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13th August 2015

Care Regulation in Wales – Friend or Foe?

Care Regulation in Wales – Friend or Foe?

The Social Services and Well-being (Wales) Act (SSAW) 2014, will come into force in Wales from April 2016. This is the first overarching regulatory legislation within the Principality for 13 years and marks the next stage of the evolving regulation journey.

As many of us return form our well-deserved summer break, our thoughts are likely to turn to what the next year will bring. This will undoubtedly include 'old-friends' such as maintaining staffing levels and the Christmas rota – but it is inevitable that the SSAW act, with its accompanying inspection framework, will increasingly occupy our thoughts. So as we stand on the threshold of new regulatory standards in Wales, it is worth re-examining what regulations do for us. To expand on our title – do they help us in our busy management roles, or are they a time-consuming burden?

Regulation generation

Perhaps some familiar names from the past can teach us something about Care Standards? Let’s take a trip down memory lane, go back to the future, and find out...

It’s 1985. Margaret Thatcher is two years into her second term, the summer is disappointingly damp, Are You Being Served?, Open All Hours and World of Sport are still on TV, the Miami Vice theme is the epitome of cool and Welsh rugby is in a state of decline...

Also in 1985: in addition to all of us being a little more youthful than we are now, the independent care sector was in its infancy. It was a fraction of its current size and largely unregulated. Nursing homes tended to spring up when hotel owners considered them to be more profitable than a seasonal industry, group homes for supported living were a serious novelty, and the domiciliary care industry was virtually non-existent.  Thirty years on, the infant has grown up – but seems to be subject to a plethora of complex measures more befitting an episode of Yes Minister. Whilst there have undoubtedly been some well- publicised problems supporting the case for regulation, have things gone too far? Has the regulation designed to enhance care become such a burden that it holds services back and inhibits good care and practice?

Policy-driven initiatives

I put this question to the owner of a group of care homes close to the M4 corridor.

“It's really about organising things so that all my staff know what their role is, but it’s really difficult communicating systems and practice through the organisation. I recently implemented the new Welsh induction training framework. I found that, while some of my managers understood how it would change practice when I spent time with the support workers who attend the courses, they had 101 reasons why they might stick to their existing practice.”

This is only a small example, but this anecdote illustrates many of the problems associated with regulating practice. In particular it shows how difficult it can be to manage change and effect better practice through policy-driven initiatives. A policy-practice gap anyone?

Let’s examine another scenario common to anyone with management experience in the care sector – the dreaded inspection! Time to make sure everything is dusted off and looking its best for the inspection, and heralding a couple of weekends of manic work for the manager to make sure that everything is not only shipshape but demonstrably so.  References to the ‘Hotel Inspector’ episode (1979) of Fawlty Towers would probably be inappropriate, except to say that when the episode was made there would have been no comparable inspection regime in care homes.

So... regulation - is it our friend or our foe?

Friend? The moral case for regulating care standards seems unanswerable. The importance of caring for vulnerable individuals not only deserves the best and skilled efforts of those directly involved in delivering care, but also the attention of the authorities in ensuring and overseeing acceptable standards.

Recent highly publicised cases of abuse illustrate the importance of ensuring that standards are set and enforced. The way to do this is seen to be top-down implementation of standards, and the increase in standards over recent decades appears to validate this approach.

Furthermore, what is the alternative to ‘hard’ legislation and policy from which care standards are derived? Can we allow the market, social conscience or professional diligence to fill the vacuum if our legislature and regulatory authorities choose not to take the lead in defining what standards are acceptable? We need standards for this reason alone.

Foe? The moral panic caused by high profile care failures is a difficult environment in which to issue quality regulation. The obvious temptation for policy makers is to try and address systemic organisational shortcomings or wholly exceptional aberrations through regulating practice at point of delivery. However, any regulatory framework which attempts this will always be constrained by the impossibility of regulating all interactions which occur in the care environment.

There is also the question of how effective is ‘hard’ regulation at promoting standards in care, when other ‘softer’ factors such as staff selection, training, leadership and staff support are arguably more influential.  Top-down initiatives can be ineffective, whilst standards created by government bodies can be felt to be too aspirational rather than measures which might be considered best practice.

At the end of the day, we have no alternative but to work within the regulations as set. The regulatory framework has grown-up for a reason – to promote best possible standards of care and support, and it would be incompatible to be operating in the sector if we couldn’t sign-up to that aspiration.  Implementing standards to their best effect, and crafting them into all aspects of care will be a factor which distinguishes good care services from the rest.

To quote from a George Harrison song from 1987 - ‘it’s gonna take time, a whole lot of precious time, to do it right...’

In the context of the new standards, it’s also going to take understanding, leadership, organisation and blood sweat and tears. But if it’s done well, it will deliver care befitting of the people we support to the satisfaction of the inspectorate, and help create businesses which are likely to flourish in today’s complex social care environment.

Nic Bowler – QCS Expert Welsh Care Contributor

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