Submission of Evidence to the Enquiry into Public Services Reform (Scotland) Bill of the Education, Lifelong Learning and Culture Committee of the Scottish Parliament on behalf of Aberlour Child Care Trust.
In response to the Committee’s enquiry at Stage 1 of the bill process, Aberlour has considered general principals of the bill, particularly section 4 and 6 specifying the establishment of Social Care and Social Work Improvement Scotland (SCSWIS). These are outlined in the Part II of this paper.
As an organisation providing social care and social work services to children, young people and families in Scotland, we are presently regulated and inspected by a number of bodies, including the Care Commission, SWIA and HMIE. We welcome this opportunity to contribute to this consultation and provide information from our experience, which would contribute to the debate about the establishment of SCSWIS as well as an improvement of inspection and regulation of social care and social work services.
In preparing the response to this enquiry we have consulted our services, asking from their experience about the role of inspecting bodies and the effectiveness of the inspection process. We believe that better knowledge of the strengths and weaknesses in the present model of inspection could inform improved functions of the new body. Part I of this paper outlines our findings.
Part I. Aberlour’s experience of inspections
Aberlour services and inspecting agencies
Inspecting arrangements of Aberlour services are complicated, costly and demanding. Annually Aberlour services are inspected by at least 3 or 4 different inspection bodies - each has its own function and role.
For example, many of Aberlour services in East/Central Region are registered with the Care Commission – including disability respite services, Play schemes, Early Years services and many others. Our service provision in this area can be inspected as part of SWIA or HMIE inspection of child protection services of local authorities. If identified by local authorities as a significant partner or provider we are asked to relevant meetings of stakeholders in the inspection.
For our residential services, the Care Commission and HMIE inspect Aberlour’s services directly. Services such as Crannog (which supports young people aged 12–17, who are experiencing social, emotional and/or behavioural difficulties) will be inspected by HMIE indirectly as part of the service user’s school inspection. Some services will also be subject to regulation by local authority environmental health services and also fall under the scope of HSE. Some services will also be subject to inspection by local authorities as part of their contract compliance arrangements.
We support the attempt to simplify the inspecting/ regulating process, improve joint working, and remove duplication in functions of the inspecting bodies. We would welcome improved information sharing between regulators to reduce burden of having to provide the same information to different bodies.
Inspection costs
Apart from paying registration and annual continuation fees services commit resources to the inspection process in terms of time at the self-evaluation stage, the inspection stage and at the post inspection stage. Aberlour is not currently calculating how much this costs. This applies to all regulatory activity – not just Care Commission.
Involvement of service users
Aberlour aims to involve our service users in all stages of an inspection process - giving views at the self-evaluation stage, being available during the face-to-face field work stage and as part of the process for agreeing and distributing the final reports in the case of Care Commission reports.
Benefits of inspections
Our service users and the services themselves unarguably benefit from the inspection process. Two years ago Aberlour started using a self-evaluation framework for assessing services which is a useful internal tool for identifying our strong points as well as areas for change. The process encourages service quality improvement, giving opportunity to reflect on our strengths and weaknesses. It also gives external validation that the service is operating legally. Openness and accessibility of inspection reports allow service users to learn more about the services. It is also beneficial for stakeholders who might be looking to contract services. However, an inspection process would be of greater benefit to services if they had sufficient time to implement recommendations and introduce changes emerging from the inspection process.
Nature of relationship
Services generally have a positive relationship with inspecting and regulating agencies. They remark that good relationship with the inspectors generally improves the inspecting process. It is also helpful to have an inspector who knows the organisation well and who knows the staff, and has background and expertise relevant to the inspected services.
Positive changes
Many positive changes have been introduced in Aberlour as the result of inspection process, particularly changes in relation to mediation policy, recruitment policy and participation strategy.
What needs improvement in the current inspection system
A number of suggestions can be made about how the inspection process could be improved:
- Service Managers could bring greater influence on the content of inspection reports and realise that they are part of a process as opposed to being passive recipients.
- More consistency is needed in how the Care Commission regulates services and how scoring is applied.
- Improved knowledge of Care Commission in the Regulation of Care Act. We have had two examples where a lack of knowledge (or interpretation of the law) has caused Aberlour problems.
- Improved Care Commission IS system – services have reported problems with the online service provided by the Care Commission.
- More sharing by the Care Commission of best practice. Some services have been scored as 3 in some inspections but no recommendations have been made. It would also be good if the Care Commission could provide examples of best practice between service providers.
Part II. Consultation on the Bill - Public Services Reform (Scotland) Bill
In this section we give comments in relation to particular sections of the Bill that are relevant to Aberlour.
Part 2 - Section 10
In order to be clear about the ambition to allow Scottish Ministers to “improve public functions” it is imperative that some functions and offices are protected. Very clear expectations should be communicated in terms of what is expected to evidence the “efficiency, effectiveness and economy” of any function before evidence of outputs and outcomes are gathered. Any order to abolish, modify or other should be debated by full parliament.
Part 4 - Chapter 1
Section 34(1) - general duties
Apart from improvement in the quality of social services some general duties of SCSWIS should include:
- Ensuring that service is meeting existing as well as emerging needs and resources are spent in appropriate efficient way;
- A duty to specify improvement targets and ensure that local authorities/partners deliver continuous improvement across the range of social work and social care services.
Section 34(2) - powers to direct and guide
To have powers to direct and guide SCSWIS the Scottish Ministers have to be well-briefed on immediate issues and clearly understand the implications of regulation. They should always seek evidence about proposed changes from academic bodies, professional organisations and other significant stakeholders. Long term changes to SCSWIS activity should be debated by the parliament in order to avoid a situation of changing goal posts as individual Ministers change.
Section 35 (1) - principals
It could be beneficial to include a principal ensuring advocacy for users who are impaired, unable or indisposed to take up services. Also a principle which suggests that SCSWIS attempts to support continuous evaluation of service provision by users (specifying what works- for whom- under which circumstances).
Section 37-39 - definitions
The following terms should be included – kinship care and Holiday Play schemes for young people with disability. There is an issue about dependency residential care (parent with children) and how such is perceived in terms of registration. SSSC, ADSW, CCPS should be involved in deciding what constitutes a social care/social work service.
Section 40 - standards and outcomes
National Care Standards have to be included in this section. Care standards should be applicable to different settings. For example, in current practice the National Care Standards for care homes for children and young people are used to regulate residential services for children who have disabilities. Some of the standards do not take account of the specialist needs of such children and young people.
Section 41 - information
SCSWIS must not only provide information but also ensure that information provided is useful and sufficient, and actually used by service users and commissioners when purchasing services.
An informative website is an effective tool for informing all the interested stakeholders about the quality of services. It is useful to have inspection reports available in public domain as well as all the information that the services have to know regarding the inspection process, standards and best practice.
Part 4 - Chapter 2
Section 43 - inspection
To help streamline the process and reduce the burden, section 43 should define a term “inspection” with an emphasis on the review of information as opposed to having to visit services. The Regulation of Care Act should also include the definition of the term “inspection”.
Quality assurance is a very important aspect - it would be useful for the new body to ascertain what is already provided within the organisation and familiarise themselves with this as well as the self evaluation exercise prior to inspection in order to avoid duplication.
Section 43(4) - a timetable for inspections
Annual frequency is effective for both announced and unannounced inspections.
However, some Aberlour services find that not much advance notice is given to prepare before an inspection. While in the post-inspection period the service should be given sufficient and realistic time scale for implementing improvements. The following inspection should ensure that those recommendations are implemented.
Section 43(6) - requirement to supply information
SCSWIS needs to ensure that the information provided is not used inappropriately. Appropriate support for some services is important in order to understand and follow the process.
Section 44 - inspections at request
These situations need to be considered on a case by case basis - a clear process specified with appropriate indicators in place. Service for users should not be disrupted, while agencies should be allowed to provide relevant case before decisions are made.
Section 46 - commenting on a draft of inspection report
The service providers’ comments on the report should be included in it – this would add to a sense of ownership in the process and ensure more effective implementation of the recommendations. The process for agreeing reports feels one-sided where only factual inaccuracies are often considered.
Section 47 - regulations
More clarity is needed about the following terms: an inspection and an inspection report.
Part 4 - Chapter 3
Section 48, 49 - registration process
There can be difficulties on agreeing some categories (e.g. dependency). It would be useful to have clear guidance about the process of registration, refusal and grant of registration.
Section 54 – removing/ imposing a condition
This section could have various (both negative and positive) implications for the service providers in terms of practice and finance. In the voluntary sector the service may not have the financial resources available to meet the conditions and may have to close as a result, which in turn would effect service users. Therefore, this section has to ensure close collaboration between a service provider and the inspecting body before any decisions to remove/impose a condition are made.
Section 61 - maximum fees
This section has to ensure it takes account of diversity of the third sector while setting maximum fees.
Section 64 - a complaint procedure
The third sector should be much more strongly and effectively involved, including better representation and more effective consultations.
Part 4 - Chapter 5
Section 80
Aberlour welcomes and supports that in the exercise of its functions SCSWIS must consult Scottish Social Services Council.
Section 86 should also describe role and relations with SSSC, which has to be part of this as a regulator of the workforce providing social care and social work services. Appropriate organisation changes have to happen to ensure that a new body has the functions of those merged - does not duplicate them but also doesn’t miss out anything.
Part 6
Section 92- 93 - Scrutiny: user focus
Continuous improvement in the user focus is a ‘soft spot’ at the moment. SCSWIS should be focusing much more on the individual experience of service users and looking to ensure that local authority supports are being provided in line with assessed need. On the other hand, service providers have to ensure that participation policy and standards are followed and evidenced.
Section 94
NMC and SSSC should be added in this section to the list of bodies that must co-operate and coordinate activity with the goal of improving scrutiny.
Section 95 - joint inspections
Regarding provisions for joint inspection by social work, health and education, appropriate considerations should be made as to how they are constituted, who takes lead, and what is an agreed remit. Inspections should be able to address continuum of need at all the different levels, from universal provision to high level targeted services.
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I am very grateful to people who contributed to this consultation:
John Ryan – director of residential and integrated services, Aberlour
Trisha Hall – regional director of services, East/Central region, Aberlour
Jackie Hothersall – regional director of services, North region, Aberlour
Response is written by Natalia Duncan, Policy and Parliamentary Officer, Aberlour,
e- natalia.duncan@aberlour.org.uk;
t- 0131 558 7872