Powers to hold social care staff and services to account will undergo a radical transformation with the introduction of a Regulation and Inspection Bill into the National Assembly for Wales in 2015.
The planned bill, set out in a white paper last year, is a ‘sibling’ to the Social Services and Wellbeing (Wales) Act 2014 which received royal assent earlier this year. Taken together, the two pieces of legislation have been described as the “most significant legal change” to social care in Wales since devolution.
Powers for social care regulation in Wales are currently largely provided for by the Care Standards Act 2000 but other legislation including the Health and Social Care (Community Health and Standards) Act 2003 and the Local Government 2011 Measure for Wales have also had an impact.
The white paper sets out five reasons for reforming inspection and regulation in Wales:
- supporting the changes to social services brought in by the Social Services and Wellbeing (Wales) Act 2014;
- increasing the voice of service users and carers in the inspection system;
- developing a coherent Welsh approach to regulation to take account of changes elsewhere in the UK, including the fact that the Care Standards Act no longer apples in England;
- responding to high-profile failures of care, such as those at Winterbourne View;
- creating a framework for regulation that is flexible enough to keep pace with changes to social care.
Workforce regulation
The social care workforce is currently regulated by the Care Council for Wales, an arms-length agency of the Welsh government. The bill does not propose to make significant changes to this existing framework, but it does set out plans for a reconstruction of the regulatory body.
The Care Council for Wales would retain its regulatory functions but would adopt the new name of a National Institute for Care and Support and would lead on improvements such as “acting as an information hub for best practice” and “supporting the development of research”. The ambition is that the regulator would evolve into a college of social work and social care.
Regulation of the workforce itself will continue in its current approach, where professionals who are required to register are placed on the national register for social care workers, which was established by the Care Standards Act 2000.
Social workers, social work students, adult care home and domiciliary care managers, and residential childcare managers and workers will continue to be required by law to register. The white paper also proposes a new legislative provision that would regulate new workforce groups, as and when they emerge.
However, the bill would not extend regulation to cover the entire workforce. In a written statement summarising consultation responses to the white paper, former deputy minister for social services, Gwenda Thomas, said: “Many respondents argued powerfully to extend the current range of registration to a range of workers in our sector.
“Whilst the extent of regulation of the workforce would not necessarily be set in primary legislation, I will seek to be clear in our intentions in this area when I lay the Bill in 2015. I do not foresee, at this stage, that registration will cover our entire workforce.”
Foster carers and staff who provide advocacy services have been highlighted as examples of groups that may be registered in the future.
In addition, social workers will continue to be registered on the basis of protection of title, which means that only social work professionals registered with the workforce regulator can use the term ‘social worker’ to describe themselves in their work.
The additional key aspects of workforce regulation reform are:
• An updated workforce register that distinguishes between different social work roles, in order to better reflect and protect the varying levels of qualification and practice within the profession;
• The removal of voluntary registers, which have previously allowed social care professionals to register themselves on a voluntary basis, in order to prevent confusion for the public and workers of a low standard from falling through the net;
• Managers of care services will no longer be required to register with both the workforce and the service regulator. Managers should register only with the workforce regulator, in order to ensure they are primarily accountable for service delivery
Gwenda Thomas, former deputy minister for social services in Wales, said: “Regulation of social care has been a success story in Wales – it has delivered real benefits for those who rely on our care homes and social care services but we are not complacent.
“Our new approach is strong, robust policy that builds on this success to ensure the safeguarding of all people with a care and support need and promotion of wellbeing.”
Thomas stepped down from her post as deputy minister for social services on September 11, following a surprise cabinet reshuffle. The long-standing minister has played a key role in a number of social services committees, including chairing the safeguarding vulnerable children review and leading on the landmark Social Services and Wellbeing Bill. She is replaced by Vaughan Gething, who takes on the role of deputy minister for health.
Service regulation and inspection
The new regulation and inspection regime for service providers will be built around four key areas: outcomes, transparency, flexibility and accountability.
The Care and Social Services Inspectorate for Wales currently undertakes the regulation and inspection of care service providers. This service is delivered from inside the Welsh Government with a number of safeguards in place to ensure professional independence.
The table below sets out the key aspects of service regulation and inspection reform, and compares them with the situation in England.
| WALES | ENGLAND |
|---|---|
| A service based model of regulation will be introduced. Providers must register to deliver in particular service areas such as residential or domiciliary care, rather than registering individual establishments or agencies, as now. | This approach already exists in England but the Care Quality Commission (CQC) will now also check that providers who apply to be registered have the right values and motives, as well as ability and experience. |
| The service regulator must now also include service users and families to inform practice and a legal provision, which has not existed previously, will be introduced to enforce this. | The CQC will make more systematic use of people’s views and experiences of care, including complaints. |
| CSSIW currently regulates and inspects services against a set of national minimum standards established by the Care Standards Act 2000. These will continue to be used but the impact services have on users will now also be a key measure of delivery. Providers will have to demonstrate that outcomes of people are at the heart of service provision. | Person-centred care tops the list of the CQC’s new fundamental standards of quality and safety. All providers must now demonstrate that they design and deliver care that is appropriate for each individual and, if they are unable to do so, applications for registration may be refused. |
| Inspection reports are currently available to the public but the reforms would see all providers expected to publish an annual report on their services and a legal provision to sanction submission of false or misleading information may be introduced. This annual report would also be publicly available and would be a requirement of remaining on the register. | The CQC does not set out a specific plan but it states that reforms will involve working more closely with providers, commissioners and other sector bodies to develop information sources on the quality of care provision. |
| Currently, each provider must identify a ‘responsible individual’ to be accountable for service delivery. The reforms seek to strengthen the arrangements for the role of the individual, by introducing a way of assessing whether the person is able to prove they occupy a senior position and are a “fit and proper person” to hold this role, but the bill does not set out plans for how the regulator will do this. | Reforms in England will see the introduction of a “fit and proper persons” test for the ‘responsible individual’. Directors of providers must pass this before their services can be registered. |
| A registration fee will be introduced for providers. Wales is unusual in that the current arrangement allows providers to register for free. New powers will be introduced to enable the regulator to charge an appropriate fee for initial and ongoing registration. | This already exists in England – each registered provider pays a single annual fee to cover all registration and compliance requirements |
Reaction to reforms
Many social care professionals have welcomed the proposals for reform, but some have expressed concerns that the bill could do more to change the current regulation and inspection landscape.
Donna Hutton, regional organiser at Unison Wales, said: “Unison would like to see the regulation and inspection legislation ensure the registration of all social care professionals because care workers are only going to be taken seriously and properly paid when they are professionally recognised. We are keen to continue to play a part in shaping the legislation.”
Mario Kreft MBE, chair of Care Forum Wales, added: “Although we have some concerns, the new Regulation Bill is a step in the right direction because after nearly 15 years of the Care Standards Act, we have matured and moved on.
“The Bill is the legislative template for a new approach, putting the responsibility where it should be and that is with providers.”
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