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Regulation of the care sector is vital for the health and safety of people receiving care. But a misconception persists among some of those on the receiving end that regulation and inspection are to the detriment of care providers.

My experience, however, suggests that the red tape associated with regulation provides an invaluable protection for service providers where they have been affected by events beyond their control.

Some years ago the inspection unit which I headed received notification from a care home that an 80-year-old resident had gone missing. Three days later the resident was found dead in a local wooded area. He had died, it was thought, from hypothermia. Naturally the home, its staff and service users were all very distressed.

Relatives and other professionals felt the home may have been negligent. A team of inspectors was dispatched, not only to investigate the situation but also to offer comfort and support to the home - which up until the incident had enjoyed a good local reputation.

The inspectors sought to establish:

l The circumstances of the resident's disappearance: the time, date, resident's state of mind, staff on duty at the time.

l The service user's care plan and care needs.

l A risk assessment relating to the service user and generally in the home.

l The records and reporting processes of the home.

The inspection was vigorous and concluded that the registered person and the staff had done everything in an exemplary manner. Record-keeping was of a high order, risk assessment processes for the general day-to-day running of the home were in place and this was replicated for all individual service users. Care plans were detailed and there were regular reviews and reassessments of service users' needs. All procedures required under the legislation had been followed.

There were sufficient staff on duty at the time the service user "went missing" and in fact the service user, who was reasonably mobile and in full command of his faculties, had arranged to go and see a friend in a neighbouring village. The home was aware of this and had undertaken, with the resident, a full risk assessment of this arrangement in a discrete and measured way. This was fully recorded and signed by both the resident and the manager.

At the inquest it transpired that the resident had a heart condition of which neither he nor the home were aware. On returning from his visit he had decided to go for a walk in the local wood, where sadly his heart gave out.

The records, systems and processes operated by the home were presented at the inquest when the provider was called to account, and the inspectors gave evidence to verify that all regulatory requirements had been followed.

The efficiency of the registered person, the staff and the home's overall commitment to good record-keeping, proper procedures and risk assessment was validated. No blame was attributed to the home, its management or any individual member of staff. In short, adherence to the so-called "red tape" protected the provider.

"Just a minute!" I hear people say: "it didn't protect the service user". Well, yes it did; it protected his rights. The service user did not die because of negligence. By involving the service user in assessing the risk involved in exercising his choice to go and visit a friend, and by enabling him to exercise his choice, he was free to see someone he cared about and to walk quietly on his own in a peaceful part of the countryside. It was inevitable that his heart was going to fail at some time and if this had happened in the care home it would not have caused such a concern.

This story raises all sorts of issues relating to our view of old age, service user empowerment, assessment and management of risk. Most of all it shows that the regulatory requirements and the relevant national minimum standards relating to records, record-keeping, procedures, assessment and review of care needs are important. They are not bureaucratic processes designed to impose unnecessary burdens on staff and managers. They are designed to provide evidence to support the decisions taken and to back up the approach a home takes to any situation.

If this care home's records and record-keeping had not been of a high order, the ending to this story could have been very different. Not least because the emphasis on service user empowerment and freedom to exercise choice would have been lost in the rush to pillory the care home provider and staff.

So the message is clear, "red tape" is important; it can bind the functions of a care home together and provides a framework in which difficult risk decisions can be taken with confidence.

The real challenge for both provider and regulator is to ensure that the administrative and management processes which can flow from "red tape" are applied in a measured and thoughtful manner. These should be kept to a minimum but not watered down to the extent that they become meaningless and, as a consequence, fail to protect.

Future of the NCSC   

The National Care Standards Commission is the independent public body responsible for the inspection and regulation of social care services, nurses' agencies and private and voluntary health care services, totalling approximately 40,000 care establishments in England. The NCSC places the interests of people who use services at the heart of its operations and ensures that these services are run in accordance with national minimum standards and legal requirements. 

At present there are several organisations within government and independent of it that have responsibility for regulating different aspects of social care and health care in both the public and private sectors. The need for a more unified approach has been recognised and changes are set to take place.  The NCSC will soon be evolving to form part of the Commission for Healthcare Audit and Inspection (CHAI) and part of the Commission for Social Care Inspection (CSCI). These commissions will take charge of regulating, inspecting and auditing the social and health care sectors.

The NCSC will carry forward to the new commissions its duties in protecting service users and its work with providers in raising levels of care, ensuring everyone receives care that meets legal requirements and national minimum standards.  

Until the time when the new commissions are established, the NCSC will continue registering and inspecting care services; investigating the complaints and concerns of service users and the general public; taking enforcement action where necessary and reporting back to government on the issues affecting the care sector in England.    

Heather Wing is director of adult services, National Care Standards Commission. 

Website  

www.carestandards.org.uk