Gwenda Thomas, Deputy Minister for Social Services
This was published under the 2011 to 2016 administration of the Welsh Government
I am pleased to inform members that I have now published a report following the recent consultation on the White Paper ‘The Future of Regulation and Inspection of Care and Support’. In all 99 responses were received along with a number of additional contributions that fell outside the standard process. The report includes all formal submissions received alongside a summary prepared by officials.
The consultation lasted 14 weeks over the final quarter of 2013 and closed on 6th January 2014. In addition to the consultation, officials attended and spoke at a number of events across Wales. Three major stakeholder events were also held to raise awareness of the consultation - in Cardiff, Llanelli and Llandudno. These were popular with stakeholders and over 200 individuals attended the three events.
In addition to the formal responses, officials have also held significant discussions with other Welsh Government areas including the Care and Social Services Inspectorate Wales (CSSIW) and Health Inspectorate Wales (HIW).
This broad range of engagement has provided me with a rich basis for developing the policy of our forthcoming Bill on the regulation and inspection of care and support in Wales. This primary legislation, effectively the sister bill of our Social Services and Well-being (Wales) Bill, will be laid before the National Assembly for Wales in early 2015.
The White Paper covered five key areas – a citizen-centred approach, firm and broad regulation, strong and professional delivery, taking the next step to improvement and professionalisation, and working together.
A citizen-centred approach
On the first of these – a citizen-centred approach – I laid out proposals to improve the involvement of citizens in the work of regulators. At the heart of this was the aim to refocus our regulation of services on the outcomes achieved for users and carers. This links directly to the legislative framework established by the Social Services and Well-being (Wales) Bill and the changes that the Care and Social Servies Inspectorate Wales have made in assessing the experience and outcomes for people receiving care. The consultation showed an overwhelming level of support for this approach. I am strongly convinced that this is the direction we must take if we are to achieve the ambitions of Sustainable Social Services, and will therefore continue to place this at the centre of the new legislation as it is planned.
The other significant proposals in the area of a citizen-centred approach were around increased transparency and information for citizens. The White Paper outlined a new requirement for annual reports from providers, publicly available to all, as well as a move to more explicit evaluations of care by the regulators, through the introduction of a Quality Judgement Framework. CSSIW is currently testing such a model and I hope this will provide a clear evidence based judgement about the quality and safety of care services, in addition to assurance on compliance with essential standards.
Broadly, both these proposals were supported by respondents, but a number of submissions included valuable advice about the potential risks of over-burdensome regulations and the need to ensure consistency. I have asked officials to ensure these useful pointers are considered as they develop the detail of these proposals.
Alongside these ideas, the consultation asked more generally for ways to improve the involvement of citizens in regulation and inspection. In Wales our unique lay-led workforce regulation approach has demonstrated how effective we can be. In our consultation a number of ideas were provided, including citizen panels and the use of lay inspectors. A number of submissions specifically mentioned the role of advocacy. I have asked officials to consider these as we proceed, although many may be more suitable for secondary legislation or guidance rather than the bill itself. I am convinced however that there is a strong and broad desire to actively engage citizens within our regulation and inspection regime. I will therefore seek to place a statutory duty on our regulators to do so in the new Bill.
Firm and Broad Regulation
In the White Paper I set out proposals to end our current regulation system based on establishments and agencies, and to move towards a service based model. This approach would allow us to be more flexible in our approach to regulation and to update our processes as new service models emerge. The overwhelming view of the consultation was supportive of this move and we will continue to develop our legislation along these lines. Some respondents did raise concerns regarding any potential diminution of our focus on individual care homes, and I want to reiterate that I expect the level of inspection and oversight of care homes by our regulators to not decrease because of this change and the regulator will continue to annually inspect individual care homes I wish to take the opportunity via this bill to not only develop a flexible, responsive model of regulation of inspection but to also shift the emphasis of our current system from one focussed purely on compliance to one designed to encourage and support sustained improvements across the whole of the sector.
A central element of the changes we wish to make to our regulatory regime is to strengthen and clarify the corporate accountability of those that provide services. The consultation has provided further support for our intentions in this area, although some raised questions as to where precisely this accountability should lie. I will be developing legislation that reflects lessons from recent failures by making clear the duties and responsibilities on both service providers and Responsible Individuals and what will happen if they fail in those responsibilities.
One of the proposals that has raised most debate in the consultation has been whether to continue to have the power to charge providers to be registered with the service regulator. This power currently exists although it is not exercised, and providers do pay fees in all other parts of the UK. There has been a strong response to this proposal, with a significant majority against. Concerns have been raised about the impact on provider sustainability, administrative costs and the recycling of money around the care system. I am keen to understand these concerns more fully and have asked officials to look carefully at the impact a re-introduction of fees might have. However I am not yet convinced that the Welsh public should continue to underwrite the regulatory support that benefits care providers without asking them to make a contribution to those costs.
Strong and professional delivery
This section of the White Paper dealt with proposal regarding registration and regulation of the workforce. The consultation demonstrated that regulation of the workforce is valued and has been successful. Indeed many respondents argued powerfully to extend the current range of registration to a range of workers in our sectors. Whilst the extent of regulation of the workforce would not necessarily be set in primary legislation I will seek to be clear on our intentions in this area when I lay the Bill in 2015. I do not foresee, at this stage, that regulation will cover our entire workforce. However I am very interested in the responses which raised alternative methods of public assurance other than formal full registration, and I have asked officials to look at these options and provide advice to me in due course.
The consultation responses were clear in their support of our proposal to end voluntary registration and I am committed to making this happen. On negative registration there was a shared view that this form of regulation may not achieve the desired results. I shall continue to review the case for this form of barring scheme for the social care workforce in Wales and will keep stakeholders informed of my thinking on this proposal.
We are also aware of important work undertaken on workforce regulation by the Law Commission. This will lead to a proposed Bill in Westminster on the way that a variety of professions are regulated. Whilst this does not extend to social care workers in Wales it will be an important contributor to thinking for our own Bill.
Taking the next step to improvement and professionalization
This important chapter set out my ambition to establish a new strategic approach to workforce regulation and improvement in Wales. It proposed that the Care Council for Wales be reconstituted as the National Institute for Care and Support (working title), with an extended range of functions and powers. The consultation has demonstrated a genuine appetite across the sector for this step change in our approach. Some respondents argued that the current Care Council was a powerful basis to build on and should be continued, whilst others sought clarity over the precise role the Institute would play. A common theme was the need for the Institute to be a shared endeavour across the sector, exploiting common interests and the synergy between workforce and service improvement. Overall I am encouraged by the consultation that the time is right to take this important next step in our strategic leadership of the workforce and improvement.
I will therefore continue to pursue the establishment of a new and expanded body to play this important role, recognising that we need to build it in partnership across the sector. This means that I will seek to put in place an inclusive, cross-sector approach to the Institute’s development that will involve the current Care Council.
In the policy building surrounding the bill’s preparation I will also seek the advice of my newly established Strategic Improvement Board, also the National Partnership Forum and the National Leadership Forum in matters of service improvement and workforce development.
Working together
In this final chapter, the White Paper set out the importance of better working between those in our sector, particularly regulators. The consultation clearly supports this general aim. It will be important therefore to ensure that the alignment of our social care regulatory systems will mesh appropriately with other regulatory bodies. In this regard, the Government’s wide ranging review of audit, inspection and regulation which is ongoing, may have a bearing on the draft bill and I will of course update Members and engage with stakeholders if relevant developments arise.
To conclude, the formal consultation is now over, and I am very appreciative of all the effort and thought that have gone into the submissions. I am aware that many organisations have taken much time to make a considered and constructive input into the process. I, and my officials, will continue to work with the sector and members of the National Assembly for Wales to develop the policies that will shape the draft bill. We must also begin to think about the level of regulatory detail that will be required to turn our ambitions into reality.