New Law to Reform Social Care

In the wake of several scandals relating to treatment of people in care, the Regulation
and Inspection of Social Care Bill aims to tighten up professional regulation.
(Pic : nursingcarehomesincornwall.co.uk)

Yesterday, Health Minister, Mark Drakeford (Lab, Cardiff West), introduced the second major piece of legislation reforming social services this Assembly term.

The Regulation and Inspection of Social Care Bill (Bill [pdf], explanatory memorandum [pdf]) outlines a number of reforms to how social care services are regulated and inspected....funnily enough. More info from the National Assembly's In Brief blog.

Why do we need a Social Care Bill?

Around 84,000 people aged over 16 in Wales (55,000 of them aged over 65) received some sort of community or care home support in 2013/14. In addition, there were some 5,800 looked-after children.

There are almost 1,800 registered social care establishments in Wales, and more than 900 providers (including the 22 local authorities). Just over 1,100 of these establishments were residential care homes, and the rest include children's homes, fostering and adoption services and home care agencies. Most of these facilities are privately-run.

Currently, the job of inspecting and regulating the care industry falls on the Care and Social Services Inspectorate Wales (CSSIW). There are said to be "loopholes" where English providers of services, like adoption, don't currently have to register with Welsh agencies like CSSIW or Estyn even though social care is devolved. Workforce regulation is currently carried out by the Care Council for Wales (CCW).

Since the wide-ranging changes brought in by the Social Services & Wellbeing Act 2014, the need for a completely new regulatory system has become ever more pressing. Also, there's a clear need to learn lessons from scandals which have harmed the image of the sector like Southern Cross, Mid Staffs, Bryn Estyn and Operation Jasmine – which is investigating neglect at care homes in south Wales.

Devolution has also brought about the need for a consolidation of existing law. The sector was previously subject to the Care Standards Act 2000, but England has since largely abandoned the provisions in the Act, while Wales has – as mentioned - brought in its own laws.

What does the Social Care Bill propose?

Service Regulation

The Bill :

• Makes it a specific offence to provide "regulated services" without registration, punishable by a fine or 2 years imprisonment.
• Defines "regulated service" as : residential care homes (for adults, families and children), fostering and adoption services, secure accommodation and home care.
• Gives Welsh Ministers the power to either issue a registration certificate or refuse to grant the request.
• Will grant flexibility in the way services are delivered, meaning a provider can have its registered office in one part of the country but provide services to another part. Also, the registration details themselves can be amended if providers want to provide new services - which is less bureaucratic.
• Will also grant flexibility to the Welsh Ministers, meaning in circumstances where a care company runs two homes in two different local authorities but only one home is failing to comply with standards, the Welsh Ministers can withdraw registration from that single care home.
• Places a requirement on registered providers to submit an annual return to the Welsh Ministers, which will be published.
• Means the Welsh Ministers must issue an improvement notice before cancelling a part of, or a whole, registration certificate.
• Will require "responsible individuals" (the person named on the registration certificate) to pass a "fit and proper person" test. However, a "responsible individual" can be named on more than one registration certificate if the Welsh Ministers are satisfied they can fulfil their duties.
• Outlines the process for urgent cancellations and amendments of certificates in circumstances which threaten the lives or physical/mental health of a cared-for person, or cases of serious neglect – subject to approval from a magistrates court.

Inspection & Regulation

The Bill :

• Means most current provisions about social care inspections in the Care Standards Act 2000 are unchanged, but have been expanded to cover local authority services.
• Gives Welsh Ministers the power (through regulations) to create a rating system for social care providers, and require the inspector to put that rating on inspection reports.
• The Welsh Ministers must maintain a register of care providers, make that information public, set a fees regime and publish an annual report on their regulatory functions.
• Creates new and specific offences :
• Failing to comply with a condition or requirement of registration
• Providing false descriptions (i.e. false advertising on what services are provided)
• Failing to display a registration certificate
• False statements
• Failing to submit an annual return
• Failing to provide information to inspectors
• Means failing to display a certificate or submit an annual return makes a provider liable for a fine. For other offences, the punishment could include imprisonment for between 6 months and 2 years (if tried on indictment). It will also be an offence to obstruct the work of social care inspectors, also punishable by a fine or prison term of between 6 months and 2 years.

Local Authority Social Services

The Bill makes a number of amendments to the Social Services & Wellbeing Act 2014, which means :

• Local authorities will be obliged to publish an annual report on social services.
• The Welsh Ministers will have the power to review local authority social services, fee regimes and research as well as pass regulations on some aspects of social care – in particular looked-after children.

Market Oversight

Many of these provisions are similar or identical to those in England's Care Act 2014. The Bill :

• Gives the Welsh Ministers the power to pass regulations governing the financial requirements and stability of registered care providers.
• Means that if a care provider's finances are a risk to their ability to provide care services, the Welsh Ministers can order the provider to draft a plan to put their finances on a sound footing and mitigate against/remove risks. As a result, the Welsh Ministers will have the power to demand access to information relating to a care provider's finances.
• The Welsh Ministers must publish a national market stability report in order to provide information to current and prospective care providers about the Welsh care market as a whole.

Social Care Wales

The Bill :

• Means the Care Council for Wales will be renamed "Social Care Wales".
• Give Social Care Wales responsibility for maintaining standards and provision in care quality, conduct and practice of social care staff, training and public confidence in social care workers.
• Defines "social care workers" as social workers, paid carers, managerial/administrative staff of care providers or anyone contracted to provide care services to the above.
• Requires Social Care Wales to maintain a register of all social care workers in Wales, including visiting social care workers from other EU member states.

Workforce Registration

The Bill :

• Will require "social care workers" to register with Social Care Wales.
• Sets out the criteria to be registered with Social Care Wales :
• That the person is appropriately qualified (i.e has completed a Social Care Wales approved course)
• Their fitness to practice isn't impaired – no deficient performance (i.e negligence), no serious misconduct, not on a barred list, no adverse physical or mental health problems.
• They're applying to the correct role.
• Sets out the appeal process for those whose application is turned down.
• Places a duty on social care workers to inform Social Care Wales of any changes to registration information.
• Outlines the detailed procedures by which a social care worker's fitness to practice will be determined if they breach their code of conduct, and the sorts of punishments they can expect to face – from no further action taken to de-registration.

How much will the Social Care Bill cost?

There are so many different things factored into the costs associated with this Bill it's just easier for myself, and anybody reading this, to list the costs in total.

When current ongoing costs are taken into consideration (£169.9million), the changes outlined in the bill increase that to £178.8million. So the cost associated with the Bill itself is just over £8.9million.

Most of the additional costs fall on the service regulator and service providers. Social care workers themselves will save around £533,000 between them.

What does this mean?

Although this law is unlikely to completely eliminate abuse of people in care, it might make
scenes like the above less common and lead to quicker reactions by authorities.
(Pic : BBC Panorama via The Telegraph)

At its most basic level this Bill is a consolidation of existing legislation, factoring in the divergence between the Home Nations on social care. Also at its heart is a realisation that since high-profile scandals elsewhere in the UK, and with an ageing population, the need for a more robust regulation and inspection regime for social care providers has never been more urgent.

There are some questions that are perhaps unanswered, like the status of domestic violence shelters, homeless shelters and care in the community centres (unless these qualify as "secure accommodation").

One of the few boom industries in Wales is "granny farming" (c/o Jac o the North), whereby care providers set up care homes in picturesque parts of Wales so elderly residents can see out their final years somewhere nice and quiet. There's nothing wrong with that in principle as long as it provides skilled local work; but if these centres – housed by some of the most vulnerable and service-needy people around – are based in areas which are already struggling to provide key public services due to their rural location, it's a recipe for disaster.

Any annual report on market stability has to take into account the status of other public services provided to care homes, not just the state of the care home market itself. If more care homes are going to be provided in, for argument's sake, Meirionnydd, then the reliability of ambulance services and access to primary care will have to be factored in.