Regulatory Processes for Adult Care in the UK

1. Introduction

1.1. Background and Importance of Regulatory Processes in Adult Care

Unregulated adult social care leads to serious consequences, such as instances of abuse and neglect in care homes or domiciliary care provision. Since the early 2000s, a regulatory framework applicable to adult care services in the UK began to evolve. The development of the regulatory framework incorporated activities within the various public sectors and involved multiple stakeholders. In England, significant developments introduced the need for regulation of healthcare and adult social care services. This also established a body responsible for ensuring adult social care providers adhere to National Minimum Standards. In Scotland, influential legislation was also pivotal in tightening controls on the unregulated adult social care services sector.

In Wales, legislation established a Care Social Services Inspectorate. Legislation in Northern Ireland has also been passed. An organisation was responsible for regulation and inspection of health and personal social services in Northern Ireland. This blog explores the regulatory processes for adult social care provision within the UK and the impact of public sector governance and regulation on social care services; it is the first in doing so with this focus. The analyses from various regional contributors offer an original examination of adult care in the four areas of the UK.

2.1. Key Legislation Affecting Adult Care

The National Health Service and Community Care Act 1990 introduced a number of significant shifts in the legislative framework for adult care, enhancing individual choice and self-determination. Replacing the old Poor Law principle of "abode," this new duty is underpinned by a person's settled accommodation in the locality, a significant chapter from the Philosophy of Independent Living. Further human rights will see delivery upon the Kilbrandon Review of Social Work regulations for the chronically sick, including the right to expect individual social work assessment, help, and reassessment set within the context of a coherent care package. The Government’s white paper proposed three objectives through a shared savings scheme, and at the same time promised "availability."

The Care Standards Act 2000 creates unified standards in service users’ environments, rolled into National Occupational Standards and conducted into Professional Time. This shift to community care services and the promotion of independence states that such access will not be restricted for units dependent on who can pay and the eligibility rules too slow of tripartite funding agreements. Under the terms of the Act, those responsible for making decisions about adult care services aren’t legally covered by the professional standards for their actions, choices, and decisions, yet this remains a multi-crisis situation. The Independent Living Policy really applies to statutory services delivering home care, residential care, and flexible housing services where the service provider response is dependent on the degree of investment in consultation. Decision-making about failing adults should consider the possibility that successful intervention must include the necessary conditions attached. Just because a person cannot be reached does not mean every success must be defined by each of the proposals' extra "gains."

2.2. Role and Functions of Regulatory Bodies in Adult Care

In England, adult care is regulated by the CQC and, in Wales, by CIW. In Scotland, the Scottish Social Services Council (SSSC) is responsible for registering care professionals locally known as care staff and social workers working across social services in Scotland. These regulatory bodies have a role to register, monitor, and inspect these services, ensuring that patients in such services are receiving standard care and are not at risk of making consultations when they are not satisfied. The 2011 Health and Social Care Act stimulates independent healthcare providers to produce quality reports in addition to the inspection and regulation of services provided by NHS bodies and local authorities, the aim being to enhance the quality of patient care and, therefore, have transparent, independent, and standardised information available about independent healthcare organizations.

Regulatory bodies work by issuing licenses or certificates to businesses and professionals who fulfill certain commonly agreed standards and requirements; they exert some control over service providers by monitoring and inspecting services to ensure that standards and performance indicators are being met, and they use political, financial, and legal sanctions to enforce compliance with the law and these regulations. The four essential functions of a regulatory body are: monitoring how well the system works and the service is being performed; providing advice and assistance to the service provider to help them develop and improve the performance of the organisation; involving stakeholders, especially service users and their families and healthcare professionals, in the development of regulation; and public services providing data that helps the public access the service. Data-driven regulation can also help policy and regulatory development, as well as policy and regulatory research.

3. Compliance and Inspection Procedures

This obliges operators to cover the basic needs of those who rely on their care services. To ensure these obligations are adhered to, regulators are set up to check regulatory compliance. Regulation influences how care is provided and who provides it by placing requirements on providers, services, and staff within those services. Once authorities have set standards, the regulatory body takes over, ensuring that the highest possible level of care is provided by inspecting the quality, auditing, examining, and attempting to develop the service provided to improve the life experience of those who use care services. The regulatory framework has been robustly debated and criticized, but little is known about how regulators interpret the regulatory requirements and satisfy their legislative duties as well as their actual outcomes. In an effort to explore these phenomena, the present research examines inspectors' perceptions and experiences while working for the regulator with responsibility for the monitoring and inspection of services provided in adult care in Scotland. This text has presented the external appearance of the inspection regime, theoretical elements, conceptual frameworks, and what they deliver through the external inspection systems that undertake inspections of child and adult care services.

3.1. Importance of Compliance in Adult Care

It is a matter of common knowledge and acceptance that care of those who are unable to look after themselves is best largely with those relatives or professionals who are most involved with them. Social care in the United Kingdom is provided through a diverse range of settings such as care homes, community-based care, and within the carer's own home. The majority of care is funded by the independent sector and provided by private businesses and charitable organisations.

Local authorities are charged with the responsibility to ensure these services meet required standards, and there is a responsibility to regulate services to ensure this. Regulation is for those aspects of care that are seen as critical for good outcomes for people, service users, and their families or carers.

Compliance with regulatory expectations is one of the areas attracting daily attention; hence, this is a central preoccupation of the majority of services, no doubt aware of having entered the midst of an industry. On the other hand, individuals may see their jobs as primarily those of a caring nature such as nursing, psychiatry, and social work, and only secondly as requirements of a particular industry such as health and safety at work, licensing, testing, and registration. In choosing a home for an elderly relative or a care service for a patient, individuals are also obviously primarily concerned to choose a company or persons capable of delivering the caring aspects of the service. Since few individuals have the knowledge or the experience, or sometimes the inclination, to monitor the quality of care, they make assumptions or rely on the work of others. The necessity of effective regulation and procedures or practices to assist this should be clear.

3.2. Inspection Procedures and Outcomes

Inspectors are employed by the local care authority within whose area the residential home is located to carry out the inspections. Inspection teams normally comprise one or two people with a social care background. The frequency of inspection is determined by the authority, and the inspection teams are supposed to look at all aspects of running the home to evaluate compliance with the National Minimum Standards. In practice, this will normally include looking at the overall management of the home and service, staffing levels, service provision, and health and safety issues. If an area of concern is identified, such as inappropriate staffing levels, the inspectors have the power to seek redress through the enforcement of a notice of proposal. Such notices can be contested; however, enforcement actions may in practice be swayed by commercial, geographical, and personal considerations, as well as by the legal evidence at the inspectors' disposal. However, this probably does not negate the deterrent effect that the inspection process has for most care home owners.

The outcomes of inspections and other official information are normally available in summary form from the authority responsible for registering residential care homes for older people. The public availability of such information is a fairly recent and growing development, reflecting the staggering increase in private sector accountability that has been driven by legislative and financial initiatives. The first of these legislative initiatives was the requirement for all inspections to be announced and the statutory obligation for all homes to have and maintain a complaints process; these expanded by a specific power for monitoring responsible inspectors to investigate complaints. News of the inspection regime is gradually permeating the consciousness of managerial personnel and service users in both the statutory and private sectors, and certain interest groups have recently amplified the public accountability of the registered homes through the mediums of the press and internet.

4. Quality Assurance and Improvement

The Department of Health and Royal Colleges have statutory responsibilities for the quality assurance and improvement of the staff within health and social services. The only statutory regulatory body responsible for establishing and regulating the services of adult care workers within care homes, nursing homes, and in the community is the General Social Care Council. It is the role of the Department of Health to set standards for training and to make regulations and orders to ensure that the staff within services are of adequate quality through independent inspection systems, which are regularly implemented and produce objective and uniform information regarding the quality of care within services. Services themselves continuously seek to quality assure their own services through partner and team meetings, staff appraisal systems, care planning, external sign systems, auditing, and clinical governance systems. The key personnel within each authority are the lead elected member responsible for quality services, the chief executive, and the head of OBA. The Department of Health, social services inspector, and commission for social care inspection, and the General Social Care Council. The Royal Colleges are professional bodies for physicians, surgeons, and nurses who set and maintain standards of care in the prevention, identification, care, and treatment of medical conditions. They also accredit or regulate the education and training of professionals to ensure that training courses meet their professional standards of practice. The training curricula also enable professionals themselves to improve their knowledge, skills, and abilities in order to maintain competent and safe practice. Non-statutory, fulfilling the government's elite and the training needs of social workers within the Children Act. Provide training advice according to functions under the statutory regulation of training regimes. The General Social Care is an independent regulatory body for social care in England and sets standards and tracks the professionals who are part of the services they regulate.

4.1. Frameworks for Quality Assurance in Adult Care

Quality assurance frameworks are designed to ensure that the services provided in the regulated care environment meet prescribed standards. Enforcing the basic standards of care is a crucial role for regulators. They must ensure that care services have processes, policies, and procedures in place and deliver care to an agreed standard. In the adult social care sector, this has become increasingly complex due to the rise of the personalisation agenda and the corollary rise of the private home care worker. The development of models of risk to assist the regulators is one area of ongoing research. At a more fundamental level, new standards combining assessment of the care environment with regulatory checks based on at least this casual surveillance may be required to inform and protect users of the vulnerable care sector. This paper provides a critical analysis of the present system of risk assessment in home care settings in the light of the recent changes to the regulatory system and the growing body of research on the risk of poor care in domiciliary care. The paper has two aims. The first is to review the voluminous research evidence on home care regulation in order to test the contention that home care is inherently a high-risk setting and that risk-based regulation is, therefore, the only appropriate approach for services that support the oldest, sickest, and least ambulant members of our society who live in the place where many indicators of consumer choice are eliminated.

4.2. Continuous Improvement Strategies

Continuous Improvement Strategies

The Single Quality Framework, in development for the last 9 years, was produced by the Association for Residential Care, the Northern Ireland Commissioner for Older People, and the older people's reference group, a steering committee, and a stakeholder reference group. After three versions and a year-long trial begun in 2004, it was launched in August 2005 for free use by providers who want to improve the quality of care for older people. It is designed to function without interfering with existing compliance, audit, and regulatory systems, but will allow regulators and purchasers to keep score by being linked to compliance regulation. The Single Quality Framework is a collegiate, consensus-based continuous improvement process. It assesses people's human rights and the quality statement set: what older people say matters most in their user inspection 'sort of care home' and these that drive risk assessment compliance using schedules, quarterlies, provider, and external verification.

Recurring theme issues are addressed through learning sets. The 'North Star' or standard to aim for is always 'If that was my granny, get me out of here!', a clear, simple 'user tested' message given by older people themselves. The extensive learning manual is a constant prompt about human rights and includes 3 years of free adaptations. The Children's Care Home version was launched in May 2006 with the Northern Ireland Committee for the Protection of Young People, following an approach by a Commission representative. A Young Disabled User Group is looking at the feasibility of creating a 'sort of care home' template for young disabled people.

5. Challenges and Future Directions

5.1. Current Challenges in Adult Care Regulation

In the case of adult care, as with children's services, the regulatory framework is extensive and long-established. It also presents a bewildering number of different regulatory bodies with overlapping responsibilities, reflecting the complexity and diversity of adult care services in the UK. Front-line adult care services are provided by Health and Social Care trusts in Northern Ireland, health boards and councils in Wales, and primary care trusts and councils in England. As with England and Wales, regulation is differentiated by size and function. There is now a specific set of Quality Standards for Residential Care Services to cover small services that are funded by direct payments or by individual users. In Scotland, nursing homes are registered and regulated by the Care Commission. The Regulatory Support Development Unit manages the nursing home registration process and contributes to the development of this sector of services.

The focus on User Involvement in Adult Care Regulatory Processes highlights three main areas that have been the subject of recent or current attention in proposals for change to the regulatory system. These are, in each case, aspects of the complex and multi-faceted process of incorporating multiple perspectives in the regulatory framework. Users in adult care services actively resist being considered passive in the care that they receive. The issue of the regulations and the way that they are applied is that of the very measures of quality used for regulatory assessments. Certainly, the current regulations do not provide measures against which to assess and ensure that residents' voices are being heard about the standards; and some regulations even provide barriers in the form of staff telling residents not to reveal their concerns to the regulatory authorities.

5.2. Potential Future Developments in Regulatory Processes

In recent years, there has been substantial debate about the form and content of regulation. This has been driven in part by serious concerns about the operation and effectiveness of current regulatory processes. In regard to adult care, questions can be raised about the coverage and scope of regulation. As things stand, only some elements of the sector are subject to regulation, and then not all elements and dimensions of the service. In response, it is feasible to imagine sector-wide coverage. Yet to what extent? In thinking through responses to these issues, there is a need for a common and shared understanding of what regulation is for. This in turn suggests a direct focus on the legal and administrative forms that regulation and regulatory activities might take.

The paper begins to explore these themes. The large number of reasons why people provide and access adult care suggests that, moving forward, service regulations have to be flexible and innovative, redistributive rather than neutral, and premised upon locally owned strategies. As would be anticipated, significant changes in regulatory processes are not a straightforward matter. Accounting, auditing, and inspecting all have their roles to play, and would still have work to do. Influencing and guiding rather than monitoring and controlling need to be used more often.