30 October 1990

Dear Colleague

COMMUNITY CARE: INSPECTION OF ESTABLISHMENTS

ORGANISATION AND ROLE OF INSPECTION UNITS

Summary

1. This Circular advises local authorities on the steps they should take to establish both units responsible for inspecting residential care establishments in their areas on a common basis irrespective of the sector of provision and the advisory committees to be associated with them. Proposals to this end were contained in the White Paper "Caring for People" and developed in the consultation paper "Organisation and Role of Inspection Units’ issued by the Secretary of State on 29 March 1990.

Relevant Legislation

2. The present guidance is issued under section 5(1) of the Social Work (Scotland) Act 1968. Powers of direction as regards the performance by local authorities of functions under the 1968 Act are contained in section 51 of the National Health Service and Community Care Act 1990 but no decision has been taken so far on their use in the present context.

General Objectives

3. The inspection of establishments providing residential and other forms of care is a necessary element in an authority’s arrangements for quality assurance in regard to community care services. Good inspections should measure performance against standards and agreed objectives; authorities must therefore be clear about the standards they expect and through them must establish clarity about particular objectives for those directly responsible for managing homes. The Secretary of State wishes to see service development aspects of inspection work promoted in a way which can be of benefit to local authorities, independent homes’ operators and residents themselves. Central monitoring will be important for fostering consistency of approach and standards between authorities.

4. The present arrangements for the registration and inspection of voluntary and private establishments in Scotland vary considerably from one local authority area to another. Identifiable teams are already operating in some areas for this purpose as part of the local authority’s ongoing arrangements in relation to these two functions. The development of expertise in quality assurance in such groups is seen as an important way forward in promoting work of this kind in the social work field more generally.

5. The Secretary of State is anxious in this connection that local authorities should seek to secure high standards of care that are common to the statutory, voluntary and private sectors. While, therefore, the existing work of homes’ inspection in the voluntary and private sectors will continue, it is intended that inspections of the same kind should in future extend to homes provided by the local authority itself. In order to promote an even-handed approach to this task the organisation and management of this work will need to be handled separately as far as possible from the management of the authority’s own homes.

6. The Secretary of State expects that inspection units with a remit on these lines will be set up by 1 April 1991 and that their operations should be subject to continuing oversight by an advisory committee in each case set up on the basis described in paragraphs 29-32. Proposals for the membership and functioning of advisory committees should be prepared by the same date with a view to the setting up of committees as soon as possible thereafter. It is intended to issue separate guidance on the operational framework for inspection units and on quality assurance.

7. In any case where the new arrangements set out in this Circular cannot be fully developed by 1 April 1991 it will nevertheless be important that a necessary framework of arrangements for the inspection of residential establishments on a uniform basis should be seen to be ready to operate from that date. The Secretary of State therefore expects that local authorities will have succeeded in establishing units with operational capacity and a defined work programme by that date.

8. Thereafter, there should be systems in place as soon as possible for:

- ensuring that recommendations and requirements following inspections are implemented on an even-handed basis;

- assisting the managers of residential care services within the social work departments to monitor their own services; and

- assisting other sectors of social work provision for which the authority is responsible with the development of quality assurance arrangements and the application of appropriate measures of performance.

Scope of Arrangements

9. Local authorities’ registration and inspection functions under Part IV of the Social Work (Scotland) Act 1968 extend to (a) residential accommodation for adult clients, (b) other establishments for adults (including day centres) and (c) residential and other establishments for children. The extension of inspection arrangements to the local authority’s own establishments in the way outlined above will apply to residential establishments for adults only in the first instance. The Secretary of State will consider applying the same arrangements to non-residential establishments for adults as soon as is reasonably practicable. The development of the new arrangements which it describes will not in any way affect local authorities’ duties to register and inspect such establishments in the independent sector and to exercise effective control over standards in their own establishments as at present.

10. The recently published report of the Child Care Law Review recommended that registration and inspection should be extended to child care establishments. The Secretary of State has consulted interested bodies on its recommendations before making decisions about any new arrangements for the inspection of children’s establishments in Scotland. Once he has responses he will decide whether to accept the recommendation. The remit of the new inspection units will not therefore extend to the child care field meanwhile.

Key Objectives of Inspection Units

11. The creation of separate inspection units is seen as a central element in a strategy to promote a good quality of life for people in residential care homes in the public, voluntary and private sectors. The role of these units will be to:

- monitor on a regular basis the quality of care and living environment provided in private and voluntary residential homes and in similar local authority establishments;

- adopt a consistent approach to assessing the quality of services in all homes while preserving the responsibilities of management;

- serve as a source of advice to local authorities on the quality control aspects of services provided by agencies under arrangements with them.

12. In the development of these units local authorities will be able to build on experience acquired from involvement in the registration and inspection of private and voluntary homes. As further experience is gained inspection units will be expected to play an increasing role in promoting quality assurance and quality control in other areas of social work provision.

Place of Inspection Units in the Authority

13. Inspection units should operate at arm’s length from the day to day management of local authority homes while still reporting to the Director of Social Work. A clear distinction therefore needs to be made between the functions of staff responsible for the management of local authority homes and those directing, or working in, inspection units. The arrangements that are chosen should ensure a clear line of responsibility to the Director of Social Work who will remain accountable to the social work committee for safeguarding the independence of inspection units, and for performance of the unit and the action taken within his department in response to the reports which it provides. The links between the Director and the unit itself will depend on the size and organisation of the social work department. There will need to be arrangements in all cases for involving the Director in matters of serious concern.

14. Where a person is appointed specifically as head of a unit the post should be graded and the job defined so as to safeguard the status and independence of the unit within the authority. The duties for which the unit head is made separately and specifically responsible should include planning and managing the unit’s work programme and the reporting of findings arising from inspections.

15. It is expected that local authorities will, in most if not all cases, wish to set up units at their own hand. While this is likely to be the most appropriate and cost effective approach there may be scope for a different approach by smaller authorities. Where a unit is established to serve more than one authority both management responsibilities and day-to-day working arrangements will require to be clearly defined. The interests of any authority electing to use a service other than one which it provides itself will need to be safeguarded at all times.

16. Authorities considering joint or agency arrangements should be aware that while the human and other resources necessary for the exercise of a local authority’s duty to inspect residential and other establishments may be provided by another agency under section 4 of the 1968 Act, the exercise of discretionary powers in relation to this or any other specific function is entirely a matter for the particular authority. Where, therefore, joint working or an agency arrangement is established individual inspectors would have to be authorised by the local authority on whose behalf they were empowered to act: section 67 of the 1968 Act contains the necessary provisions to this end.

Staffing and Management of Inspection Units

17. As every local authority in Scotland has staff whose present duties include the inspection of private or voluntary establishments authorities will already have a nucleus of in-house experience in this field. The Secretary of State sees advantage in inspection units also including inspectors with experience from outside local authority social work departments; he expects authorities to consider this approach wherever the need for additional or replacement staffing requires to be considered. The Secretary of State will consider setting minimum targets for outside recruitment if this should appear necessary.

18. It is not intended to lay down centrally the formal or other qualifications that inspection staff should possess. Recruitment arrangements should recognise the advantage of employing suitably qualified inspectors with a wide range of skills, appropriate training and experience. Apart from persons already working in the social work department (who might be taken on either permanently or on secondment), the field of consideration might include persons with experience of nursing or managing a private or voluntary sector establishment, or of work in the voluntary sector more generally, or persons with a professional health background. Authorities will wish to ensure that persons recruited for this purpose have no conflict of interest through direct involvement with the running of residential or nursing home services. Flexibility in the terms of employment offered may help to secure suitable outside applicants. Fixed term contracts, part-time appointments, secondments or agency arrangements may also merit consideration.

19. The expertise requiring to be drawn on for particular inspection purposes will vary depending on the special circumstances of the client group served by the home, the type of care provided and more general issues relating to quality assurance. It may be that authorities will wish to develop units with a small core of staff who build up special knowledge and skill in inspection and a larger group of other, possibly part-time, staff who could contribute special understanding of the care requirements of particular types of resident.

Functions of Inspection Units

20. The Secretary of State expects that the functions to be given to inspection units in regard to the monitoring and control of standards in residential homes will include:

- inspections of voluntary and private registered homes under arrangements authorised by the local authority;

- inspections of residential homes provided by the local authority itself under arrangements approved by the local authority;

- the provision of advice to the local authority arising from any inspections, visits or other activity carried out as above.

21. It will also be open to authorities to decide whether or not personnel in inspection units should be involved in visits or discussions of the kind which the local authority will commonly require to undertake, whether in response to applications from persons seeking registration for a home or enquiries by prospective applications or in respect of registration issues where the establishment is already registered. Whether the local authority decides to handle exchanges of these kinds on quite a separate basis or not a pre-requisite in all such matters will be consistency on the standards applied to the process of registration and inspection respectively.

22. Tasks associated with registration and inspection may be seen as complementary to some extent since the conduct of inspections in relation to particular homes will equip units to give advice both on the management of the authority’s own homes and on continuing registration of voluntary or private homes. It should nevertheless be borne in mind that only the local authority itself will be able to reach formal decisions on the registration, or refusal or cancellation of registration, of an establishment. Moreover where the staff of a unit are engaged in matters associated with the registration of establishments, management should provide clear instructions on roles and reporting lines. It is also necessary that the managers of units should be clear as to the distinction between, on the one hand, the executive elements of the task described in paragraph 20 above and, on the other hand, any advisory function they may be given on the lines of the third sub-paragraph of the passage.

23. Consistency of approach across different residential care sectors may be facilitated by the application of guidelines which local authorities have agreed among themselves for the carrying out of their functions as to the registration of establishments working within general principles of residential care contained in ‘Home Life’, referred to in Circular No SWSG16/88 of 13 September 1988, or such other reports as may be prescribed by the Department in the future.

24. Local authorities are reminded that paragraph 50 of the above-mentioned Circular indicated that the fee payable for the annual continuation of registration under the Registered Establishments (Scotland) Act 1987 was intended to cover the cost of two inspections each year and that inspections need not be by prior arrangement in every case. It will be for local authorities in the light of local circumstances to determine the frequency of inspections in respect of any establishment, whether one operating under their own management or not, but two inspections per year should be seen as a minimum for normal purposes. Authorities should consider the advantage of arranging that one at least of these inspections should be undertaken without prior notice.

Follow-up to Inspections

25. Following each inspection the unit should present to the home owner, or to the appropriate line manager in the case of a local authority home, a written report on the outcome of the inspection. The unit should take steps to ensure that the report is fully understood by the home owner/manager and that any matters of substance which it raises have been discussed with him or her previously. They should in any case seek to secure the owner’s/manager’s agreement to the findings of a report and record any disagreement expressed. Items or standards of provision or care meriting favourable comment should be recognised in the report along with any points reflecting less satisfactory aspects requiring action or review. It is clearly desirable that the report should issue as soon as possible after the inspection. The time within which the written report is expected to be available should be made known to the home owner/manager at the time of the inspection.

26. Authorities will have procedures which are already established for dealing with reports on private and voluntary establishments. The inspection of authorities’ own homes should be made subject to the same or similar procedures: a clear statement of each authority’s policy and intentions in regard to such procedures will be a matter of considerable importance. Authorities will need to ensure that the recommendations of inspection units in reports on their own homes are considered and acted upon in a similar way to that followed in relation to voluntary or private sector homes. The guidelines which authorities draw up for this purpose should explain how they will respond to reports on both their own and other homes: other services should be considered for similar treatment in due course in line with the suggestion in paragraph 9 above.

Collaboration with Health Boards

27. Effective collaboration between local authorities and health authorities on the lines set out in the White Paper will require agreed policies on quality of services in related fields. When the new arrangements for funding community care come into effect in April 1993 Health Boards will continue to be responsible for the registration and inspection of nursing homes, including some to which local authorities may look for the provision of accommodation as part of wider community care arrangements. The exchange of information about such homes will be essential. Health Boards should be made aware of contracts made between nursing home proprietors and local authorities, especially where there are issues relating to standards or quality control calling for ongoing consideration on the part of the local authority. Health Boards for their part will wish to establish arrangements to provide local authorities, either routinely or on request, with information about the registration of nursing homes in which they have an interest, and such information may extend to matters arising from inspections which the Health Board has carried out.

28. Local authority inspection teams should establish a close relationship with their opposite numbers in Health Boards both for purposes mentioned above and with an eye to the promotion of a common approach on standards of provision and care in homes. Agreement on a wider range of issues will be of assistance in dealing with applications for joint registration (dealt with in paragraphs 31-36 of Circular SWSG16/88). Joint inspections in the formal sense will clearly be appropriate in cases of joint registration, whether of whole establishments or separate parts of an establishment, but joint work on registration and inspection questions in respect of other establishments could be a basis for wider co-operation on inspections, especially when local authorities assume responsibility for funding care costs in private nursing homes in due course. Joint inspections where only one authority has responsibility for registration will however have to be carried out with a clear understanding of the balance of statutory responsibilities.

Advisory Committees

29. Each authority will be expected to establish an advisory committee which could reflect the interests of the voluntary or private service providers and service users in the role, functions and staffing of the proposed inspection units and the authority’s arrangements for securing quality assurance and control. Powers to appoint such committees as sub-committees of the social work committee are provided by Schedule 20 to the Local Government (Scotland) Act 1973. They would have no executive powers. They would be expected to meet at least twice a year. Their terms of reference would be for local decision but authorities would be expected to have regard to the range of possible activities described in Annex A attached.

30. In some areas councillors visit homes or other establishments outwith any formal inspection arrangements. Authorities may wish to continue this practice which might be equally appropriate for other members of advisory committees. Visits of this kind would normally be arranged under the provisions of section 68 of the 1968 Act. It should be made clear that authorisations conferred for such visits are in no way connected with the powers of inspection which local authorities will confer on members of inspection units.

31. Under section 62 of the 1973 Act the appointing authority is empowered to make standing orders governing the procedures to be followed by a committee, or may leave such procedures to the discretion of the committee. An indication of how an advisory committee might be constituted is included in Annex A. For the purpose of appointing persons from the independent sector or bodies representing the interests of users, the authority might wish to issue a public invitation to relevant local or other organisations to put forward nominees of their own or to consult local co-ordinating groups of home owners and voluntary sector interests for the same purpose.

32. Subject to paragraph 6 above advisory committees should where possible be brought into being in the early stages of the operation of inspection units, since the early involvement of outside persons in this way will help to provide assurance on the issue of consistency dealt with in paragraph 11 above.

Accountability and Reporting Arrangements within the Local Authority

33. Arrangements should be made for the copying of inspection reports to the Director of Social Work, or his nominee as may be the case, for consideration of what action should be taken on the matters raised in it: in cases of serious concern this would include bringing the matter to the attention of the social work committee.

34. The Director of Social Work should make a written report each year to the social work committee on the work of the inspection unit. The advisory committee should be invited to comment on this report which should be available to the public and should in all cases indicate the number of homes visited by the inspection unit and the frequency of visits as well as details of staffing and other inputs; workload indicators; an assessment of performance against plan; and a summary of the outcome of inspections including remedial action required and taken. The Government’s preference generally would be for openness consistent with the need to protect the position of local authorities in law, not least as a means of creating public confidence in the authority’s quality assurance and control processes. It would be necessary for local authorities to establish their own arrangements with appropriate legal advice on the inclusion of particular details in respect of homes referred to in the annual report.

Costs

35. The arrangements called for in this paper, including possible need for recruitment to inspection teams and the establishment of advisory committees, will have some resource implications for local authorities. The cost of inspection of voluntary and private residential care homes is already offset by the annual continuation of registration fees charged to home owners. The inspection of local authority homes, and in due course other services will lead to some increase in the net cost of undertaking regulatory work of this kind across the range of local authority activities. The financial implications of this have been discussed with the Convention of Scottish Local Authorities and were taken into account in the decisions reached in September of this year on aggregate external finance for 1991-1992.

Central Advisory Role

36. The Social Work Services Group professional advisers are working closely with the Social Work Services Inspectorate of the Department of Health on a range of quality assurance issues which will be dealt with in the Scottish guidance to be issued later on the organisation of inspection units and on the conditions expected in a good home. Central monitoring arrangements will be established to evaluate the work of local authority inspection units in different areas and to provide support and advice as may be required. This work is likely to focus on the operational framework of units, their role and functions, recruitment and management, the working methods and standards applied in inspections and action on their reports. It would also extend to the working of advisory committees and relationships with the unit and arrangements within the local authority more generally.

Action

37. Authorities are asked to set up by 1 April 1991 one or more inspection units for their area to undertake the inspection of residential homes for adults; to make the necessary arrangements for the management, staffing and operation of the units and their reporting arrangements; and to set up, by 1 April 1991 if at all possible, an advisory committee under the social work committee to be closely associated with the work of the unit.

Contact Point

38. Please direct any enquiries about this Circular to Mr Trevor Hall, Social Work Services Group, Room 44, James Craig Walk, Edinburgh EH1 3BA

(telephone 0131 244 5455).

Yours sincerely

GAVIN ANDERSON

ANNEX A

(paragraph 29)

INTENDED FUNCTIONS AND MEMBERSHIP OF ADVISORY COMMITTEES

Functions

1. Advisory committees would be set up by the social work committee. The object would be to create a broadly based group with suitable skills and experience to take an impartial view of inspection and related issues. In particular, the committee would be available to provide advice to the social work committee on the exercise of local authority functions in relation to the inspection of establishments and on other quality assurance matters. The committee could, depending on interests represented in it and the requirements of the social work committee, serve in due course as a forum for the exchange of views on matters affecting general issues of quality assurance and the fostering of closer working relationships with voluntary and private sector service providers.

Particular Activities

2. The committee would in particular be required to:

- provide comments on the annual report of the work of the inspection unit (referred to at paragraph 34 of the Circular) for the benefit of the social work committee;

- advise the social work committee on the operation of inspection arrangements and the general guidance given to it on the procedures for inspection, and on the application of guidance on standards.

Membership

3. A committee might include persons drawn from:

- the local authority itself and other parts of the statutory sector, drawing on the skills and the experience available in this way to complement the range of interests and expertise in the rest of the committee, as below;

- the voluntary sector, possibly nominated by local voluntary organisations running homes;

- the private sector, possibly nominated by a local association of care home proprietors;

- users, possibly care home residents or their representatives, perhaps nominated by local voluntary organisations or users.

4. All appointments of non-councillors would be of persons specifically approved by the authority for the purpose; and such persons would serve as co-opted members. Outside members no less than those with a background within the local authority itself should be selected for their experience and skills and they should not be seen as representatives of a particular group or sector of residential care. Such persons might be found among staff who have recently retired from local authority service. Nominees might be invited to serve for a fixed term of between one and three years. A system of rotational appointments might be introduced to provide continuity in the longer term. Local authority officers would normally be involved, if at all, in servicing the committee rather than as members of it.

Access to Information

5. The proceedings and reports of the advisory committee would automatically be available to the public by virtue of the Local Government (Access to Information) Act 1985.