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Scotland

The body responsible for regulating care services in Scotland still has a long way to go, according to care providers and inspectors commenting on its first year of operation, writes Nicola Barry.

Allan Keir, chairperson of an association of care homes in Angus, says staff think the year-old Care Commission is "feeling the weight of its responsibilities".

"They are supposed to carry out one announced inspection and one unannounced," Keir says. "That wasn't happening before, nor is it happening now. That means vulnerable people are at risk."

However, although only 80 per cent of inspections had been carried out by the beginning of March, the Care Commission is "confident" it will have updated information on all the sites by the end of the month, says a spokesperson

The commission was established a year ago under the Regulation of Care (Scotland) Act 2001 and is responsible for regulating and inspecting the care services monitored previously by local authorities and health boards.

Its five inspection regions check the standards of 8,000 childminders, 300 creches, 2,500 nurseries, 2,200 care homes, 900 out-of-school services, 400 day care establishments and 93 nurse agencies.

From next month, these numbers will increase and include adoption and fostering agencies, home care, housing support services and school care accommodation.

Scotland has 360 inspectors from a range of professional backgrounds, including child care, education, social work and nursing. They carry out visits in multi-disciplinary teams.

But Keir says many of the commission's inspectors have no previous inspection experience and are tending to assume that standards - which are not minimum standards as they are in England - are law.

"The law says staffing levels are up to proprietors," he says. "Inspectors can make recommendations. But, in some cases, they are treating guidelines as statutory requirements."

Joe Campbell, director of Scottish Care, which represents 80 per cent of Scotland's care homes, says: "It's early days for the commission. They need to get to know our homes, not just apply formulae."

The commission has dealt with more than 1,000 complaints, mainly from carers and relatives, more than half concerning care homes.

"Most difficult of all is when the ethos of a home is wrong," says commission chief executive Jacquie Roberts. "If this happens we work with the manager or owner to change that ethos."

Inspection reports take 10 days to complete and homes are given 20 days to respond with a plan for improvement. Either they carry out the improvements or the commission issues an improvement notice.

"If the work isn't done we serve a cancellation notice," Roberts says. "So far, we have only had to serve one urgent cancellation notice."

Roberts admits that 2 per cent of the complaints received have been about the commission itself.

"Usually it's about an inspector," she says. "Perhaps the approach was wrong. Sometimes it's a lack of information or a delay."

Pat Brown, of Troon Community Council, has been fighting to save a care home run by South Ayrshire Council, but has been unsuccessful in her attempts to obtain a copy of the home's report despite pressing the commission for one for weeks.

"I have been repeatedly assured it is on its way," she says, "but nothing arrives".

According to the commission's website, reports can be obtained free by completing a feedback form.

Jim Gibb, chairperson of the National Association of Inspection and Registration Officers in Scotland, agrees that the commission's first year has not been easy.

"Demands on our members have been high," he says. "There was a wholly inadequate lead-in time to prepare and train staff, creating difficulties in interpreting and implementing legislation, regulations and standards consistently."

The association supports the development of national standards, but Gibb is concerned that the desire to meet regulations has taken precedence over the objective of achieving better outcomes for service users.

"The commission has not taken full advantage of previous experience and more bureaucratic demands have been made on providers, when fewer were needed," he says.

"However, the commission has a long way to go and many new areas of service to regulate. The association will offer constructive, professional and balanced criticism and contribute to achieving our shared goal."

Wales

Driving up standards through communication and co-operation has been the aim of the Care Standards Inspectorate for Wales - and it seems to have worked, writes Alex Dobson.

The first 12 months have not been easy. But the small size of Wales and the way the inspectorate has been set up have cultivated a spirit of partnership working that may not be so easy to achieve elsewhere in the UK.

Unlike its counterparts in England and Scotland, the CSIW is not an independent statutory body. Part of the Welsh assembly, the inspectorate covers a range of settings. These include responsibility for registering and inspecting children’s homes, care homes, independent fostering agencies, voluntary adoption agencies, residential family centres, boarding schools and domiciliary care providers.

It also looks at private and voluntary health care sector and nurses agencies and is responsible for facilities for children under eight.

Mario Kreft, head of policy for Care Forum Wales, which represents care, residential and nursing home owners, says the first year has been difficult as providers have struggled to come to terms with the new legislation. But he says senior leadership within the inspectorate has listened to the difficulties.

"In Wales there are some positive aspects of the first year that are certainly different in approach from what I hear is happening in other parts of the country and that gives us cause for optimism," he says.

"The picture across Wales is not uniform and there is still a lot to do, and some regions seem to be making the transition more easily than others. But, because it is still so new, we need to give the CSIW time to develop.

"Because the organisation is part of the assembly, people can lobby their local politicians. Although that will not affect the regulations themselves, it does have an effect on the way they are implemented."

Former social worker Rob Pickford, who heads the CSIW, acknowledges that he and his 270 staff in 12 offices have had to climb a steep learning curve in the past year.

He says that, although the overall aim is to create a single comprehensive Welsh regulation system that will remove the inconsistencies inherent in the old system, the organisation was aware that a rigid approach would not help.

About 7,000 inspections have been carried out so far, but Pickford admits the organisation is struggling to meet the target of within 63 days.

Although data have yet to be published, Pickford says no provider has failed its inspection outright because work has been carried out to help identify gaps in provision and make plans to correct it.

Details of the inspectorate’s work will be included in an annual report due in the summer.

Additional flexibility has also been built in by changing the inspection format halfway through the year. This has resulted in a new four-point scale to assess whether the quest for higher standards has been met, almost met, partly met or not met.

Pickford says: "In consultation with providers we altered the format because we found that what we started with was more complex than it needed to be. We did start the year with met/not met criteria, and we were told that people had to trip up on only one aspect of the national minimum standards for their home to fail the requirements of the inspection. They felt that that was an unfair reflection of the way they work, and we agreed with them."

For the inspectors themselves the year has been a challenging one. Robin Bradfield has just come to the end of his six-month probationary period in the job and says he and his colleagues, who cover Rhondda Cynon Taf, Merthyr and the Vale of Glamorgan, have tried not to take a "heavy handed approach".

He works for the adult team that inspects a range of settings and he says that, although the team has been challenged by the work, they have also been supported well by the organisation itself.

As the CSIW enters its second year, that support will undoubtedly continue to be needed.