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Inspecting local councils
The Local Government Minister, Kris Hopkins, has declared that inspection by CQC of local authority commissioning services is unnecessary. This was said in the context of concern expressed at the poor funding of home care services. Service providers feel that short, sharp visits to support dependent people are not enough; visits need to be more extended to provide a more personal service.
The discussion showed that only in exceptional cases (where 'systemic failures are identified') would the CQC be able to exercise the power to inspect local council care provision. The power to inspect local authorities was previously held by the CQC, but remained un-exercised since 2010. In the lead up to the Care Act the Bill was amended to exclude this power of local authority inspection, apart from the exceptional circumstance of identified systemic failure.
A short-sighted approach?
This could be seen as a short-sighted approach by our policy makers. Inspections should be carried out to detect systemic failures, rather than being retrospective and triggered by them. To expect systemic failure of quality to initiate an inspection seems wrong; inspection and regulation should aim to prevent the decline in quality of services in local authorities, as it aims to do in independent services.
Recently, we have not had far to look recently to see systemic failures being identified. Rotherham, Oxford are among examples fast becoming notorious. In these cases, protection of young people appears to have been a widespread failure, including systematic ignoring of whistleblowers, scapegoating and blaming of the victims. It is clear, after the event, that inspection and investigation will not erase the damage which has been done to individuals, families and communities.
Securing the stable door
In Scotland the inspection of social work services has been the norm for many years. The Care Inspectorate was set up in 2011 to merge the regulatory functions of the Care Commission, HM Inspector of Education and the Social Work Inspection Agency. Healthcare Improvement Scotland was set up at the same time, taking over some of the previous healthcare inspection work of the former Care Commission.
The overall regulatory approach is therefore holistic in Scotland. Individual health and social care services (care homes, home care, clinical services, Trusts) are regulated and reported on, as well as Social Work Departments, special schools and child protection provision in each area. This system may not be perfect, or prevent every crisis, but it does aim to bolt the door before the horses stampede from the stable, rather than bolting it afterwards.