Shifting the burden

Regulation, regulation, regulation. No, not Tony Blair’s latest
mantra, but what carers providing adult care placements feel they
are saddled with. Under the current system, adult placement carers
who provide overnight accommodation and personal care to vulnerable
adults must register individually with the National Care Standards
Commission. It is carers’ responsibility to ensure they meet
regulatory requirements, which include being subject to unannounced
inspections of their home by inspectors.

At the end of last year the government launched a consultation into
changing the way adult placement carers are regulated in England
(news, page 6, 8 January). It proposes to move the focus of
inspection away from individual carers and to the adult placement
schemes themselves, which are run by councils and voluntary
agencies. If the suggestion goes ahead England’s 1,669 registered
adult placement carers will no longer have to shoulder the
regulatory burden.

In Scotland and Wales the responsibility of meeting regulations has
always lain with the adult placement schemes. The different
approach adopted in England has resulted in a number of problems,
particularly as not all individual carers providing adult
placements are regulated by the NCSC. This covers carers providing
accommodation and support and those providing daytime or outreach
support. In effect, some carers escape all forms of
inspection.

The current system has other difficulties, according to Sian
Lockwood, chairperson of the National Association of Adult
Placement Services (Naaps) and chief executive of private agency
Adult Placement Services. Adult placement carers regulated by the
NCSC are expected to take responsibility for activities that, in
practice, are within the remit of the adult placement scheme. But,
the NCSC “sometimes has no way of holding the schemes to account”,
she says.

Although NCSC inspectors try to be sensitive to carers and their
placements, Lockwood says some of their methods for gathering
evidence cause distress: “Just how do you check whether a person
has had a nourishing meal? Do you watch someone eat?”

Existing regulation is “too onerous” for adult placement carers,
agrees David Congdon, head of external affairs at learning
difficulties charity Mencap. He says: “It is an ordinary house and
the user is part of the family. They don’t need the same level of
intensity of regulation as a home with 20 residents.”

This point is picked up by James Churchill, chief executive of
learning difficulties charity the Association for Real Change. He
says because adult placement carers bear the full force of
regulation many are made to feel that they are like a small care
home – which is not how they see themselves.

Such is the concern about the negative impact the regulatory
approach was having on carers that the NCSC commissioned an
internal survey. It found that between January 2002 and October
2003, 26 per cent of carers decided to leave the adult placement
sector altogether or to limit their support to people without
personal care needs.

The entire sector has welcomed the government’s decision to consult
on a possible regulatory change, not least Naaps, which Lockwood
says has been campaigning for this for four years. But will schemes
cope with the additional responsibility of taking on the NCSC
assessment role? Lockwood says most will meet the standards, but it
will challenge the good practice of the whole sector.

John Dixon, the Association of Directors of Social Services’ lead
on adult placements, is aware of the “considerable variability” in
schemes and says the sector should use any change to improve its
practice. He says: “We want to put pressure on adult placement
schemes to up their game in terms of the consistency of quality of
their work.”

But is there a danger that unsuitable carers will slip through the
net while schemes get to grips with their new responsibilities?
Lockwood says if the new approach goes ahead it should make the
entire service safer because all schemes will be monitored, not
just carers who provide accommodation and personal care. She
believes that only “a tiny number of schemes” will need additional
help to cope with regulation because they didn’t have enough
resources to put the correct procedures in place.

If the proposal goes ahead Churchill says extra government funding
for placement schemes would be “helpful”. However, he adds that it
would be difficult to ensure the funding was not siphoned off
elsewhere.

Lockwood believes Naaps will have to provide extra help to schemes.
This is something the Department of Health’s adult placement
project management group, of which Naaps is a member, will need to
discuss.

Congdon says it is difficult to argue against more government
funding for adult placements, but calls for the onus to be on local
authorities to provide a complete range of housing and support for
people with learning difficulties.

Social services departments need to be more aware of the benefits
of adult placements, says Dixon. “If we don’t rescue and support
adult placements it is the clients who will lose out.”

‘I made a difference’ 

Sandra McNally became an adult carer by default three years ago
when a relative of her husband Barry became unhappy at the care
home where she lived. The couple had a good relationship with
Susan, who has learning difficulties, and did not like to see her
upset. McNally says: “We felt we could give her the life she needed
and deserved.” They took Susan into their Scarborough home and she
began to feel happier. “At first Susan led with the same foot to go
up the stairs and now she uses both feet. It’s brilliant seeing
that change in her.”  Initially, McNally was working as a part-time
nurse and cared for Susan informally, receiving no payment. After
the local authority organised respite care with the agency Adult
Placement Services (APS), McNally and her husband decided to become
registered adult carers. She says they made the decision because
“there weren’t enough people doing it”. In July 2002 the couple
began the process of becoming adult placement carers for APS and
two months later they applied to the National Care Standards
Commission to become registered carers. 

After lost paperwork was recovered, McNally and her husband had
their “fit persons” interview with the NCSC in December 2002. She
found the interview with two inspectors daunting and bureaucratic.
McNally admits they may not have gone ahead had they known what it
was going to be like. She felt her professional experience as a
nurse was seen as a problem. “The inspectors talked to us about how
we would respond in different crisis scenarios. I felt that I was
damned if I said I would step in to help and damned if I didn’t. We
came out of the interview feeling very drained.” 

Despite this experience the couple were approved as adult
placement carers last January. Since then they have provided seven
people with respite care and taken on two women with learning
difficulties full time to live with them and Susan.   McNally
supports regulating adult placement schemes rather than the
individual carers because of their expertise. “It would also build
on our positive relationship with APS,” she says. Despite their
trials and tribulations, McNally never considered giving up being
an adult carer. “It’s about making a difference to someone’s
life.”