Provider expectations

Colin Angel reflects on what operators should expect from regulators

People with care and support needs benefit from the statutory regulation of social care services.

The overarching expectation for everyone using, providing or commissioning care is that the four national service regulators contribute to protecting the public from harm.

Over the last decade, regulators and providers seem to have become much better at working together and – overall – there has been a sense of shared purpose, rather than ‘them and us’.

Regulation, however, is an expensive business with the costs borne either by the state, or by providers themselves where central government’s policy of ‘full cost recovery’ for regulatory fees applies.

This month’s column offers a reflection on what providers should be able to expect from their regulator.

These are not criticisms aimed specifically at any of the four regulators, but I hope that they provide thoughts for further consideration.

Unparralled access
Providers expect their regulators to be able to demonstrate independence from government to the maximum extent, where it is in the public interest; a willingness ‘to speak truth to power’.

Our regulators have unparalleled access to the state of care in their respective administrations and should be unfettered in their ability to comment proactively on the whole sector, including where the

commissioning functions of the statutory sector have an impact on people’s care or the stability of local markets, or where the legislation which empowers the regulator’s functions is insufficient for public protection.

As the policy direction in all four UK administrations places a strong emphasis on putting people at the centre of care, the focus of inspection should be on people’s experience of their care service, rather than the inspection of systems and paperwork.

Inspectors should therefore prioritise gathering a proportionate sample of people’s views on the homecare service and cross-check their findings for balance.

While this is more labour-intensive in homecare than residential care, defaulting primarily to office-based inspection risks losing the voice of people who use homecare from the regulators’ judgements.

There are excellent examples of properly trained and supervised lay ‘experts by experience’ gathering views from people using homecare.

Such approaches need to be consistently used, within and between, the four administrations.

The costs of regulation (whether through grant-in-aid or charged to providers through fees) should be proportionate to the benefit to society and providers, particularly where charged at ‘full-cost recovery’, have a right to expect business efficiency and a sense of ‘value for money’ in their interactions with their regulator.

The provider sector strongly supports the idea of an improvement regulator which works collaboratively with them, as opposed to a simple compliance inspectorate, and this means that regulators should be willing to give specific advice about improvement in areas where the standards have not been met in individual circumstances.

Inspectors need to be appropriately trained and knowledgeable about the service types they inspect, including not seeking to assess working practices suitable for home-based care as though they were being delivered in an institutional setting.

This is most frequently seen in medication support, but also applies more generally where the provider is unable to control the premises where care is delivered, because it’s somebody’s private home.

Each regulator also needs to have ways of assessing consistency of approach by individual inspectors and processes for factual accuracy challenge and complaints.

Providers should not raise unjustified objections to adverse inspection findings, but they need to be confident that genuine concerns will be dealt with impartially and not risk reprisals back at local level.

The provider sector regularly complains about inconsistent inspection, and regulators seem to find this particularly challenging to resolve.

Because their primary function is to inform the public about whether a service can meet their needs, inspection reports themselves need to be timely, logically organised and written in plain English.

A concise report which is well organised is considerably more helpful to both the public and the provider.

Quality ratings systems appear to be highly appreciated by providers in the administrations where they operate. In UKHCA’s view, ratings provide a tangible incentive for improvement.

What seems to be missing is the ability for providers genuinely committed to improvement to obtain a reassessment where they have acted to address problems quickly and effectively.

Such an option is one which regulators should consider seriously, even if this needed to be a chargeable service.

Finally, as legislation never keeps up with emerging models of care, providers expect their regulators to alert government to areas where their regulations are no longer adequate.

Public protection is undermined by an outdated system which regulates traditional services, but enables market disruptors to rely on exploiting gaps in regulation as a way of providing what appear, at face value, to be low cost options compared to regulated care.