news analysis of the health secretary’s proposal for a new regulation body

David
Brown looks at the implications of separating the roles of
inspection and policy development in the health secretary’s proposal for a new
regulation body.

Two
weeks after plans for a Commission for Social Care Inspection were announced
its remit remains vague. This has led some MPs to quip that the secretary of
state for health Alan Milburn has mislaid the cigarette packet on which he drew
up his proposals.

However,
the few sketchy details published in Delivering the NHS Plan have still
proved enough to fuel speculation about Milburn’s vision for the new inspection
and registration body.

Early
clues suggest that the social care functions of the recently launched National
Care Standards Commission will fit smoothly into the new commission, as will
the inspection functions of the Social Services Inspectorate.

Milburn
says the new commission will be "independent" and will publish a
report to parliament on national progress on social care, as well as an
analysis of where resources have been used.

But
it is unlikely to take over all its new functions for at least two years. The
government could put forward the legislation required to create it this summer,
although it is more likely to appear in the Queen’s Speech in the autumn and be
followed by a period when the new commission will shadow the NCSC.

Chairperson
of the National Care Standards Commission Anne Parker believes that all the
NCSC’s social care functions, including those relating to children, will be
merged into the new commission.

However,
she admits that some people may question its future work in education, which
currently comprises inspections of boarding schools, residential special
schools, and further education colleges alongside Ofsted and the Independent
Schools Inspectorate.

Whatever
the eventual make-up of the new commission, it is likely to have more freedom
to set criteria and to criticise the government than either of the current
bodies.

"In
Milburn’s modernising speeches, the role of central government has been very
much strategic, setting the framework that people will work to, and then making
sure that they are accountable to an independent inspectorate," says
Parker.

"The
SSI’s analytical and policy functions will fit in very well with our duties to
report on financial and market issues that might impact on the way the
government chooses to make its social care policies.

"But
I am sure there are some people that the Department of Health will be keen to
keep and if I was Alan Milburn I would say you can not take X, Y or Z," she
adds.

Despite
the announcement of the NCSC’s demise just 17 days after its launch, there is
little sense of gloom within the organisation.

"The
vast majority of staff are involved with inspections and saw straight away that
their jobs will continue," says Parker.

"When
I took this job, I looked around and it was clear to me that there would be
some realignment – although I did not really expect it to occur quite so
soon."

Simon
Spoerer, chairperson of the National Association of Inspection and Registration
Officers in England (Nairo), says: "The government recognises that day to
day political interference is not the best way to organise a service in the
medium and long term.

"It
will clearly want to include consultation on policy in the role of the commission
– so it can contribute to the government’s thinking – but there is a question
of the degree to which it should be the originator of the thinking."

Although
Nairo has been surprised at the announcement of the merger, it accepts that
there may be some advantages.

"The
devil will be in the detail," Spoerer adds. "I would suspect that
Nairo members would not support any proposals to move children’s services away
from the current set-up. There are excellent opportunities for
cross-fertilisation and development across the services at present."

Paul
Burstow, the Liberal Democrat spokesperson on older people, says changes to the
inspection system are needed because of the "overwhelming" number of
targets and criteria for social care emanating from Whitehall.

"What
is needed is an independent body that can set the inspection criteria," he
says, adding that central government would still set the framework and shape
the criteria through its policies and guidance as well the judicious use of
specific grants that can be used to pump-prime services.

Burstow
believes that making the commission report to the House of Commons health
select committee would strengthen its independence from political interference,
adding that a similar reporting system works well for the National Audit
Office.

Chief
Inspector at the SSI Denise Platt sees the proposed new commission, which would
take on many of the SSI’s functions, as "a big boost for social
care", giving the sector its own inspection and regulation service.

"The
government will continue to set standards and responsibilities, but the
commission will have the ability to comment on the standards and the
policies," she explains.

The
new commission will also have a strong working relationship with the new body
proposed to cover the health care sector, the Commission for Healthcare Audit
and Inspection. Milburn had considered creating a single commission to cover
both health and social services, but felt the difficulties that the Commission
for Health Improvement was experiencing in terms of coping with the scale of
its task had made the move too risky in the short-term.

"The
two inspectorates will work together as if they are one," predicts Platt.
"They will have powers to delegate responsibilities between them that will
strengthen the links."

She
also has a major decision to make over her own future. She is currently
director for children, older people and social cares services at the Department
of Health as well as chief inspector – a situation that has been criticised for
undermining her independence.

A
further 19 SSI staff have policy-creating positions within the DoH that are
unlikely to fit in with the new commission’s role.

Platt
has accepted that her two roles must be split but refuses to discuss which she
will choose. However, few can imagine "the most powerful person in social
care" voluntarily giving up her throne in Whitehall.

Social Services Inspectorate and the DoH

The
Social Services Inspectorate, set up in 1985, is best known for inspecting
social services and assessing councils responsible for providing social care.

However,
it also provides policy advice within the DoH and manages the department’s
links with social services departments and social care agencies. SSI inspectors
are based within the DoH’s policy branches to provide advice and expertise to
ministers and policy makers.

Denise
Platt, the chief inspector, was recently voted by a panel of experts in the
field as the most powerful person in British social care. The former hospital
social worker became director of social services at Hammersmith and Fulham
Council, west London, before being appointed the chief inspector for social
services in 1998.

Her
duties include being the "principal professional social services adviser
to ministers" as well as being "responsible for overseeing the
development of social care policy". She has a leading role in developing
government policy as well as ensuring that it is delivered.

With
the confidence of Alan Milburn, Platt has ensured that social care gains a more
prominent role in government policy as witnessed in the recent Budget.

She
has now been given a key role in the development of the government’s agenda to
remove barriers between health and social services.

Her
new responsibilities include policy, services and legislation for health and
social care services for older people, children’s services, maternity and
health services for women, and general social care.