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Chief inspector David Behan tells Craig Kenny why he wants inspections to focus on poorly performing care providers and shift the emphasis from providers' paper policies to users' experiences.

Thursday 25 November 2004 00:00

A volunteer with a service that gives breaks to informal carers has to send out for a neighbour to take her charge to the toilet because she is not registered as a personal care provider.

Is this regulatory correctness gone mad? The Commission for Social Care Inspection's chief inspector David Behan believes so. "It strikes me as barmy," he says.

Cases like this explain why the inspectorate plans a radical review of its inspection, regulation and registration regimes, which it set out in a consultation paper this week.

Within three years, the CSCI aims to transform the way it carries out inspections, giving less attention to care providers' policies on paper and more to the experiences of service users.

More time is to be devoted to stamping out bad practice. To help, the CSCI proposes recruiting paid informants, from mystery shoppers who pose as prospective customers to hairdressers and podiatrists who visit care homes regularly.

"We are clear we are not going to be able to deliver our vision and values by tinkering - we needed to hold a radical review," says Behan.

"People who are using services tell us they want inspectors to visit more often and unannounced. Just because inspectors are known to be coming, children in residential care don't want the meals to suddenly improve, and older people don't want flowers introduced."

By cutting back on announced inspections, the CSCI hopes to spring more unannounced visits on providers it regards as high risk. That means fewer visits to care homes regarded on past form to be of good quality.

Inspectors would spend less time "ticking boxes" and more on interviewing service users, while self-assessment would replace many of the paperwork checks. Behan hopes that the changes will free up 20 to 25 per cent more time to focus on taking enforcement action against bad providers.

To this end they also need to get more sources of intelligence. This is where the mystery shoppers come in. "We have closed six homes this year on emergency orders," says Behan. "A lot of our enforcement action is taken on the back of complaints and whistleblowing.

"If we get a complaint, one way to check the quality is to get a trained person to visit saying they are looking to place their elderly mother there. Mystery shoppers are used a lot in the retail industry."

Behan adds: "Where I came from, Blackburn, we had a view about what is a good pub, what is a good care home. We need to tap into that community knowledge. But it's not about replacing our judgement."

As residential care gives way to home-based services and local authorities devise or commission innovative services that cross service boundaries, the CSCI is increasingly aware that its registration categories are becoming outdated.

A particular issue is that there is no distinction made between paid workers and volunteers.

"A number of sitting services have stopped operating because they don't want to be registered to provide personal care," says Behan. "Many sitters are volunteers in their sixties, who have had criminal record checks and some training, but don't want to become paid carers or take NVQ2 in social care. It strikes me as barmy that they are not able to provide that support and care."

The CSCI also wants to do away with unnecessary repeats of "fit person" interviews every time a manager switches roles, develops a new service or opens a new branch.

It aims to develop a set of regulations and standards based on what clients want from a service, such as choice, independence, consistent and competent services and safety.

The growth in commissioned services and direct payments has left many people not knowing where to complain to, so the CSCI still has a long way to go to raise its profile.

"It's important that people know who we are and what we stand for, that they know they have some redress and there's somebody on their side," says Behan.

Inspecting for Better Lives: Modernising the Regulation of Social Care, CSCI consultation document, 2005-8. Available from www.csci.org.uk

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