Huw Irranca-Davies, Minister for Children and Social Care
I am pleased to be able to provide Members with this statement. I will outline the timeline for the implementation of the regulation of services under phases 2 and 3 of the Regulation and Inspection of Social Care (Wales) Act 2016 and our progress with phase 2 of implementation, including the laying of The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. In addition, I will touch on how these will impact upon the requirements for Registered Nurses in care homes in Wales.
Service Regulation Implementation timeline
Implementation of phase 2 of the Act will commence next February, when the application window will open for all providers of care home, domiciliary support, secure accommodation and residential family centre services to register with the Care and Social Services Inspectorate Wales. The re-registration of providers will take place from April next year, with the determination of each application expected to take between two and four months. These registrations will take effect as soon as the notice of decision is issued, so that care home, domiciliary support, secure accommodation and residential family centre providers will start being regulated under the 2016 Act from summer 2018.
In relation to adoption, fostering, advocacy and adult placement services, we are working with the sector on regulations for these services as part of phase 3 of implementation. The relevant regulations will be considered by the Assembly in autumn/winter 2018. Therefore these services will not be required to register under the Act until April 2019. For these services, inspection against the new requirements will commence from April 2019 onwards.
Consultation on and laying of phase 2 regulations relating to care home, domiciliary support, secure accommodation and residential family centre services
To take forward implementation of the Act, we recently consulted upon the draft Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 and associated penalty notice regulations. The consultation on the service-related aspects of the regulations took place over twelve weeks between May and July 2017 whilst the workforce-related consultation overlapped this, taking place over eight weeks between June and August. The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended following this consultation, were laid before the Assembly on Friday and today I am publishing the associated consultation reports and draft statutory guidance.
184 written responses were received, in total, to both consultations from a wide range of stakeholders, in addition to the valuable contributions made by the 180 attendees at our consultation events. As a result, we have made a number of changes to the regulations in order to further our policy intentions, which are to focus regulation and inspection on supporting the achievement of an individual’s personal wellbeing outcomes and on improving the quality and continuity of care whilst also simplifying and streamlining regulation and inspection from the perspective of the provider.
We have made particularly important changes to the requirements in relation to Registered Nurses, which I address below. However, first I would like to draw members’ attention to some of the other significant changes which, in response to consultation feedback, we have made.
Post-consultation changes to the regulations
A number of respondents were concerned about the requirement for a service provider to notify various parties 28 days in advance of any revision to the Statement of Purpose coming into effect. They felt that this requirement did not allow for changes to be made more urgently. We have listened to this and amended the regulations to recognise that there may be cases where it is necessary for a service provider to revise their Statement of Purpose with immediate effect and to set out the requirements which will apply in such circumstances.
Similarly, our proposals in relation to shared rooms for adults attracted a range of views from respondents, which has prompted us to remove the requirement for people sharing to have an existing family relationship. Instead, we are focusing on the individual’s voice and control by making sure that whether or not to share a room is their own free choice, consistent with their well-being. In order to avoid an increase in the number of shared rooms the regulations now state that the number of adults in shared rooms must not exceed 15% of the total number of adults accommodated by the service, thus mirroring a requirement in the existing National Minimum Standards.
We consider that the requirements in relation to Responsible Individuals are very important. We want them to know and engage with the services for which they are responsible, but we also want to ensure that our requirements are proportionate. For this reason, the requirement relating to the frequency of visits by the Responsible Individual to the service has been adjusted from monthly to 3 monthly in response to the consultation feedback. There were questions about to what extent Responsible Individuals could delegate this function. We have maintained the view that the visit has to be made by the responsible individual in person but have amended the regulations so that the words ‘put suitable arrangements in place’ have been used consistently to provide clarity on areas where the responsible individual can delegate some tasks to others but still retain overall accountability and responsibility.
Changes to requirements in relation to nursing provision in care homes
Under the Act, the Statement of Purpose is a key document for the registration and provision of the service. It describes the vision for the service, the needs of the people to be cared for and how those needs are to be met, including the staffing arrangements in response to that need. As such it forms a touchstone for the ongoing inspection of the service.
In relation to staffing, the Statement of Purpose requirements are complemented by requirements on providers to evidence how the staffing arrangements are appropriate for the range of needs to be met and services to be provided.
After consultation and further engagement with the Royal College of Nursing, we have reviewed and strengthened our approach to staffing with reference to Registered Nurses in particular. The new requirements on service providers in relation to staffing build on the foundation which I have described above. They are in line with our whole approach to the regulation of care and support in that they are not, as has been suggested, about diluting the presence of Registered Nurses in nursing homes where these are needed, but rather about strengthening it by tying it to the needs of the residents. The regulations require the provider to have on the premises as many nurses in attendance as the residents’ assessed needs dictate, and to be able to demonstrate how they have determined this number. This includes a specific requirement that where an individual is assessed as needing 24 hour nursing care, there is a sufficient number of suitably qualified registered nurses deployed to work at the service at all times. This is so that providers consider and can justify the number of Registered Nurses on site, and the core competencies they are required to have, in order to care sensitively and comprehensively for those individuals with nursing care needs in receipt of the service.
Our new Regulations focus on strengthening the requirements whilst also providing flexibility for those homes which do not have residents with 24-hour nursing care needs. In these situations care providers can set out exactly how needs will be met without the additional and burdensome regulatory requirement.
Engagement with the nursing sector and others in developing our proposals
Throughout our work in implementing the Act and in taking forward these regulations we have sought to work co-productively with our key stakeholders, maintaining the positive approach taken in relation to legislation under Sustainable Social Services for Wales. This time last year we worked extensively with our stakeholders through a series of technical groups looking at the different regulations. These included representatives from local government, health, care providers and the third sector. The Royal College of Nursing was represented on the group looking at our proposals for the regulation and inspection of accommodation-based services, and meetings have also taken place, both Ministerially and at official level, to further explore the requirements on accommodation-based services where nursing care is provided.
Future communications and engagement
The significant level of response to our consultations, and well-attended stakeholder events, evidence our comprehensive approach to consultation and engagement. However, we recognise that there is more to be done in order to ready the sector for implementation next year. Implementation of the Act is an ongoing process. We are committed to supporting this through working with our partners to raise awareness and understanding of what implementation of the Act means, amongst those most directly concerned. The Welsh Government works alongside the Care and Social Services Inspectorate Wales and Social Care Wales (SCW), who are the delivery agents of the changes introduced by the Act, and has close oversight of the communications and engagement activities which they lead.
The Welsh Government has produced easy read and children’s versions of the 2016 Act to aid and extend engagement. Further accessible material is planned in the run-up to implementation in spring next year. Resources are made available online and promoted at appropriate stakeholder events.
To support this, SCW has been funded to expand its Information and Learning Hub to host resources and information about social care legislation in Wales, including the 2016 Act. An Information and awareness pack has also been produced collaboratively including PowerPoint slides, videos, leaflets, and Frequently Asked Questions.
Supporting the social care workforce
As reflected in our proposed regulations, the Welsh Government is committed to supporting and valuing the social care workforce. After careful consideration of respondents’ views in relation to offering domiciliary care workers contracts after a qualifying period and delineating care and travel time, we will not be making changes to the proposed regulations. We feel that by making these regulations we will progress our aim to improve the quality and continuity of care for people receiving domiciliary support as well as proving much-needed clarity and support for domiciliary care workers. The requirements in these regulations complement the Welsh Government’s wider agenda in support of the workforce, with its focus on helping it to adapt and develop to meet the new service requirements, as well as ensuring the long-term sustainability of the social care workforce in Wales. Through SCW, we are taking forward a range of actions to support the workforce including developing career pathways, reviewing social work degrees and developing a national data set to identify future trends for social care. This will help to raise the profile and status of the sector, facilitate effective workforce planning, and address current difficulties around recruitment and retention so social care becomes a positive career choice where people are valued and supported responsibly.