Will social care play second fiddle when inspections regime merges?

When the Commission for Social Care Inspection was launched last
April, chair Denise Platt joked it would do well to outlast its
predecessor.

The National Care Standards Commission had been in existence for 17
days when its abolition was announced in April 2002. Unfortunately
for Platt, her joke has come back to haunt her.

Last Wednesday, chancellor Gordon Brown announced the CSCI would be
dismantled, with its children’s functions handed to education
watchdog Ofsted and its adult responsibilities to the Healthcare
Commission.

It is part of Brown’s aim to reduce the cost and the burden of
inspection on front-line workers by merging the 11 main public
service inspectorates into four bodies.

There has been talk of the move, which will come about in 2008,
since last summer’s Gershon efficiency review criticised public
sector regulation and the duplication of work.

Since then, all the inspectorates have emphasised their work to cut
duplication and make regulation proportionate to risk and focused
on user outcomes.

Strategic regulation was the idea invoked against those who called
for a cull of inspectorates, with the CSCI’s planned reforms of
social care regulation set out in Inspecting for Better Lives
fitting this tradition.

The chancellor’s announcement drew a blunt response from Platt, who
said she was “disappointed” that social care regulation faced “a
further period of instability” and that the CSCI would have to
modify its plans.

A week on, the reaction from the CSCI is more pragmatic. Chief
inspector David Behan says he is confident that the Department of
Health will give the CSCI its full support in delivering its
reforms until 2008.

He says: “Last week we were disappointed, frustrated and angry.
This week we have had to move on from that. We are determined to
continue modernising regulation. We’re still on the pitch.”

Among social care bodies, charities and think-tanks, there are
fears that Brown’s proposals will be disruptive.

English Community Care Association chief executive Martin Green
says: “It will be an enormous loss of time and energy to deliver
the CSCI’s ambitious plans if they are diverted by the need to
undertake structural change. Constant change such as this is
destabilising.”
But disruption is only one side of the story.

One of the CSCI’s greatest selling points was its exclusive social
care focus when government policy, particularly in children’s
services, was forcing the pace of integration.

There are fears that this perspective may be lost, or at least
significantly diluted.

On the children’s side, the government wants Ofsted to take over
the CSCI’s children’s functions, a point reflected in the opposite
reactions of Platt and Ofsted chief inspector David Bell. He says:
“I am delighted with these developments, which are testimony to the
work Ofsted has done to date and the government’s confidence in our
capacity to deliver on a broader front.”

This will only inflame the nagging worry that children’s social
care will be subordinated to education in integrated children’s
services.
Tony Hunter, president of the Association of Directors of Social
Services, says: “I see this not as an expansion of Ofsted but a
merging of Ofsted and CSCI functions to create arrangements that
embrace the entire Children Act 2004. If there’s any compromise it
would not be good news for the delivery of the Act.”

Paul Ennals, chief executive of the National Children’s Bureau,
says there were similar fears when Ofsted took over early years
inspections in 2001, but it has proved itself up to the task of
regulating care services.

Although he sees the move as a logical consequence of integrated
children’s inspections, which will come into force this year, he
has reservations. He says: “I don’t think anyone should fight for
the maintenance of those old organisational boundaries. But I’m
concerned that the concept of social care for children is becoming
seriously diluted.”

He cites the low profile of social care for children at the
Department for Education and Skills and the Social Care Institute
for Excellence as symptoms of the same problem.

On the adult side, the government’s rhetoric is one of “merger”,
not takeover.

However, it is perhaps instructive that the Healthcare Commission
has reacted positively to Brown’s announcement. Chief executive
Anna Walker says: “The barriers between health and social care have
been evaporating for some time, so this is a natural step.”

Not so, say adult charities, which see the CSCI’s efforts to put
the user centre stage and emphasise rights as running counter to
the Healthcare Commission’s approach.

Claire Kober, policy manager at disability charity Leonard
Cheshire, says: “An enforced merger with the Healthcare Commission
not only threatens to ‘medicalise’ social care, but also silences
service users.”

Stephen Lowe, policy officer at Age Concern, says: “CSCI has made
it clear that they would base regulation on human rights. I’m not
sure how aware the Healthcare Commission is about human
rights.”

The proposal has exacerbated perennial worries that social care
will be further subordinated to acute health, given the latter’s
dominance of the political stage.

Scie chief executive Bill Kilgallon says: “I think it will be
important in the new arrangement that social care is not seen as a
service that’s just there to assist the NHS.”

One organisation to give the plans a relatively warm reception is
the Local Government Association, which has been fighting a pitched
battle with the government to reduce the burden of regulation on
councils.

Simon Milton, chair of the LGA’s improvement board, says the
reforms are positive: “A streamlined body of inspectorates could
help ensure that councils are no longer subjected to wasteful,
unnecessary inspection regimes.”

But fewer inspectorates may not mean fewer or better targeted
inspections, says Milton. “Only local authorities’ experiences on
the ground will give us a clear measure of the difference today’s
streamlining proposals will make,” he says.

Kilgallon says social care has much to teach health and education.
“Social care has been much further ahead in terms of developing
personalised services for people,” he says. “The CSCI will be able
to bring that experience and knowledge to Ofsted and the Healthcare
Commission.”

This depends on whether the proposals bring about a true
integration of social care inspection with that of health and
education – or its subordination.

The sector’s historic Cinderella role next to its more illustrious
public service cousins leads many to believe the latter is the more
realistic outcome.

Criminal justice on same path 
Perhaps the most radical proposal on public sector
regulation is the plan to merge the five criminal justice
inspectorates together.

However, it has raised serious concerns that the Prisons
Inspectorate’s championing of human rights in custodial settings
will be blunted when placed alongside the service-based concerns of
the other regulators.

In her annual report, published in January, chief inspector Anne
Owers said: “Custodial inspection focuses on the culture and detail
of individual establishments not the system as a whole; it employs
human rights-based criteria, not service standards government
targets.”

She added: “I remain concerned that, over time and in practice, the
sharp focus and robustly independent voice of the Prisons
Inspectorate will be lost or muffled in a larger whole.”

Some see a sinister purpose in the proposed reform, given the
inspectorate’s reputation for giving governments a bloody nose on
penal policy.

Frances Crook, director of the Howard League for Penal Reform,
says: “Since the Prisons Inspectorate has been set up it has been
very challenging. I think [ministers] find it difficult.”

Echoing Owers, she says a combined inspectorate “would be about
service delivery rather than human rights”.