News

A quiet revolution has taken place in the social care sector this week. But fear not if you missed it because, when the Commission for Social Care Inspection for England went live, there was no fanfare to mark its arrival.

The new commission takes on the work of the National Care Standards Commission, the Social Services Inspectorate and its joint reviews' assessments of value for money carried out with the Audit Commission. Its launch represents a major overhaul of inspections but it will take time to make an impression following its low-key launch.

For the next year at least, it will be business as usual for inspectors, service users and providers, says the commission's chief inspector David Behan. "We are trying to strike a balance between continuity and change. The planned inspection programme will not be complete until next year. For some people there will be little change. A manager of a residential care home, for example, will see very little difference."

Doubtless that will be welcome news to care home managers who were unsettled by the announcement that their new inspectorate, the National Care Standards Commission, would be replaced by the commission just weeks after it went live in April 2002.

This decision "inevitably coloured" the NCSC's relationship with the care home sector because of the knowledge it would soon be replaced, says James Churchill, chief executive of the Association for Real Change, formerly the Association for Residential Care.

He believes good work has been started by the NCSC, which should be continued by the commission, but adds there is scope for improvement.

Top of his wish list for the commission is that it introduces inspections that are "closer and more relevant to the service user". The preoccupation with ticking boxes about issues such as room size fails to capture how well the service user's needs are being met, he says.

This wish may be fulfilled. While inspections may go on in much the same way as before in the immediate future, Behan says work is under way to examine the current framework of inspection and regulation and to look at how it can be integrated and improved.

He says: "We want to ensure that inspections will be simpler so less time is spent doing paperwork and more time is spent speaking to people. We need a better balance between looking at the essential components of the service and speaking to people about how they experience it."

The inspection process itself may also be changed. For example, the inspection of adoption and fostering, currently carried out separately by the NCSC and the SSI, could be combined into one.

Much more emphasis will be placed on service users, and Behan says ways to involve them more are being considered including encouraging service users to accompany inspectors on visits to give their input.

High-scoring care homes will be rewarded with fewer inspections, in much the same way as three-star councils have been given greater freedoms and lighter inspection regimes.

Behan acknowledges that staff training will be of paramount importance. A course designed to make staff from different professional backgrounds feel they belong to the same organisation and a performance management system will be introduced. The commission has 2,300 staff from the NCSC, 300 workers from the SSI and about 30 from the Audit Commission.

Staff formerly employed by the SSI and the Audit Commission will be familiar with the personal development plans, which allow the employer and employee to guide careers, but for staff from the NCSC it will be a new departure.

Among the issues covered by the personal development plans are training needs, which will be welcome news to many care home owners who have complained in the past that the inadequate training given to inspectors when they joined the NCSC led to inconsistent inspections around the country.

Churchill hopes that it will also be easier under the commission to report problems with the way inspections are being carried out and to communicate issues over the appropriateness of some standards, which may be interpreted differently from place to place.

But while there is widespread agreement on the virtues of a single inspectorate, there are concerns too. Liberal Democrat spokesperson on older people Paul Burstow questions whether the commission's much-celebrated independence from government goes far enough. The commission will enjoy greater freedoms than its predecessors but Burstow wants reassurances that it will truly demonstrate this independence. "I hope it will be prepared, if it finds evidence that concerns about social care are down to government policy or government under-resourcing, to say so.


"The legislation that sets up the commission still puts too many strings in the hands of the secretary of state. It is still too close to government for my liking. The act of parliament under which it is set up says the secretary of state will issue directions on how it will conduct its work."

But, despite his reservations, Burstow says the creation of a single social care inspectorate is a step in the right direction.

"We need a whole systems watchdog for social care and health that will follow a person though the whole health and social care system. We are still missing a trick."

New or enhanced responsibilities of the commission for social care inspection

• Encourage improvement in the quality of social care services
  The commission will use evidence gathered through the inspection process to help councils and staff improve their services.
• Encourage improvement in the quality of registered services
  The commission will keep a register of social care providers and offer them advice and guidance.
• Assess use of resources and appropriateness of services
  A key function is to assess whether councils deploy their resources effectively when providing social care services. One measure of effectiveness will be whether the services delivered actually meet the needs of the people using them.
• Social care research
  The commission has been given the power to comment on research and to carry out its own research. It may also carry out specific studies into any aspect of social care services, for example, into whether particular models of care are effective.
• Investigate complaints
  The Health and Social Care (Community Health and Standards) Act 2003 makes provision for the secretary of state to transfer responsibility for stage three of the process of investigating complaints against councils to the commission.
• Report annually to parliament and ministers
  The commission will report on the performance of social care services overall, the state of social services provision in England, and how social services resources have been used. For the first time, this function has been written into legislation.
• Integrate inspection and assessment across the social care sector
  The commission will inspect and assess commissioners and providers of social care services. For the first time, one organisation will be able to see the whole picture. It will be possible to track the service provided for an individual user from the initial point of assessment through to the planning and delivery of the services they receive.
• Collaborate with other inspectorates
  The commission will be working closely with the Commission for Healthcare Audit and Inspection, Ofsted, and the Audit Commission. Criminal Inspectorates will also participate in this work.
• Take action when services do not meet minimum standards
  The commission will have the power to issue notices to service providers to enforce the regulatory requirements of the national minimum standards. It will also have the power to issue notices to local councils when services are not improving where they should.