The shocking report of the parliamentary joint committee on human rights again reveals alarming levels of elder abuse and poor standards of care in hospitals and care homes.

Yet despite ministerial assurances, several policy trends perversely serve to counter the urgent culture change that is needed. First, statutory regulation in health and social care is now less direct, relying increasingly on self-reporting by providers against set standards - and trusting them to do so. Second, more and more such care will be provided in future in the independent sector and in people's homes, often by new providers with profit in mind. Third, the measures contained in the Local Government and Public Involvement Bill will serve to severely limit access by lay community observers to local wards and care homes and, where requested, to the domestic setting.

Independent public involvement at the local level is essential to achieving the vital culture change the joint committee has demanded. Abuse and poor practice thrive behind closed doors and drawn curtains. The work of patient and public involvement forums in the past three years has shown how important community engagement is in finding out what elderly people really think privately about the way they are being treated.

Abolishing the forums, curtailing the independence of local involvement structures and watering down their powers to visit, observe, and listen to patients, providers and carers is quite contrary to the opening up of elder care that is now needed.

The only real safeguard for the elderly vulnerable patient is for their care to be delivered in a place that is part of and not separate from the community. For that to happen, there must be proper arrangements, with teeth, for the eyes and ears of the community to access the point of delivery of care, and for them to be a hostage to no-one in speaking out about what they find.

It is not too late for fresh thinking to take place on the bill.

Sharon Grant is chair of the Commission for Patient and Public Involvement in Health.