|National Care Standards Commission Regulations 2001
Mr. Paul Burstow (Sutton and Cheam): The regulatory impact assessment says that there will be a difference in the fees where a minor variation is made. However, it does not go on to give exemplars of minor variations. Can the Minister cast more light on that so that those outside will know whether they will pay, say, £50 or £300 for a variation?
Jacqui Smith: The hon. Gentleman is right. There is a difference. The fee will be £50 for a minor variation—for example, a care home that wants slightly to reduce its number of residents or to change the name of a manager who has got married. As neither of those would necessitate a visit, it is right that only a small charge should be made. A larger variation might be the building of an extension or an application to change the type of resident. Those would necessitate a visit, so it is appropriate that the larger fee should be paid. Of course, that is still half the fee for the original registration.
The hon. Member for North-East Hertfordshire referred to applications from providers to cancel their registration. As he said, there is no formal process for ending one's registration under the Registered Homes Act 1984; it can be done only through cancellation, which in most circumstances prevents people from running such a service in future. The regulations will allow providers to apply to end their registration where they have decided to stop providing services or to sell their business to another provider, as long as there is no outstanding enforcement action against them. Providers who seek voluntary cancellation will be required to set out the reasons why they wish to end their registration. The NCSC will generally refuse to cancel registration only where enforcement action is in train. If no such action is taking place, no stigma will be attached to a request to cancel, and there will be no prohibition on that provider re-registering for a different service in future.
The hon. Gentleman asked about the registration of more than one service, especially in relation to transition issues for a home that houses people over 18. The answer depends on the level of services that he is thinking about. A home that provides services for younger adults and children aged 16 and 17, as well as those over 18, will have only one registration. However, where a provider effectively has two separate services—for example, for children under 16 and for adults—there will be two registrations, one for the children's home and the other for the care home. That is the same as the current position. It is appropriate that we recognise that there may be very different needs and standards in relation to children and to adults.
The hon. Member for North-East Hertfordshire also asked about criminal record checks. Under the current framework, police checks are required on people seeking registration as providers or managers of services. Most local authorities also require checks on such staff being employed in children's homes and other children's services before the commencement of employment.
The new regulations require that criminal records checks are undertaken for all those working with vulnerable adults prior to commencing work. That is
Column Number: 12linked to our policy on the protection of vulnerable adults, and access to the new list will be through the criminal records check. Under the current system, checks can take 12 weeks or more to be processed by local police forces. The Criminal Records Bureau, which will come into operation in April, will reduce the time to 10 days for a standard check and three weeks for an enhanced check. I am aware that some providers are concerned that that will affect their ability to recruit staff. I remain committed, as do the Government, to the principle that such checks should be undertaken before people provide intimate care to vulnerable adults.
However, I am also aware that there may be a need for transitional arrangements to be put in place, particularly if there is concern about the timing of checks from the CRB at the start. Therefore, the Government are considering what, if any, additional arrangements will be put in place to prevent delays in recruitment as a result of the time lag in receiving the results of checks, with the proviso that any such arrangements will need to protect the interests of vulnerable people.
Mr. Heald: Will those additional arrangements be set out in the amended regulations? If not, how will they be promulgated?
Jacqui Smith: I am not sure. We already have to make transitional arrangements and, as we consider what they should be, we shall consider the most appropriate way to deliver the objectives that I have spelt out—maintaining the protection of vulnerable people while ensuring that the time between the interview and when a person can start work is not too long.
The hon. Member for North-East Hertfordshire also asked about providers of intense pulsed light treatment. Following advice from many people in the sector, the Department argues that intense pulsed lights are as dangerous as lasers and can cause damage to eyes and surrounding tissue if used inappropriately. As I suggested at the beginning of my remarks, our main concern is to ensure the safety and quality of the service for users, so we consider it appropriate to regulate in that regard. Electrolysis was exempted, because it does not involve the same risk.
The hon. Member for North-East Hertfordshire and the hon. Member for Bromsgrove have asked about the distinction between residential special schools at which children stay for longer than 295 days a year and those at which children stay for less time. The National Children's Bureau has expressed understandable concern that children in residential special schools receive the necessary protection—a concern that I share. That was the reason for the new processes of regulation and inspection of residential special schools. In particular, the 295-day rule was introduced to reflect the difference between schools that operate on a normal three-term basis and schools that are effectively a child's permanent home. Schools that provide services for more than 295 days a year must be registered. Welfare provision in schools that provide a permanent home for children will be inspected by the National Care Standards Commission, alongside Ofsted inspections. The
Column Number: 13NCSC can carry out follow-up inspections, as necessary, if there are concerns. I have discussed the subject of residential special schools with the National Children's Bureau.
The hon. Member for North-East Hertfordshire referred to the proposals for full cost recovery. He is right; the Government want to progress to full cost recovery in the next five years. We have set the fee levels to ensure that, with the investment that the Government have made, the commission is able to carry out its inspections and duties. That is beneficial not only to users but to providers because a standardised approach to regulation, consistency and higher standards will ensure that providers benefit from the extra trust and understanding of the new system.
During the consultation on fee levels, the Government suggested a phasing in of regulatory costs to be reviewed after two years. That proposal was generally supported. The approach has been to base the fees on the regulatory work required. Particular concerns were expressed about the impact of regulatory fees on small providers such as adult placement carers, small care homes, and small domiciliary care or nurse agencies. We have lowered their annual fees to recognise the concerns of that sector.
Local authorities and health authorities, as commissioners of services, have been compensated so that they can bear the increased regulatory costs in the commissioning fees that they pay to providers. Therefore, little burden should fall directly on providers. In the short term, we have taken a gradualist approach to fees because we do not want sudden increases to jeopardise the early success of the new regulatory regime.
I am glad that we have had an opportunity for the first instalment of the discussions on the Government's proposals. I look forward to the second instalment in another Delegated Legislation Committee tomorrow, but I hope that hon. Members understand that we all share the objective of ensuring that care and independent health providers are of the highest standard. In our regulatory provisions, we must put the needs of users at the centre of the way in which we regulate, inspect and improve those services.
Mr. Burstow: During the passage of the Care Standards Bill, the Liberal Democrats supported investment in raising standards and a regime that was more detailed in setting those standards. We welcome the establishment of the National Care Standards Commission.
However, it makes more sense to consider a regulatory regime that encompasses the whole care system. Experience of the care system often involves a journey through different parts of it, so it is sensible to have a system that can accommodate that journey. The current system makes that difficult to achieve. I have several questions about how the Commission will improve outcomes for those receiving services. The hon. Member for North-East Hertfordshire has already addressed the legitimate concerns of providers.
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My first question concerns the role that the commission can play in providing the Government and others with more information to enable them properly to plan capacity in the care sector. Could the regulations in any way prevent the commission from doing that? The provision of long-term care and services for children does not have the same level of capacity and the systems are not in place to ensure that there is the information at national level to enable decisions about investment to be made. Is the NCSC able to go beyond the statutory limitations placed upon it, which require it merely to encourage improvement in quality, to collect information that will be fed into the capacity-building process to which the Minister referred?
How will compliance with the staffing requirements set out in standard 27 of the care home standards be monitored by the NCSC? That standard requires that determining whether staffing numbers and the skill mix of qualified and unqualified staff are appropriate is based on an assessment of the needs of service users. The NCSC is dependent on those assessments being undertaken, and until that happens it will have to rely on old assessments to make an overall judgment about the staffing mix in care homes. Will the Minister tell us how often people will be assessed for this purpose to enable rational decisions about staffing numbers and the mix of skills to be determined? Otherwise it will be difficult for the standard to be made a reality and for the commission to undertake its work.
That relates to another matter—the capacity of the commission to fulfil its brief in terms of the numbers of staff that it has to discharge its role. In 1983 there were eight homes per inspector. By 1999 there were 20 homes per inspector. I have not seen figures subsequent to 1999, so it would be interesting if the Minister could tell us what the current ratio is and what it is likely to be under the NCSC. Is the Minister satisfied that the resources that will be available to the commission from day one, and the planned level of resources thereafter, will be sufficient to ensure monitoring of compliance with the standards that will be debated tomorrow in the Committee that considers the Private and Voluntary Health Care (England) Regulations 2001 and the Care Home Regulations 2001.
Will the Minister address an issue that I have raised on several occasions—the inappropriate over-medication of care home residents? That, and the inappropriate use of restraint, was discussed in a report by Counsel and Care, a charity that deals with such matters.
Before the Christmas recess I asked a question about the number of pharmacists that the NCSC would employ. The Minister gave the planned number but was unable to tell me how many were currently in post or the likely time scale for employing more. Will the Minister tell us how many pharmacists will be employed by the commission on 1 April and how many are currently in post?
The National Care Standards Commission (Fees and Frequency of Inspections) Regulations are predicated on the assumption that inspection frequencies will be much as they have been until
Column Number: 15now—one announced and one unannounced inspection. The Minister is probably aware of the representations made by Action on Elder Abuse and others about the welfare of residents in homes. It should be recognised that in some circumstances more visits and inspections will be necessary, not least to secure compliance with some of the more serious aspects of the standards. I hope that the Minister can confirm that there will be that flexibility and that the resources will be available to make it a reality.
Can the Minister say what models will be used for inspection, particularly of care homes? I recently read an article in the British Medical Journal that examined the quality of care in a range of private and public sector homes and found it to be dubious. The report went on to say that methods used for inspections do not rely much, if at all, on direct observation of the care provided in homes, but on records and measuring. Can the Minister tell us whether there will be changes, such as the use of dementia care mapping and other techniques that enable a better fix to be had for the person in the home in respect of how they perceive their quality of care?
The regulatory impact assessment fails to consider the possibility of increased work from not only complaints—I hope that the new NCSC will make it easier for people to complain about their experience of care—but the fact that because, for the first time, there is to be a consistent approach to regulation, issues will arise about inconsistencies in the delivery of care from one provider to another in the same locality. Why has that not been considered? The Minister could indicate what steps are being taken to ensure that that is monitored so that any resource implications that the regulatory impact assessment has not taken into account are made clear.
The Treasury is prepared to fund, at least for a transitional period, the costs of operating the NCSC. Can the Minister confirm whether that underpinning of public money to support the NCSC is short term, and that the objective of self-financing remains? Is that objective more important than securing the standards, which the commission is to register, regulate and enforce?
Access to information is another area on which the public will want to be assured. Will a range of methods for gaining access to the information collected by the NCSC be made available to the public? For example, will it be possible to see more than the total number of formal notices of non-compliance and prosecutions, which give an impression of what is going on, but not the whole picture. Will information be collected on outcomes in care homes so that people can make informed judgments about the standard of care provided in their locality, and will that, as well as inspection reports, be available on the web?
What are the plans to overhaul the system of data collection? The Minister rightly said that care should be centred around the needs of the individual, to which I entirely subscribe. However, the NCSC has no statutory duty to consult those who are users of care services. That is a strange omission from its statutory
Column Number: 16duties. Can she confirm that, as things stand, the office of the health service ombudsman has no jurisdiction when it comes to people who want to make complaints about the work of the NCSC? It seems strange that people will have to take the route of approaching their Member of Parliament and going through the parliamentary ombudsman, rather than using the health service ombudsman who, after all, will deal with some of the same matters in the state part of the system.
My concern is to make sure that the system works and that the providers of care have the resources to deliver a higher standard. In her concluding remarks, the Minister referred to the largesse that has been bestowed on local government to provide the increases in fees. When I talk to directors of social services, and others in the business of providing care, they say that they are looking closely at the standard spending assessment to find the largesse; it is certainly not a large largesse. The problem remains that the gap between what councils spend on social services and what the Government believe that they need to spend continues to widen. While that is happening, it has a hollow ring if Ministers come to Committees such as this and say that the money is there.
I look forward to any further answers that the Minister can give us today to clarify the way in which the user of the services will benefit from the new National Care Standards Commission.
|©Parliamentary copyright 2002||Prepared 29 January 2002|