Expert Guides

Social care inspection and regulation in England has been revolutionised since 2000 with significant reforms to inspection standards, inspectorates and the government's approach to targets.

Social care is assessed in two distinct ways. Local authorities are judged on their success in implementing government policy, managing public resources and responding to the needs of their communities. And social care providers, from public, private and voluntary sectors, must register with inspectorates and then face regular assessment and inspection. As with social care policy more generally, adults and children's services are assessed separately.

Inspectorates:

The Commission for Social Care Inspection assesses councils' performance in adult social care and registers and regulates adult providers. In April 2007, Ofsted took responsibility for these functions in relation to children, from CSCI. Under the Health and Social Care Bill, a Care Quality Commission will from 2009 assume responsibility for CSCI's adult social care functions, alongside the Healthcare Commission's health regulation role and the Mental Health Act Commission's function of upholding the interests of people detained under mental health legislation.

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Local government: present

Local authorities are currently assessed annually on their performance in adults and children's services, through the star ratings system managed by the CSCI and the annual performance assessment, provided by Ofsted, which also carries out three-yearly joint area reviews of children's services.

Adults:

Star ratings were introduced in 2002 and since 2006 have only applied to adult social care. They tend to be published each November, but are based on performance in the 12 months up to the preceding March. In the 2006-7 ratings, which refer to performance from April 2006-March 2007, councils showed gradual improvement with 81% receiving at least two stars, up from 78% the previous year.

Councils are assessed in line with CSCI's performance assessment framework, which was reformed for the 2006-7 performance year. It is now based on the seven outcomes in the Our health, our care, our say care services white paper, published in January 2006: improved health and well-being, improved quality of life, making a positive contribution, choice and control, freedom from discrimination, economic well-being and personal dignity. In addition, councils are judged on leadership, commissioning and use of resources.

Within the PAF is a set of performance indicators, against which councils are judged. CSCI makes its judgements on the basis of self-assessments provided by councils, targeted inspections and meetings between authorities and CSCI business relationship managers.

Children

The Children Act 2004 introduced radical changes to the assessment of council children's social services. Since 2005, councils have received an annual performance assessment (APA) of all of their children's services, notably education and social care. And by 2008, each authority will have received a more comprehensive joint area review (JAR) of services for children, which also include an inspectin of council services and look at outcomes for children in non-local authority provision, such as health and criminal justice services. Both the JAR and APA conform to a framework for the assessment of children's services based on the five outcomes laid out in the 2003 Every Child Matters green paper: being healthy, staying safe, enjoying and achieving, achieving economic well-being and contributing to the community.

Under the APA, each council receives a rating, from one to four, on their overall children's services performance, and individual ratings for each of the five outcomes. A separate children's social care star score was published until 2007.

Ofsted was due to publish its 2007 annual performance assessment scores for English councils in December.

Local government: the future

The APA, JARs and adult star ratings will be scrapped in 2009, and replaced by the comprehensive area assessment - a single inspection and assessment system for local authorities for all the services they commission or deliver, singly or in partnership.

The Audit Commission is currently consulting on how this will work. It is likely to include

The CAA is likely to include: a "risk assessment" by all relevant inspectorates detailing the quality of life in an area and its prospects; a direction of travel assessment of the council, detailing its potential to improve; and a judgement on councils' use of resources.

It will be informed by the much-reduced set of 198 national indicators for local government, published in October 2007 as part of the 2008-11 comprehensive spending review.

It will also be informed by Ofsted and the Care Quality Commission's assessment of council performance in children's and adult social care services. Both inspectorates will produce performance assessment frameworks for this purpose.

Some debate remains over whether councils will also receive a score for children's or adults' services. The Department of Health has said it has no plans to retain a scoring system, though it is rumoured this is under consideration.

In most cases, the periodic inspection of council services will cease, with inspections largely triggered by concerns raised in the area risk assessment. However, there are a few inspections. Councils will receive a three-yearly inspection of their performance in relation to looked-after children, and the government is also considering whether to introduce similar regimes in relation to other services for "vulnerable people", including elements of adult social care.

Alongside the CAA, councils and their partners will also be assessed through local area agreements. Under reforms introduced through the Local Government and Public Involvement in Health Act 2007, public bodies in an area must select 35 from the 198 national indicators, according to local needs. Provided these are accepted by their regional government office, the partners and government sign a three-year LAA, under which they will be assessed on their performance against these indicators. The LAA is backed by a grant, which rolls together a number of previously separate government funding streams and is designed to provide councils and their partners with financial freedom.

One issue raised by LAAs is how far local areas will choose social care-related targets among their 35 indicators. The Youth Justice Board and Naomi Eisenstadt, director of the social exclusion taskforce, have both urged councils to select targets relevant to their agendas.

The reforms mark a shift in the government's approach to assessing public services - from one with many targets, heavily prescribed specific grants and regular inspection to one of fewer targets and more freedom for local public bodies. Under this model, inspection and intervention are reserved for those organisations and areas which are unable to improve themselves.

Provider regulation:

Adults:

All providers of care and nursing homes, domiciliary care, adult placement schemes and nurses agencies in England must apply to register with CSCI, showing that they meet relevant reguations under the Care Standards Act 2000 and the National Care Standards (Registration) Regulations 2001. Each organisation must appoint a "responsible individual" - a senior person in a managerial role - who must show they also meet regulatory requirements, including by undergoing an enhanced Criminal Records Bureau check.

Registration is then granted, refused or granted with conditions. Applicants can appeal to the relevant CSCI regional director and then to the independent care standards tribunal if they are not satisfied with the decision.

All registered providers are inspected. Until 2005, frequency of service was generally the same for each service (though poor performers were visited more frequently), for instance twice a year for care homes. However, under reforms introduced that year, CSCI ruled that services would face comprehensive key inspections a minimum of once every three years, with more frequent inspections for poorer providers.

This has since been redefined in line with the new star ratings regime for care providers, due to come into force in 2008: three-star providers will face an inspection once every three years; two-star services will have one every two years; one-star providers will face an annual visit and zero-star services a twice-yearly inspection.

CSCI has justified the changes in terms of being a better use of its resources, with attention paid to those providers who most need it. It has also pointed out that it carries out random inspections where a particular issue arises in a service, including potentially two- or three-star services, and thematic inspections, to identify national trends. Each service that has not received an inspection receives an annual service review, summarising all the information CSCI has received on that service this year. This includes the annual quality assurance assessment - which all providers must fill in, assessing their performance.

The new regime has proved unpopular with certain groups, including adult protection campaigners and even some CSCI staff amid fears that less frequent inspections will remove valuable safeguards.

The registraiton and regulation system will become the responsibility of the Care Quality Commission by 2009.

Children

A similar system of registration applies to children's services, which has been within Ofsted's since April 2007. Under this system, independent fostering, adoption and adoption support agencies, children's homes, both open and secure, residential special schools and residential family centres must register with the inspectorate, and then face regular inspection.

The government did propose to change the frequencies of inspection for some children's services along similar lines to the reforms in adult services, with inspection frequency in inverse proportion to performance.  

However, while plans to change the minimum frequency of inspection for fostering agencies and residential family centres from once a year to once every three years, proposals for the best children's homes to be inspected once a year with the worst receiving at least three visits were dropped. All children's homes, as before, will continue to be inspected twice a year.

Workforce

Unison represents staff at Ofsted and the CSCI, whilc regulatory staff have professional representation through the Social Care Association, which in January 2007 absorbed the former Care Regulators Association.

Scotland

In Scotland, social work functions provided by or on behalf of local authorities are inspected by the Social Work Inspection Agency, set up in April 2005.

The Scottish Commission for the Regulation of Care, better known as the Care Commission, handles the registration and regulation of care services for both children and adults.

Wales

As of April 2007, Wales has had a joint regulator and inspectorate for social services for children's and adults. The Care and Social Services Inspectorate Wales replaced the Social Services Inspectorate for Wales, which previously assessed councils, and the Care Standards Inspectorate for Wales, which previously regulated care services.