Regulation of care - managing the risk for service users
The abuse uncovered in a private care home by a recent BBC Panorma program highlights once more the potential risks if care regulators adopt a light touch approach to the regulation of care services. The program uncovered very serious abuse at Winterbourne View, a 24 bed hospital run by the private provider Castlebeck.
Services such as these are regulated by the CQC ( Care Quality Commission) in England and by SCSWIS ( Social Care and Social Work Improvement Scotland ) in Scotland. The care services minister John Birstow said that there had been " "failures of inspection and adult protection which have exposed people to appalling abuse" at the care establishment and he has ordered investigations into the failure of regulatory and safeguarding processes to protect people in the establishment.
This case raises disturbing questions though about the nature of care regulation not only in England but also in other parts of the UK.There has been an increasing tendancy to take the view that regulation of care can be conducted by using providers own self assessments and somehow " validating" these. Seldom is any real explanation forthcoming as to what such validation will mean if it doesnt amount to inspector boots on the ground though.. There has also been talk of providers being subject to overall inspections at an "organisational level" and so de-emphasising the importance of the inspection of individual services. This is the new "management speak" in regulation, it's the latest buzz idea.
Those with any real experience of regulating care services know that the performance of individual services can vary widely even where they are provided by one provider. The claims that providers make about their own performance need to be treated with the utmost caution - even when those providers are public bodies such as local authorities. Equally, while demanding that providers involve users and carers can be very effective in driving improvement when coupled with good grading systems ( as evidenced by the former Scottish Care Commisison system for example in their report Improving the Quality of Care in Scotland ) this can only work when it is delivered through a system built on regular and sufficiently deep on site inspection of individual services.
The problem with the direction that regulators seem to now be taking is that they are turning regulation and inspection into a fire-fighting exercise rather than a pro-active system which goes out looking for service failures.
Building systems based on risk is a sensible developement and the Scottish system referred to earlier is an example of how risk factors and quality measures can be used within an overall risk based system.
The problem is not with the principle of these systems, it is with decision makers who seem to think that risk judgments can be informed by largely self -reported data or by waiting for infromation to reach them that something has gone wrong with a service.
This approach to a risk based system becomes very passive but of course it can be delivered much more cheaply that a pro-active system based on frequent inspections. These new approaches which are built on greatly reduced inspection programs of course suite the politicians because they can be delivered with much smaller budgets. It also fits in with the demands of providers who always complain about being over-regulated. To some extent it also suits the senior management of the regulators who must please their political masters by claiming that regulation will continue to be effective even while budgets for on-site inspection are slashed.
It is time to stop kidding ourselves. Risk based approaches to regulation are needed but they can only work if delivered through an approach to regulation which is properly funded and can deliver regular on-site inspections.
It is time that the heads of regulatory bodies stood up and were counted and told the politicians clearly that unless regulation is properly funded to deliver regular boots on the ground inspections then there is a grave risk that other services like Winterbourne View will go undiscovered for long periods of time.
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