Low-key start to new commission heralds a big inspection shake up

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.