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Friday, April 09, 2010

Sarah Baker case and the funding of care regulation

The case of Sarah Baker, the former drug addicted manager of Parkfield Care Home in Somerset, who has been convicted of the manslaughter of an elderly resident and theft of residents drugs should sound a serious warning bell for all political parties as they contemplate levels of funding for care services regulation after the election.

There has been a trend in the last few years, and a highly naive one in the view of this blog and in the light of the failure of regulation of the financial sector, to take the view that regulation of all forms can be drastically scaled back and the risk "transferred" back to the providers of care services by relying increasingly on a self assessment and self regulation model - with the regulator scaling back direct inspection drastically and "verifying" these activities.

While some movement in this direction is a healthy thing, there is, as is often the case in social care, a terrible tendancy to throw the baby out with the bathwater. The Sarah Barker case illustrates in the starkest terms the perils that lie ahead if a future government, under the excuse of "better regulation" , seeks to drastically reduce the funding for care regulators and leaves a mere rump which will "validate self assessment" and deal with complaints investigation after things have gone wrong.

The case illustrates why effective and in depth regulation directly at the service unit level is so vital and why models which relies too much on how the "organisation" is performing are deficient.  The only real way of testing if good quality care is being delivered is by actually going out and looking at it in detail.

Even in the best regulation system there will be severe cases like the Sarah Barker case. Nothing is more certain though than that we will see more and more of these cases if governments look to make "easy" savings by cutting back on regulation in this area.  Regulation can and must be made efficient and good risk predictor models developed so that intervention can be targeted. Self assessment can and should be encouraged and providers and services with a good consistent record can and should get a lighter touch.

But we should be acutely aware that as we tread this path the risks of more serious incidents in the care sector will rise significantly. The process of modernising regulation needs to be handled incrementally and with caution. Government needs to think very carefully before it abandons effective regulation and makes swinging budget cuts that will limit the ability of the Care Quality Commission (and the Care Commission in Scotland) to carry out effective regulation.