Minister forgot to answer my first question: why is there a requirement for the CQC to come back to the Government if it wants to inspect commissioning?

I apologise for that. I responded to the same point when it was made by my right hon. Friend the Member for Sutton and Cheam, but I had intended to repeat that in response to the hon. Lady. If organisations are given powers to do things, they will feel under enormous pressure to use them and, thereby, diffuse their efforts and reduce their effectiveness in the areas in which we want them to focus their attention. The additional condition of the Secretary of State sanctioning the inspection of commissioning ensures that the Care Quality Commission will focus on its core task: driving up standards of the provision of care, which is what we are all ultimately concerned about. I repeat that it is in the Government’s interest—whoever happens to be the democratically elected Government of the land—to ensure that, where there is that clear link between the quality of commissioning and poor care, the inspection of commissioning can take place.

Now I will get on to paragraph 9. Concern has been expressed about the change we are making, with service providers arguing that that will leave them answerable for failings in care that, in reality, have their roots in commissioning, and scepticism has been expressed about whether Ministers will ever approve a special review of commissioning. I want to be clear with the Committee on that point.

If my intention was for the CQC never to carry out a review of commissioning, I could have proposed to remove its power to do so from the statute book. I accept that there is a link between commissioning and quality and the CQC should be able to look into that, but only where there is clear evidence of a problem. Its main focus must be on providers. As far as I am concerned, where that link is established on a prima facie basis, these powers should be used because we must be able to challenge poor commissioning that leads to poor care. I hope that that provides reassurance to my right hon. Friend.

I have been asked what areas such reviews will consider and whether the CQC will be able to review 15-minute commissioning, as referred to by my right hon. Friend, and look at commissioning where evidence exists of poor employment conditions of carers resulting from that. My reply is the same in all cases: if there is strong evidence of a link between commissioning and poor care, the CQC will have the power to look into that.

Will the Minister also consider examining pricing? One of the challenges in commissioning is the basis on which the decision is made and it seems to me that that should be based on quality and not simply on cost.

If the local authority was unrealistically pricing care in its commissioning and there was a clear link between that and poor care, as in the other examples, that could provide a basis on which the CQC could inspect that commissioning function. It is about focusing on clear evidence and setting the bar quite high so that it does not need to be constantly poring over local authorities’ work and taking resource away from actual provision of care. It is important to focus the work of regulators on where there is evidence of a serious problem. If these powers are used where there is such evidence, that will send out a signal to local authorities that if they engage in poor quality commissioning, there will be potential consequences. That is important in driving up standards.

That would indeed send that powerful message. Will the Minister indicate whether he will give some thought to my suggestion of a themed inspection of sector-led improvement to address the concern that emerged in the Committee about whether we are really getting the results that we want?

I will give thought to that—not just casual, complacent thought, but serious thought. My right hon. Friend makes a reasonable point and I share his concern that the danger with sector-led improvement is that those bodies who are up for change and improvement take part and those who are dysfunctional and failing do not engage.

Why then could this power only be exercised with the agreement of the Secretary of State or, in the case of reviews of local authority commissioning, the Secretaries of State both for Health and for Communities and Local Government? I return to my starting point: I want the CQC’s main focus to be the regulation of providers of health and adult social care. The oversight of commissioning is not the core purpose of the CQC.  Any review, investigation or study by the CQC of the commissioning of services will impact upon its capacity to oversee service provision. It is a finite resource, and we all understand that. For it to perform this function should be an unusual rather than a routine part of its work. It is therefore right that any review of or investigation into commissioning is subject to ministerial agreement.

I hope that I have reassured my right hon. Friend and, indeed, Opposition Members that there absolutely is an intention to look at the quality of commissioning where this is justified by the evidence. However, this should not be done as a matter of routine because that would take resource away from the provision of care, which is what we are all after.

I agree with the Minister that it should be intelligence-led. It should be based on the evidence, not done as a matter of routine or by rote. However, that does not suggest to me that the Minister is therefore required to stand as the bulwark against all sorts of pressures on the CQC to conduct these inspections willy-nilly. That is why, while I entirely accept and very much welcome his reassurances about the intention to use this power, it seems to me that there would have been a way to do this through guidance. Criteria could have been set out to enable the CQC to say that it cannot do an inspection on this basis, because the evidence threshold has not been reached and it is not worth doing.

I say that to the Minister, but I appreciate what he has said about sector-led improvement and that he will seriously and meaningfully consider it. It would be good for him to do that, and then to reach a conclusion sooner rather than later. My reason for saying this is that if he states that he will commission the CQC to do such work, it would have the benefit of putting local authorities on notice that sector-led improvement is not the only game in town and will be put to the test. That would help raise the game for many of those authorities that are not really participating or that do not take it seriously. It would be a useful spur to drive sector-led improvement in a positive direction.

With that, and with the very welcome assurances the Minister has given in this debate, notwithstanding I am still concerned about why a Minister needs to sign off such an action, I am happy to withdraw the amendments.

Briefly, I offer one tiny clarification. I appreciate that the Minister has been exceptionally generous. He is entirely right about the duplication of effort, which of course we do not want to see, and he is entirely right about the finite resources we have to spend. I genuinely do not want to test his patience any further, but I would like to raise the issue of inspection triggers. Suppose the CQC was to inspect a local hospital trust and see something, whether bed blocking or some other quality of care failure, which was obviously a canary in the coal mine with regard to the local authority’s provision in this regard. Would the CQC have the power to immediately investigate the relevant local authority, without recourse to ministerial approval?

Just to be clear, where the local authority is a provider of a service registered with the Care Quality Commission, there is no obligation on the CQC to seek the approval of any Minister. Where the local authority is the commissioner of care, then there is a requirement to seek the authority of the Secretary of State. I stress again that there is the potential power to look at commissioning by clinical commissioning groups as well as the local authority, so there is a sort of equilibrium in the system by way of this clause.

I will not press the amendment to a vote.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 88 ordered to stand part of the Bill.

Ordered, That further consideration be now adjourned. —(John Penrose.)

Adjourned till this day at Two o’clock.