Probably the most significant issue that will affect and worry us providers are the regulations and guidance under the Regulation and Inspection of Social Care (Wales) Act 2016 (RISCA). Presently, these have not been decided but many months of consideration have been put into them. The essence of the RISCA is to do away with outputs and rely on outcomes. National minimum standards, we are told, are to be dropped and outcomes relied upon. Many in the civil service recognise that en-suites for non-ambulant residents are a waste of resources as they are for some residents with mental health issues. Indeed, some providers have provided ensuites for mental health residents and then have to lock them to safeguard the resident themselves and other residents who may be subjected to inappropriate use and resultant flooding. Room sizes are also an issue as it is becoming recognised that one size does not fit all. There have been many occasions when large rooms have not been chosen in favour of smaller ones as they feel more cosy and secure.
So where do regulations go? Most providers of quality homes want to see poorly performing homes close as they give a bad image to the public of the sector, doing no one any good. Regulators would find a tick box much easier to administer. A new group of civil servants has recently taken over from the team who developed the bill and act. One of that team is presently meeting residents in care homes across Wales to try and understand what is important to residents themselves. The early findings appear to confirm what providers have been saying. However, how would regulators establish what is good and poor practice? At what level would a provider’s service be considered so poor that the outcomes for people are so risky that the provision should be closed? I have argued that even with clearly defined national standards that we have, there are occasions when inspectors believe that a home should be closed but cannot find sound reasons to convince the courts.
If increased room sizes are imposed (these are perceived as being improvements to quality) it could result in homes that are presently vulnerable financially having to lose some or indeed many rooms and it would result in homes having to close, some say unnecessarily. CSSIW have recognised this and have realised that they have no data to understand the impact. As a result, they have demanded all homes to complete a self-assessment service specification (SASS) to understand the impact. These are now all past their return date and the data is being analysed. When it comes to room sizes and adequacy of space and facilities despite the findings it may well be that there will be a move to defer the introduction of minimum sizes until a review in ten years or so. See clauses 27, 28 and 29 of the Act.
Initial indications are that about 50% of beds in care homes would be lost if the ensuite and minimum room sizes are set at NMS levels.
The Minister for Public Health and Social services, Rebecca Evans, A.M. asked to visit me in April and gave me the impression that she was more interested in outcomes than relevant standards which somewhat reassured me.