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Chapter 11: Regulation and inspection issues
Regulation has been established at different times and for different reasons. It usually has a number of purposes, which include:
- to protect people from unscrupulous operators or unsafe practices
- specifically in the health and community care field, to protect frail and/or vulnerable people who may not be able to speak up for themselves
- to ensure specified standards of services are delivered, whether in terms of physical design ( e.g. of a building - care home) or competency of staff (minimum qualifications, training requirements) etc.
- a national system of care regulation ensures consistency of standards across the country, and a level playing field for all care providers
- to investigate complaints about care services.
In short, regulation is designed to ensure individuals receive high quality care delivered to nationally agreed standards. Across community care, health and housing we noted 8 regulation and inspection bodies, as follows:
Care Commission - regulation of care and support services.
Scottish Social Services Council - regulation of social service workers.
Social Work Inspection Agency - works with others to continually improve social work services, so that they meet the needs of the public; and the public has confidence in them.
NHS Quality Improvement Scotland - has the lead for improving the quality of care and treatment delivered by NHSScotland across all its services.
Mental Welfare Commission - mental health services (including learning disabilities and dementia).
Accounts Commission - ensures that the Scottish Executive and public sector bodies in Scotland are held to account for the proper, efficient and effective use of public funds.
Communities Scotland - registered social landlords and supported living accommodation.
HM Inspectorate of Fire Services - for fire safety issues.
While this list may seem extensive enough, a housing association has to satisfy the following 13 bodies about its activities:
- Care Commission
- Scottish Social Services Council
- Mental Welfare Commission
- Communities Scotland
- Scottish Executive (Census material in Care Homes and Supporting People returns)
- Office of Scottish Charity Regulator (Charitable Status)
- Financial Services Authority (Company Accounts)
- Office of Public Guardian (Adults subject to AWI)
- Each funding local authority (Approved Provider Status, Supporting People funding, care at home funding, care home funding )
- Local authorities (Houses of Multiple Occupancy Licences)
- Local authority Environmental Health Departments (food preparation and handling)
- Each funding Health Board (Approved Provider and funding)
- Health and Safety Executive (any breaches in regulations)
It is interesting that in this list of 13 bodies, only the first 4 are in the earlier list of regulation and inspection bodies.
The purpose of regulation is to protect often vulnerable members of the public in specific situations in life, but the number of regulation/inspection/review bodies listed here raises the question of duplication between these various forms of registration and accreditation. One point of entry to these bodies would be helpful. There needs to be work about sharing of information, data standards, and how that is managed.
The questions are:
- what functions are required or are essential, and
- how we can make the system of regulation/inspection/scrutiny more coherent and joined up.
As far as older people themselves are concerned, a good starting point is where do they and their relatives take complaints.
The Better Regulation Task Force has attempted to measure the cost of regulation It estimates that the cost of regulation to the UK economy is more than £100billion - between 10% and 12% of Gross Domestic Product (the total national wealth). This is similar to the total annual revenue from income tax. Of this, two-thirds is the cost of achieving the policy objective, paying the minimum wage, providing maternity leave or constructing wheelchair ramps. The other third is administrative costs, inspection, form filling and the like. Thus across the UK as a whole we are probably spending at least £30billion a year on red tape. (Sir David Arculus, Chairman of the Better Regulation Task Force, quoted on 7 December 2005).
The Better Regulation Task Force was put on a permanent footing from January 2006 as the Better Regulation Commission, an independent advisory body set up by the Prime Minister and the Chancellor.
The percentage of total staff and management time spent on the bureaucracy of regulation, registration and inspection (filling in forms to satisfy audit trails, the time absorbed by inspection visits etc) in the care sector must be substantial. Our aim in Scotland should be to reduce these considerable pressures, whilst maintaining standards, allowing more effort to be directed to service provision.
We lighted on 2 other specific issues in relation to regulation:
- The definition of care services in terms of the Registration of Care (Scotland) Act may mean that under current arrangements providers who offer flexible services might have to register the same facility under more than one category of care service. This also means that they would be required to pay separate registration and continuation fees for the different care services provided. If we want care units/homes to be flexible, we need to recognise that the providers of the service ( e.g. a care home owner) are being flexible and that they should not be disincentivised by the regulatory regime. The Care Commission has submitted this to the Health Committee inquiry as an issue it wishes to see changed.
This becomes even more of a problem in rural communities where the likelihood is that it would not be economic to have separate provision for a range of flexible services (e.g it may be that the only service provided locally is a care home and that if any care at home service is going to be provided it only makes economic sense if that is developed as part of the care home service). - The Regulation of Care (Scotland) Act 2001 defines regulated services on the face of the Act. The definitions therefore reflect the way services were delivered at that time (2001), when in practice service delivery moves on. New definitions can be added to the Act by secondary legislation, but the existing definitions cannot be changed. There could potentially be difficulty if some innovative service cut across definitions or did not fit with any of them.
While we are not currently aware of any such services, we flag up the issue as one to which consideration should be given as and when it arises. There could be 2 options: - whether there is a need for changes to be made to the definitions of care services within the Regulation of Care (Scotland) Act 2001 and the requirement to separately register these different care service types; or
- whether the regulator can be "smarter" about the use of the definitions to meet the future agenda.
The Care Commission's purpose is to contribute to the improvement of care services, and by virtue of its vision is fully committed to being smarter.
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