The Future of Regulation and Inspection of Care and Support in Wales

The Future of Regulation and Inspection of Care and Support in Wales

Consultation Response Form

Your name:Paul Myres
Organisation (if applicable): Academy of Medical Royal Colleges Wales
E-mail:
Telephone number: 01495 332216
Your address: Regus House, Falcon Drive, Cardiff Bay. Cardiff.
Postcode: CF10 4RU

Consultation Questions

Section 3 – A Citizen Centred Approach

1. What, if any, challenges will there be to introducing an outcomes-based approach to regulation and inspection?

Need for clear definition and agreement on outcomes. These need to be objectively measurable and client focused.
The challenge will be achieving agreement between providers and stakeholders and training staff to adopt new ways of thinking, one that is more customer driven.

1. What, if any, benefits will there be to introducing an outcomes-based approach to regulation and inspection?

There will be major benefits in introducing an outcomes-based approach to regulation and inspection. The focus will shift from processes to people. Service users will be at the centre of the care so that personalised care planning and services will be integrated and built around individual needs
It will encourage providers (and customers) to be clear what they wish from a service and it will be necessary to agree measures for assessing the effectiveness of the service. This should be useful for the providers to review and improve their service and for regulators to use data which is meaningful to them, the providers and the customers or clients.

1. What is your view of our requirement for service providers to produce an annual report?

Annual reports provide useful summaries of activity that is universally available in easy language. They are however time consuming to produce. They need to be relevant and interesting to read otherwise they sit on shelves or electronic files unread. A national format would be useful to ensure consistency and allow comparison. Annual reports should demonstrate how far objectives for the year have been met , recognise and celebrate success but also offer explanations where objectives have not been met. They will go some way to providing transparency in the quality of care that is provided. It’s important however that these public reports reflect the true representation of service delivery and outcomes achieved.
Local health boards and Local Authorities must work better together in a way where they share responsibility for delivering outcomes and achieve a high level of integration

1. What information do you think should be included in the annual reports?

-Objectives for the year and how far they have been met.
-Main themes of ongoing activity
-Key events
-Key individuals (Senior officers and non exec directors) and responsibilities
-Financial statement.
-Numbers of clients served.
-Comments on unmet need.
-Constraints
-Complaints and lessons learnt

1. Do you think a quality judgement framework will be a useful tool for the citizen? Why/why Not?

A quality judgement framework would provide patients, carers and the public a more personal perspective on how well services are run and should allow citizens to be able to comment on the services received.
A standard framework will aid analysis but there needs to be room for some free text.
Any framework should be produced by clients and frontline providers as well as quality assurance staff.
We need to improve the quality of service by reducing variation, waste and harm, adopting a patient-centred care and ensuring a cohesive, motivated and professional workforce

1. Are there any other ways we could provide citizens with more control over the care and support they receive?

Care planning should be undertaken by professionals with clients and their close carers.
Provision should be made in any care plan to adjust as circumstances change.
There needs to be a culture shift so that services are client focussed but all must be realistic in what can be provided within limitations of personnel, geography and skill level.

1. How could the service regulator involve citizens further in their work?

Citizens should be involved in the planning of inspection process and the production of minimum standards.
Lay people should be involved in inspections although it might be argued that as soon as lay people receive specific training they are in essence part of the system.
Consideration should be given to extending the Community Health council to being a community Care council - this will support the concept of integrated care and ensures a separate voice from the providers and regulators.

1. Are there any other ways we could strengthen the voice and control of the citizen in regulation and inspection that you believe we should consider?

Encourage existing citizen groups to express their views eg third sector organisations.
Regular feedback forms, complaint forms and suggestion boxes
Section 4 – Firm and Broad Regulation

1. What, if any, risks are there to a service based regulatory system?

May be seen as a tickbox exercise or as intrusion/interference with service delivery.
May create a focus on outcomes and less on process with a risk of providers being less adaptable and more risk averse. Leading to a reduced use of common sense.
A balance is needed to regulate but encourage autonomy and clinical leadership.

1. What, if any, benefits are there to a service based regulatory system?

-Providers take a bigger interest in the quality of service and how it is perceived by clients.
-There is less variability.
-Problems can be corrected earlier.

1. Are there any services that are not currently regulated that you feel should be? Why/why not?

At the moment there is no regulation of domiciliary care and the quality of care varies greatly throughout Wales.

1. Should local authorities be required to produce an annual report which will provide the basis of inspection by the service regulator? Why/why not?

An annual report for inspection will be different from an annual report for the public and other stakeholders.
There is a need for some uniformity to the structure of these reports so that the regulators can have an overall view of the performance of service providers across Wales. This would allow regulators to identify similarities, differences and irregularities with relative ease. If there is no structure or format to these reports, they will differ considerably from one area to another and there will be a tendency to concentrate on what works well rather than what doesn’t work well.
The production of a traffic light system might be of benefit in producing annual reports as it will encourage services to continue good practice while developing and improving others.
Additionally, there is a need to move towards continued monitoring rather than a flurry of activity for an annual report. This means good data systems so information on activity can be entered at or around the time the activity takes place and is incorporated as part of routine practice.

1. How could the regulator assess whether the Responsible Individual is a fit and proper person?

Create job descriptions and person specification and assess the individual against that.
360 degrees appraisal –collecting views from a random selection of colleagues, stake holders and customers.

1. Do you think the requirement for service providers to undertake a risk assessment about continuity of service would help prevent provider failure? Why/why not?

Yes, this would be useful for all concerned but guidance should be available to providers on how to undertake this. It should be proportionate to the level of service.
Accounts should be available to external auditors to assess business failure risk

1. In the event of provider failure, would local authority contingency plans help ensure the continuity of service provision? Why/why not?

Whilst commercial providers should not rely on LA back up and (be less secure in their operational and financial procedures, there must be some assurance for recipients of care that they will not be abandoned if there is service failure.
There should be some form of insurance scheme available collectable from clients and providers but it should not in itself create a financial cost that would jeopardise business viability.
Putting an obligation on LAs to intervene where there is discontinuity of a service will encourage them to support and monitor service providers (internally and externally)

1. Do you think a registration fee should be introduced for organisations registering to provide care and support services? Why/why not?

Providers should be aware of the importance of assessing risk and the need for quality. Registration fees ensure some commitment but also risk raising the cost of care provided. There must be transparency over the level of the fee and assurance that the fee will not be spent on inappropriate bureaucracy which is in itself a risk of regulatory mechanisms.

1. Do you think a fee should be charged for organisations providing care and support services to renew registration?

Annual fees may spread the cost and allow the regulator a better idea of income from registration but the cost must be proportionate of the size of the business or service.
Should the fee be related to the turnover of the business or number of clients serviced?

1. What, if any, challenges would there be to introducing time limited registration, in particular circumstances, for organisations providing care and support services?

This will depend on the frequency of inspection. Registration should include a commitment to continuing quality of service and the provider should evidence the care provided in the previous period. This should not be burdensome and only include essential information. Any changes in information to be provided should be given at least 6 months in advance.

1. What, if any, benefits would there be to introducing time limited registration, in particular circumstances, for organisations providing care and support services?

Ensuring standards are maintained

1. Do you think that the service regulator has sufficient enforcement powers? Why/why not?

1. Should the existing offence of providing false or misleading information in an application form be extended to the provider’s annual report to the inspector? Why/why not?

Providing false or misleading information in any format should be an offence. It can harm citizens. If not done knowingly the penalties should be minimal but if done knowingly there needs to be adequate penalties to prevent repetition.

1. What are your views in relation to making provision for ‘aggravated’ versions of certain regulatory breaches which would provide stronger sentencing powers to the courts in relation to the most serious regulatory breaches?

A middle approach may be favourable
Section 5 – Strong and Professional Delivery

1. Are there any groups in the care and support workforce that are not currently registered, that you think should be? Why/why not?

1. What, if any, challenges would there be to extending registration of the care and support workforce?

Personal registration may deter applicants for posts . It creates additional bureaucracy and the need to check. Those needing registration would not unreasonably expect higher level of remuneration to cover the costs of registration.
We agree that registration of those with a professional title of Social Worker should be registered and it might be appropriate there is some specialty registration for those working with children and young people Those with professional skills should be registered as an indication of competency attained. We do not believe everyone providing care needs registration. What is more important is monitoring work performance in a constructive manner.

1. What, if any, benefits would there be to extending registration of the care and support workforce?

We can see that this provides some assurance of competency at the start of employment but unless there is a strong professional and ethical framework that such individuals sign up to as part of the registration we do not feel there is sufficient gain. Again we favour review and monitoring as a more effective means of assuring quality.

1. If registration is extended, what are your views about extending protection of title to other groups in the care and support workforce?

See above

1. If registration is extended, what are your views about extending protection of role to other groups in the care and support workforce?

There must be flexibility in role based on demonstrable competency. Protection may hinder care delivery in smaller organisations and reduce flexibility in workforce.

1. What is your view of the proposal to require social care managers to only register with the workforce regulator?

It makes sense for individuals to register with the workforce regulator and organisations to register with the regulator. That model works well in health and education. Dual registration of individuals places an unnecessary burden on them. However when key individuals leave organisations it may be necessary for LAs to inform regulators.

1. What are your views on our plans to remove voluntary registers?

If registration is to provide consistent assurance, it needs to be for all. Otherwise how can we maintain standards and accountability ?

1. What, if any, risks are associated with negative registers?

We do not understand the legal implications of such registers but suspect it will cause some confusion. If it is deemed people need to be registered , it should be for all and those not complying with registration standards should be removed.
We appreciate that there will be provider staff who may cause harm to individuals and who may seek employment elsewhere. Such a system doesn’t exist in other areas of public service so it would be seen as unfair to care workers.

1. What, if any, benefits are associated with negative registers?

None

1. Do you think we should adopt negative registration in Wales? Why/why not?

No. Further discussion and impact analysis is required.
Section 6 - Taking the next step to Improvement and Professionalisation

1. What are your views on the proposal to introduce a National Institute of Care and Support?

We have no problem with the Care Council for Wales changing its name and to focus on improvement. We would hope it would work closely with the Improvement Unit in Public Health Wales as there will be common agendas and collaboration will encourage better integration. There is already an Institute for Health and social Care Research and a UK college of Social Work. We cannot afford to spend public money on duplication.

1. What functions should the Institute be responsible for?

Section 7 – Working Together

1. Do you think that the functions of service and workforce regulation should be carried out inside or outside of the Welsh Government? Why?

Outside. The role of government is to set strategies, and policies. Operational issues and regulation must sit outside politics.
A conflict of interest may arise between the policy producer and regulator
Other
The Welsh Government is interested in understanding whether the changes proposed in this White Paper will have an impact on groups with protected characteristics. Protected characteristics are: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, and sexual orientation.

1. Do you feel that the changes outlined in this White Paper will have any positive impacts on groups with protected characteristics? If so, which changes and why/why not?

1. Do you feel that the changes outlined in this White Paper will have any negative impacts on groups with protected characteristics? If so, which changes and why/why not?

1. What are your views on any costs associated with the changes outlined in the White Paper?

1. What opportunities do the proposed changes set out in this White Paper provide to reduce or replace the current system of regulation and inspection?

1. We have asked a number of specific questions. If you have any related issues which we have not specifically addressed, please use this space to report them.

One concern is how feedback would be obtained from vulnerable children and adults. If they are unable to provide written feedback then an advocate would be needed. Additionally, all feedback should be confidential.
Responses to consultations may be made public – on the internet or in a report. If you would prefer your response to be kept confidential, please enter YES in the box.