Author Archives: Stephen Lowe

Care providers demand more regulation shock

What do care providers want from regulation? Less of it might be a glib answer, and in the past there might have been some truth in this. However the new Care Provider Alliance ‘vision’ of social care regulation is in many respects a plea for more and better Regulation.

Inspectors should look, say the Alliance, not just at whether services are fit to be registered, but at quality, and should grade services on the basis of quality and of the outcomes they achieve. Regulation should be sufficiently rigorous to stop local authorities feeling the need to carry out their own inspections of services that they contract with. Regulators should take time to talk to service users and their families, whose views should form the basis of inspection reports.

Inspectors should be prepared to consider individual complaints from service users and their families. There should be a national framework of regulation in order to prevent local inconsistency in regulation. Local links between providers and inspectors, fractured by reform of the system should be repaired. Poor performing providers should pay more towards the regulatory system.

All of this is strikingly at odds with the views of the current government (and in it’s latter years, the previous one) that providers simply want reduced ‘regulatory burdens’, that the market will drive quality, and that inspection and regulation is a prime area for making cuts. As a result of successive cuts in funding the current regulator, the Care Quality Commission, operates on a much reduced budget of £164.4 million in 2009-10 compared to the £240 million spent by its predecessor organisations in 2005.

The Health Select Committee report on the CQC concluded that the CQC should have been more vocal in pointing out that it did not have the resources to carry out its statutory duties.

CQC has asked for 10% additional funding to carry out it’s duties and seems to be gaining allies in unexpected quarters. However supporters do want improved performance in return for more resources – the Care Provider Alliance wants the CQC to take some of it’s own medicine and to publish evidence that it is meeting it’s own quality standards.

Find out more about our care in crisis campaign

Read our briefing on the Dilnot Commission report on social care

Roundup – National Children’s and Adults Services Conference

This year’s ‘National Children’s and Adults Services’ (social care) conference, saw contrasting perspectives on the changing role of local authorities. Peter Hay, the current President  of the Association of Directors of Adult social Services, speaking at the morning session, welcomed the new leadership role of local authorities with regard to public health.

In the afternoon, by contrast, Andy Burnham, the new shadow Secretary of State was concerned that current reforms would result in a loss of local authority powers and of local accountability. Concentrating on the NHS and on education, his view was that reforms were dominated by provider interests. They hand huge power to GP’s and Head Teachers and take it away from service users. ‘In a world with no PCT’s,’ asked Burnham ‘how can patients challenge decisions by GP commissioners?’. He concluded that Parliament has not yet woken up to the full implications of these reforms.

The current Localism bill includes proposals for independent social work practices to take over local authority social work functions, so this raises the question of whether Burnham’s concerns will be an issue for adult social care. Independent practices are already being piloted, and in August the Secretary of State for Health issued the Contracting Out (England) order 2011 to ensure that the delegation of local authority functions to these practices is lawful. The order can be found here.

Whether this order was strictly necessary depends on what independent social work practices will be expected to do. Older people for the most part do not receive extended social work interventions. Their contact with social work is more likely to be through assessment, arranging services, and if they are lucky, subsequent reviews of their care and support arrangements. Continue reading

Caring for our future; shared ambitions for care and support

Last month the Department of Health announced that it intended to ‘co-produce’ the proposed social care reform white paper. This month, on the 15th of September it has launched an ‘engagement’, entitled ‘Caring for our future; shared ambitions for care and support’ which is intended as the first step toward making good on this commitment.

The content of the engagement reveals that the scope of reform is meant to go well beyond responding to the proposals of the Dilnot Commission on long term care funding or the Law Commission review of adult social care law.  However the government does ask for people’s views on the recommendations of the Law Commission and the Dilnot Commission ‘and on ‘how we should assess these proposals, including in relation to other potential priorities for improvement’.  So the DH is still thinking about the extent to which they intend to implement the proposals of the two commissions.

The engagement focuses on six key areas. These are;

  • quality – including improving quality and developing the future workforce;
  • personalisation – giving people more choice and control and helping them to make informed decisions;
  • shaping local care services in order to ensure a wide range of innovative and responsive services;
  • prevention and early intervention;
  • integration, in particular better connections between the NHS and local services; and
  • the role of financial services.

The engagement runs for three months. There will be a series of events and meetings which will be attended by six ‘discussion leaders’ drawn from the ‘care and support community’ – one for each of the six key areas. The discussion leaders come from a variety of backgrounds representing service providers, local authorities and the NHS. Jeremy Hughes from the Alzheimer’s Society and Imelda Redmond from Carers UK represent service users and carers. There will also be a web based feedback form that people can use to respond directly. This can be found at www.caringforourfuture.dh.gov.uk. Written comments must be sent to the Department of Health by December 2nd.

Find out more about our Care in Crisis campaign

Care Quality Commission Annual Report

The Care Quality Commission has published its annual report on the state of health and adult social care in England. This report is different in format from it’s two predecessors as a result of being  produced under the  new regulatory system brought in by the 2008 Health and Social Care Act.

It therefore looks at whether services comply with the essential standards of safety and quality bought in by the act, rather than the old minimum standards.  Introduction of the new system means that CQC has only been compiling data on compliance by social care providers for 6 months.

Also, as the Health Select Committee report published yesterday points out, there has been a dramatic drop in the number of inspections of social care services carried out.

Some of CQC’s findings are alarming and show low rates of compliance with the essential standards, particularly by nursing homes and by NHS hospitals. Under outcome 4 – which requires that people experience ‘effective, safe and appropriate care, treatment and support that meets their needs and protects their rights’, only 51% of nursing homes an NHS hospitals are compliant.

They  also lag behind  on outcome 9, management of medicines,  where they both achieve just over 60% compliance, on outcome 16, management of risks to health, welfare and safety, and outcome 7, safeguarding.

The CQC is also planning to launch a new website which will make it easy for people who are looking for a service to see why services have been rated as non compliant.

Find out more about care on the Age UK website