Summary of conclusions and recommendations

29.11.2011

Regulation of the workforce

• The Committee considers that for many years the social care workforce has been undervalued - as reflected in wage levels, terms and conditions and limited investment in training and development. The Committee considers that employers in the social care sector should aim to pay all staff at least the “Living Wage”.
• The Scottish Government should consider accelerating the current timetable for registration of care workers.
• The Committee encourages employers to consider the funding available from ILA Scotland as one way of supporting training for staff.

National Care Standards

• The Scottish Government should conduct a review of the National Care Standards.
• It is ten years since the National Care Standards were originally drafted. The National Care Standards should provide a key mechanism for ensuring that equality and human rights issues are embedded in the framework for the delivery of care services for older people.
• It is vital that HIS and the Care Inspectorate work together on the revision of the National Care Standards so that they reflect the direction of travel towards the further integration of health and social care.

Assessment of healthcare needs

• The Committee recommends that the Care Inspectorate should engage with the Mental Welfare Commission for Scotland and other interested parties in order to produce guidance and information to service providers on the use of psychoactive medications. This issue should be considered as part of a review of National Care Standards.
• The Scottish Government should consider allowing care home residents to register with the chronic medication service.

Complaints

• Service providers should routinely publish information about their own feedback and complaints systems. In order to promote accessibility, such information should be made available in alternative formats, such as large print and audio, on request.
• The Care Inspectorate should review in early course the guidance currently available to all care service providers and bring forward additional guidance as necessary.
• It is vital that all service users, carers and staff who witness poor care, but are unable or unwilling to raise concerns with a service provider directly, are aware of the Care Inspectorate’s complaints procedure.
• The Care Inspectorate should review the manner in which it handles complaints in order to reduce the time taken to reach a determination, and to introduce an appeals process.
• The Care Inspectorate should publish guidance for care staff who wish to raise concerns about a care service on a confidential basis.
• The Scottish Government should consider the establishment of a single point of entry for complaints about integrated services, with a view to greater integration in the future.

Risk-based approach to inspections

• Independent research and evaluation of the Care Inspectorate’s Regulatory Support Assessment tool, including the self-assessment system, should be conducted.
• Corroboration of the content of self-assessments should be sought from service users.
• The Care Inspectorate should ensure that all self-assessment information is sent to health professionals, service users, friends and relatives to invite comment.

Frequency and type of inspections

• The Committee urges the Care Inspectorate to implement the recently announced increase in frequency of inspections for all care homes and personal care and support services as soon as reasonably practicable.

Engagement of healthcare professions

• The Committee believes that the Cabinet Secretary should discuss with the General Medical Council and the Nursing and Midwifery Council ways of ensuring that healthcare professionals responsibilities in relation to having a duty of care to report all concerns, including those that apply to social care, emphasised during healthcare professionals’ training.
• The Committee welcomes the Care Inspectorate’s development of a questionnaire for all health and social care professionals involved in care services and seeks further information from the Care Inspectorate regarding the timetable for implementation of this system.

Inspectors and grading of inspections

• The Committee encourages the Care Inspectorate to continue to engage with service providers in order to improve the consistency of inspection gradings.
  Involving service users, friends and relatives
• The Committee recommends that the Care Inspectorate consider whether there are other areas of the risk assessment process where service user engagement could be encouraged and enhanced particularly the use of independent advocacy.
  Publication and dissemination of inspection reports
• Active steps should be taken by the Care Inspectorate to reduce the time taken between inspection and publication of an inspection report. The Care Inspectorate should take steps to improve the accessibility of a report’s content, including providing a summary of the report’s recommendations at the beginning and to do more to disseminate report findings to interested parties via its website and other means.

Registration 

• The Scottish Government should explore how the Care Inspectorate’s suggestion of  legislative changes with regards to it being granted powers to refuse further registration of care services from a provider which has other poorly performing services, could be taken forward.

Enforcement powers 

• The Committee invites the Scottish Government to consider whether changes should be made to the current enforcement and appeals process.

Healthcare regulation in the community 

• The Care Inspectorate, HIS and other interested parties should work together in order to ensure that there is proper clinical and social care input into care home, community and acute hospital inspections. The Committee believes this may be facilitated by a review of the National Care Standards.

Commissioning and procurement

• The Care Inspectorate should encourage all local authorities to adopt a similar approach to commissioning services to that of the City of Edinburgh Council, which use the findings of Care Inspectorate reports to directly inform the commissioning of new services, in order to improve outcomes.
• The Committee, recommends that the Scottish Government should explore further the merit in extending the Care Inspectorate's powers in relation to being given enforcement powers for the commissioning and procurement of services.

Monitoring financial viability

• There is scope for the Care Inspectorate to build into its risk assessment process a greater degree of on-going financial scrutiny and the Care Inspectorate should require registered service providers to submit copies of their annual accounts.

Resourcing the Care Inspectorate

• The Scottish Government is invited to clarify, in its response to the inquiry report, its intentions regarding fees charged by the Care Inspectorate.