My Lords, I rise to speak to the amendments in my name—Amendments 86L, 86M, 86N and 86Q. These amendments are all about quality of care. We know what happens at the moment. There is the opposite of a monopoly in that there are lots of sellers, but largely one buyer of care. Many care homes know this. The local authority is in a very strong position and will tell the care home managers—in the private or voluntary sectors—that they will take 20 beds and negotiate a price which is very low. That means that the care home cannot provide a decent quality of care at that unrealistic price. This has been talked about and written about by Laing and Buisson and
various other bodies. It is a known fact among those who follow very closely what goes on, but at the moment it is not really known to the public.
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This is an impossible situation that should not continue. Care homes charge self-funders more than the required amount in order to cover the true costs so that they can provide a decent quality of care. In a time when we are looking for transparency, this Bill, when it is enacted, will open up these arrangements to public scrutiny because self-funders and those funded by their local authority will know what is going on. This secret tax, as I think of it, on self-funders will then be out in the open. It is really bad that this kind of thing is going on in this country, although it is not recognised by many people.
We must make sure that we have an independent adjudicator who can settle funding disputes between local authorities and care providers. We must also recognise that not all care providers are large private sector chains. I have received a lot of information about this from the Royal British Legion. It may be quite a large body, but it is a charity. Because of these arrangements, it cannot manage to provide a decent quality of care at the sort of price being quoted. There is a great deal of secrecy in this area, with local authorities not consulting local providers and no one inspecting the quality of the services being provided before a maximum tariff is agreed. All of these operations should be much more open and clear. Apart from the appointment of a care providers’ adjudicator, we have to ensure that the duties on local authorities enable us to be clear that a consistently high standard of care is being provided in the area. If we go on otherwise, we will be promoting secrecy, which is entirely inappropriate. Moreover, we can ensure minimum standards of care if we get this right, and we can do that by specifying a suitable level of quality when commissioning services.
The last thing I want to propose is that the Government should look at the tasks that a care worker has to do in order to make a visit to a person needing care worth while. The noble Lord, Lord Hunt, also talked about this. In most cases, they cannot manage to do everything that is necessary in around 15 minutes, plus make the journey to and from the person being visited. It is physically impossible. As we know, it is largely a breach of human rights simply to pop in, try to clean someone who may not have had a visit for many hours, serve a meal and talk to the person, change their clothing and the bedding, and do those things that are considered to make up a reasonable quality of care provision in 15 minutes. That needs to change. It should be necessary to adhere to specific minimum standards, not to the length of time taken to make a visit. It should be the qualifying tasks that matter, not the time it takes to do the work. We have to change things around so that it is what needs to be done that matters, not the time taken. These amendments, together with an adjudicator, would ensure that that happens.