6 July 2015
Article by Amy Clifton, National Assembly for Wales Research Service
This is the message from the Health and Social Care Committee’s Stage 1 report (PDF, 1MB) on the Regulation and Inspection of Social Care (Wales) Bill. The Bill seeks to improve the quality of care and support people receive in Wales by reforming the legal framework for regulating and inspecting social care services and the social care workforce.
One of the aims of the Bill is to learn lessons from Operation Jasmine, the investigation into alleged abuse and neglect in care homes in south Wales. During Stage 1 scrutiny the Committee took evidence from family members of some of the victims, representing the ‘Justice for Jasmine’ campaign group. In a subsequent letter to the Committee, the Minister for Health and Social Services stated that the independent review into Operation Jasmine led by Dr Margaret Flynn will be published in ‘the first half of July’.
The Committee supports the general principles of the Bill, but believes there are key areas where it needs to be strengthened, including workforce registration, involving the public in the inspection and regulation regime, and oversight of commissioning functions. The report contains 46 recommendations, including the following:
Extending workforce registration
The Committee concluded that both adults’ residential care workers and domiciliary care workers should be registered, because they provide intimate personal care to some of the most vulnerable people in Wales. The Committee heard concerns from witnesses that there is no mechanism in place to exclude those who are unfit to work in these important roles and noted that domiciliary care workers carry out their roles unsupervised in people’s own homes.
The Committee acknowledges that there is a cost associated with extending registration, but believes that in assessing whether these costs represent value for money, the impact on service users must be taken into account in terms of protection from harm, and public confidence in the workforce.
- The Committee recommends that the Minister extends the requirements on the face of the Bill for registration with Social Care Wales to include domiciliary care workers and adults’ residential care workers.
Commissioning of social care services
Many stakeholders told the Committee that effective commissioning of social care services, focused on well-being outcomes rather than costs, was vital to improving the quality of services received by individuals. They felt that commissioning standards were missing from the Bill as drafted, and that this must be addressed to achieve the Bill’s aims, which are to secure well-being for citizens and improve the quality of care and support in Wales.
- The Committee agreed that the Bill needs to be strengthened to include commissioning standards. It recommends that the Bill is amended to place a duty on Care and Social Services Inspectorate Wales (CSSIW) to review local authority and health board commissioning of social care services against quality of life outcomes.
A rights based approach
A strong theme in evidence received by the Committee was the need for the regulation and inspection regime to be underpinned by a human rights-based approach. The Committee agreed with stakeholders that the ability to uphold people’s rights would be strengthened by placing a due regard duty on the face of the Bill.
- The Committee recommends that the Bill is amended to require all those who exercise functions under the Bill to have due regard to the United Nations Convention on the Rights of the Child, the United Nations Convention on the Rights of Disabled People, and the United Nations Principles for Older Persons.
Many stakeholders expressed disappointment about the lack of reference to lay inspectors in the Bill. They emphasised the importance of including the voice of service user and carer lay inspectors as part of teams with professionals with expertise in the relevant service. The Committee agreed that using lay inspectors can enrich the information available about the service users’ quality of life and experience of care, and therefore should be an integral part of the inspection process.
- The Committee recommends that the Bill is amended to place a requirement on the face of the Bill for the Care and Social Services Inspectorate Wales to include the use of lay inspectors as an integral part of its approach to regulation and inspection.
Recognition of carers
Many stakeholders highlighted concerns about a lack of recognition throughout the Bill of the role of unpaid carers, and the Committee agreed that this is an issue which should be addressed. For example, stakeholders reported that there is no provision for inspectors to speak privately with the family or unpaid carers of those receiving care, and that sections on public engagement do not refer to carers.
- The Committee recommends that the Bill is amended to ensure that carers are recognised throughout the Bill.
Many stakeholders told the Committee that they wanted to see whistle-blowing provisions included in the Bill as part of broader changes to the ethos and culture within the social care sector. The Committee heard that there needs to be a culture in which everyone feels able to speak up about poor practice, and in which regulators, providers and commissioners act on those concerns.
- The Committee recommends that the Bill is amended to require that regulations and guidance include requirements for service providers to have appropriate whistle-blowing policies and procedures in place.
Regulation of advocacy services
The Committee’s report acknowledges that a strong case was made by stakeholders for the regulation of advocacy, particularly children’s advocacy services. It states that advocates provide vital support to vulnerable service users, who should be able to have confidence that the support provided is of the right quality. The Committee therefore believes that the regulation of advocacy services should be included on the face of the Bill, rather than in regulations (as indicated by the Minister).
- The Committee recommends that the Bill is amended to include a requirement on the face of the Bill for advocacy services to register with CSSIW.
Definition of care
The Committee shares the concerns of stakeholders that the definition of care in the Bill is too task-focused, and does not take sufficient account of individuals’ holistic needs.
- It therefore recommends that the definition of care in section 3 of the Bill is amended to ensure that it takes account of the definition of well-being in the Social Services and Well-being (Wales) Act 2014.
The Stage 1 debate and vote on the Bill will take place on 14 July 2015. Updates on the Bill will be published on the Bill’s webpage. You can also follow the Committee on Twitter at @seneddhealth, or the hashtag #RICareBill.