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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."