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The long-awaited National Care Standards Commission is hatching. Ruth Winchester talks to chairperson Anne Parker about how it intends to start work and gauges what sort of reception the new body is likely to receive.

Next month, something will hatch in the social care sector that will change it for ever. The egg has been visible for a while, but no one was sure what would emerge from it. Now, however, the shell is cracking. The National Care Standards Commission is almost upon us.

This powerful new body has been set up under the Care Standards Act 2000 to take responsibility for ensuring quality in a very wide range of public, private and independent care settings in England. These include residential and nursing homes, day centres, children's homes, domiciliary care services, adoption and fostering agencies, nursing agencies and boarding schools. In terms of regulation, many of these services represent virgin territory.

Nor is this any harmless, voluntary "do it if you feel like it" affair. The commission has very significant powers - from warnings and fines through to closure of services and exclusion of individuals from social care - and it is certain to use them.

The overwhelming response from those about to be regulated has been "we're delighted that it will put the emphasis on quality" followed by a lot of "buts" and "ifs" and "what abouts". And to be fair, the commission has hardly put people's minds at rest. Over the past 12 months it has given a lot of conflicting messages about exactly what line it was going to take over the standards and regulations. One starting point was that the standards were "non-negotiable", which caused a certain amount of hysteria among care home owners whose rooms were six inches too small.

There does, now, seem to be a reasonable understanding on all sides about the distinction between the standards and the regulations, and what line the commission is going to take (at least in principle). Regulations are mandatory; standards are not. The regulations say "jump", the standards tell you how high. The crucial point now is how the commission interprets its responsibility to "enforce" the regulations, and "take the standards into account".

Unfortunately, anyone expecting a quick, straightforward answer is going to be sorely disappointed. This body is so large and so new that it is going to take time, probably several years, before any real answers emerge.

At the time of writing - two weeks before the Commission is due to go live - only 55 of its 1,700 permanent staff are actually at their desks. This rather alarming statistic gives some idea of the truly awe-inspiring scale of the operation and the massive upheaval that is going on in local authorities and health authorities across the country.

Inspection staff are being drafted in from 200 different employers. The commission has had to negotiate with hundreds of different workers over hundreds of different sets of terms and conditions, and they are all going to start work at the beginning of April. Many are on day-release training courses in preparation, but there is realistically no way that the whole edifice will spring into co-ordinated action when it goes live next month. Even if it did, the size of its regulatory task means it will be some time before every corner of the country has had the spotlight turned on it.

And, with so many people arriving at the commission with different skills and experience, there are going to be questions about the consistency of inspection and regulation decisions. CCETSW and the General Social Care Council have created a new training course for regulators, the Regulation of Care Services Award. But it will take an estimated three to five years before all inspectors are trained to that standard. In the interim, how can one organisation be sure it is getting the same treatment as another? The answer, according to commission chairperson Anne Parker, is that they can't. Not yet, anyway.

"Ensuring consistency is going to be difficult," she says. "It may feel unsatisfactory both from the point of view of the field, and of our staff, for some time. Inspectors are going to think we are horribly bureaucratic. Some of the freedom of movement they've had in the past is going to be constrained in the short term, while we say 'hang on, can we look at this,' and a locality manager checks with her area manager. We are going to be building case law, essentially.

"And it may feel unsatisfactory from the point of view of the field, because they are not going to get a quick response. I'm sure we will be criticised, because we are taking time over some things that might have been given a snap decision in the past.

"The timescale I've got in my head is that we really ought to be demonstrating some consistency toward the end of this year, and be making good progress toward achieving that at about 18 months. And then stable by year three."

This is probably not what people want to hear. Regulation is going to be difficult for some, and hitting a moving regulatory target is going to be harder. But for those who are daunted by the task, Parker has some consolation. The first is that any "regulatory absurdities" that have arisen during the drafting of the standards and regulations - and providers argue that there are many - will be drawn to the government's attention. According to Parker: "If we identify absurdities, or if there are things that we cannot operationalise, then the government needs to know."

The second is that the standards are not set in stone and while the commission was not involved in the initial round of drafting, it will draw on its substantial experience within the sector in drawing up the next round.

"We've kept ourselves out of the consultation loop on the standards this time - we have been given the standards," Parker says. "We see our role now as to comment on how they can be used effectively as instruments for regulating - do any of them not work very well, and what ideas are we picking up - to inform the next round.

"The government intends to review these standards periodically. What periodically means I don't know - I don't imagine they'll be digging them up every six months - but the notion is that these are living things."

Feeding into the evolution of the standards is going to be a central part of the commission's remit, and that depends on intelligence gathering. There is a staggering information black hole around some services - with no centrally co-ordinated information about numbers of beds, numbers of staff, client groups, dependency levels, outcomes or costs. Part of the commission's remit is to put some flesh on the bones. The idea is that it will be a "virtual" organisation, existing wherever there's a laptop and a telephone, and regulation will be a largely web-based process.

The new IT system is, of course, late in arriving and, as Parker admits, "no one's actually pressed the button yet, so we don't know whether it'll sink into a heap with a sigh when that happens". But the idea is that inspectors will file their reports online, and providers will have access to a web-based resource centre where they'll be able to find all they need in relation to the NCSC.

The database will also provide the commission with a lot of valuable information. "The objective is to be able to gather information in computerised form, and be able to add it up, subtract it and analyse it," Parker explains. "At the end of the year we should have a lot of data which tells us which standards are being met, which aren't, which are being exceeded and what good ideas there might be out there.

"I am very much hoping that there will be good ideas from providers who say to us, well, we might not be meeting that particular standard, but we are meeting the outcome that sits on top of that standard, and this is how. And that might be built into future standards."

Another key aspect of the work is what Parker describes as "the unfolding of enforcement". She suggests that year one will be a relatively "softly softly" year for the commission while it gauges the lie of the land and inspectors learn the ropes. Year two will see the beginning of a gradual "ratcheting up" of standards. But that does not mean a policy of non-enforcement - laggards will not be tolerated. "We may well be moving into enforcement earlier in some sectors where there is a very poor history of compliance - where people are not arriving with a clean sheet."

With all this emphasis on provider organisations and the inspections, the real raison d'ˆtre of the commission is easily forgotten - protecting and ensuring quality for service users. And therein lies the rub. Service users are not a uniform bunch, and they don't always want what the government thinks they ought to want. A spate of recent battles have been fought by residents over the unwanted closure of care homes - and it is probable that sooner or later the commission will find itself in the unenviable position of taking action which goes directly against the wishes of the people it is there to protect.

Parker hopes this uncomfortable scenario will be avoided by listening to what service users tell them is important. "It might be the case that there is pressure to focus on room sizes, while all the residents tell us it is food we should be focusing on. That would moderate our priorities. But we undoubtedly will be in the position where we are making decisions that are not entirely in accordance with the wishes of some service users, and we will have to be very, very sure that we can explain what we are doing, and why we are doing it. Hopefully we won't get to that stage as a matter of surprise to everybody - if things were really that bad hopefully you would have spotted something coming. But you don't always, of course."

While deciding whether a service is good quality may be relatively straightforward, the commission is heading into tricky territory when it comes to commissioning arrangements. How, for example, will it handle a situation where a provider cannot give quality services for the rates a commissioner will pay?

One condition of any registration with the commission is that of financial viability. Parker says: "It's a very complicated thing to make a judgement on. Is it financially viable so that I'll lend you some money? Is it financially viable so I'll buy shares in you? Is it financially viable so that you can feed the residents and pay the staff and mend the roof? We are talking with the market about that.

"But at some point, once you've got all the other noise out of the system, you are going to come down to fee structures and occupancy rates. At that point, it could be that we have to say to a provider, on the basis of your assumptions on fee structure and occupancy rates, you don't look financially viable. That's a judgement we have to make."

She is unwilling to be drawn further but insists that money, while important, is not the whole equation. She cites personal experience of similar organisations producing very different outcomes with identical financial resources.

Perhaps this is the most difficult characteristic of the commission to accept - that it doesn't have all the answers. There are questions to be asked about whether it is fair to treat service users, staff and organisations as unwitting guinea pigs in an unprecedented national experiment. In any event, it is clearly going to be difficult for those on the receiving end to have confidence in a process, and an organisation, in its infancy.

Parker fully acknowledges the lack of certainty, saying: "There are a lot of don't knows." But she adds: "People are going to have to learn to live with some don't knows, while we work out what the right answer is."