Learning from experience

In the summer of 2001, Ann Parker, chairperson of the National
Care Standards Commission, described the organisation as “arguably
the most important new social care institution created for many
years”.

Prophetically, if unintentionally, she put “survival” at the top of
its list of objectives. Since then, the brief story of the NCSC has
been one of missed opportunities, wrangling over standards, and
creaking bureaucracy. It has been a remarkably expensive and
short-lived white elephant and it has just one more year to
survive. After that, it will merge with the Social Services
Inspectorate in 2004 to form the Commission for Social Care
Inspection. This should provide a chance to learn from the NCSC
experience.

The controversial new standards provided the first missed
opportunity. The commission became embroiled in squabbles over
secondary issues such as room sizes. The standards were blamed for
closures of homes for want of a few square centimetres in rooms
that had suited residents for years.

And then, humiliatingly, the government did a U-turn and amended
some of the most contentious standards. So, the NCSC lost the
fight, and could be seen as letting down all those who had expected
it to take a stand.

The second missed opportunity was linked to the first. The idea
that inspectors would concentrate on outcomes – the results for
residents – was welcome. But most inspections had failed to do
this. Generally, inspection consisted of reading, measuring and
counting rather than listening, observing and taking part.

The NCSC had the opportunity to change this culture, but instead,
it entrenched it. Senior managers who designed and now run the
commission failed to grasp what the organisation was meant to do.
Inspection is there to contribute to the improvement of services,
to inform the public and to protect users. Services aren’t run to
pass inspections but to provide care.

Most inspectors would jump at the chance to concentrate on
outcomes. However, they are distracted by having to check
paperwork, collect statistics, and complete a 36-page report.

The commission has institutionalised the worst practice of local
authority inspection and squeezed out the best, all in the name of
standardisation.
In spite of all its resources, this organisation, which judges the
financial and operational plans of social care providers, failed to
produce its own business plan until the end of its first year of
operation.

For six months of 2002, inspection was virtually non-existent.
Inspections under the NCSC were the first in many homes for nine
months or more. The reports were badly designed, inconsistent and
incomprehensible. We were told they would be available online – but
they weren’t.

Some local authority units had already put inspection reports
online and had made many other advances in the process and
effectiveness of inspection. The use of lay assessors, and the
inclusion of residents and relatives in the assessment of homes,
were well established in some areas. But such developments have
been lost in inflexible and unimaginative procedures.

According to the recently published business plan, the NCSC is
willing to “listen and learn”. The commission now has a year in
which to redeem itself and hand over an effective organisation to
the Commission for Social Care Inspection. To do this it must
concentrate on the central task: inspect outcomes and produce
reports that tell the reader what they want and need to know about
the service.

John Burton is the author of Managing Residential
Care, Routledge, 1998.

The National Care Standards Commission has now been in operation
for just over a year. During that time, we have brought together
230 separate local authorities and health authorities under one
national umbrella. It has been a challenging time, which has seen
inspectors relocating to new offices, working with new legislation
and procedures, and using a new IT system.

Obviously there were things that we failed to get right straight
away, but we have always been open about issues, and have
endeavoured to work with providers and other stakeholders to iron
out any difficulties. The primary focus of the NCSC in its first
year has not changed – it is the welfare of service users. And it
is with service users in mind that we continue to strive for better
standards of care throughout England, now and in the future.

It is unfortunate that John Burton chooses to focus only on the
negative aspects of setting up a new national regulator. In this
year, the NCSC has completed inspections of well over 30,000 care
services, ensuring that service users are safe and well cared for.
Where we had concerns, we have acted swiftly, involving social
services and even the police where necessary.

In addition, we have established a customer services unit and a
fully functioning website to provide the public with up-to-date
information. We are also very close to publishing inspection
reports online – a substantial task when you consider that there
will be tens of thousands of documents to be made available.

The work of the NCSC is based on regulations and national minimum
standards that were developed by government, not the commission
itself, after extensive consultation with service users and
industry. They underpin the belief that people receiving care have
the right to expect a basic good quality of service, no matter
where they live.

The NCSC puts service users at the heart of its operations. We
expect inspectors to focus on service users throughout the
inspection, asking them directly about their experience of the care
provided. Another part of the inspection process is, rightly, to
inspect paperwork, including risk assessments and checks on staff –
areas of vital importance. This forms only a part of the overall
picture.

We have also received much positive feedback from providers about
the inspection process. Many are happy to state on record that
inspectors were professional and thorough, and encouraged them to
view their services in a way that would lead to improvements for
service users.

On the subject of room sizes, the commission has not closed down
any care homes based purely on the size of its rooms. Homes have
closed in the past year for many reasons including the proprietors
wishing to realise the value of their property, retirement of the
owners, and issues concerning under-funding. The NCSC only takes
steps to close a home when the safety of service users is in
jeopardy.

The commission made clear its disappointment at the decision by
government to amend the standards concerning room sizes before it
had a chance to assess the state of the market. We will be
reporting to government in due course on the effect of this
decision, as well as on other factors affecting the care service
sector, once information gathered from first-year operations has
been collated.

In conclusion, the NCSC will take forward into the Commission for
Social Care Inspection the best practice identified during this
initial year. We will also continue to listen and learn, and
encourage everyone in the care community – be they user, provider,
relative or carer – to talk to us.

Trish Davies is corporate policy director of the
NCSC.