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The Way Forward for Care

Chapter 2 A new system of care service and early education regulation

Policy Objectives

10. The objectives for a new system of care and early education regulation are that it should be:

• focused on the people using the services, with the system of regulation and the standards used based on the quality of life the services enable people to experience;
• independent, with the regulatory body having no interest in providing services itself;
• consistent, so that users and providers throughout Scotland know that the same standards are being applied regardless of who is providing the service; and
• integrated, particularly so that individuals can remain in the same place with the type and intensity of care changing as their needs change.

Alternative approaches

11. The options for regulating care are:

• retaining the present system;
• amending the present system; or
• creating a national body to regulate care.

Retaining the present system

12. The present system does not meet any of the policy objectives. The main regulatory bodies are health boards and local authorities. Local authorities are also significant providers of services. The private and voluntary services they are regulating may be in competition with their own directly provided services. There is therefore a theoretical conflict of interest and a lack of independence.

13. The number of separate regulatory bodies, often operating to different standards, considerably weakens consistency of regulation across Scotland. It is also unacceptable that the full range of care services is not regulated. The present distinction in registration requirements between nursing homes, regulated by health boards, and residential care homes, regulated by local authorities, means that the system is not integrated and individuals may have to move home, often when they are at their most frail and vulnerable.

14. Finally there is no requirement on the different regulatory bodies to take the views of users and their carers into account either in the standards used or the regulatory process. While this has been undertaken by some registration and inspection units it must be given greater emphasis.

Amending the present system

15. It would be theoretically possible to require the existing regulatory authorities to work to national care standards and to operate the regulatory system in a consistent way but this would be inconsistent with the policy objective of ensuring an independent system, particularly as local authorities can be purchasers, providers and regulators. Amending the present system would not therefore achieve all our policy objectives.

Creating a national body

16. It remains our view, as set out in Aiming for Excellence, that a national body focused on regulation is the most appropriate way of ensuring that the policy objectives are met. A considerable number of those responding to the consultation paper, across all sectors, explicitly indicated that they supported the establishment of the proposed Commission. Only one respondent did not.

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