Item 2 is oral evidence on the Smoking, Health and Social Care (Scotland) Bill. Ministers have lodged a stage 2 amendment to allow a variation of the frequency at which the Scottish Commission for the Regulation of Care is required to carry out inspections. A Scottish Parliament information centre briefing setting out the current inspection requirements has been circulated to members. The provision was not included in the bill when we considered it at stage 1, so the committee has decided to take some evidence today, given the nature of the amendment.
Age Concern Scotland, which represents consumers, is against the amendment, because it could erode some of the protection that is currently available to care home residents. Our response focuses particularly on care homes.
I represent a care provider. Although we appreciate the need to husband scarce resources, we are concerned that the proposal might represent a step backwards just when confidence is growing in the current system.
Community Care Providers Scotland represents almost 60 independent service providers in the voluntary sector. It is fair to say that the membership has mixed views on this matter. On the whole, the prevailing view is one of "Yes, but". We would like the measure to be implemented, but we also want a series of additional measures to be introduced to mitigate unanticipated consequences.
I ask one of the two representatives from the Convention of Scottish Local Authorities to give us a brief comment.
I am pleased to represent local government in this afternoon's discussion. Local government is both a provider and a procurer and, as our written evidence makes clear, we are broadly in favour of the minister's proposals because they will help to target resources at where they are needed. However, our submission contains a couple of caveats.
We move next to Lesley Aitkenhead from the East Lothian community care forum.
Although I am from East Lothian, I am representing the Scottish Community Care Forum this afternoon. We are against the proposals. We feel that both visits should be retained, because they are essential and serve different purposes.
I represent Scottish hospices in the voluntary sector. We unanimously support the proposals, because the care commission's limited resources should be targeted at where they are really needed: improving the quality of care.
We have consulted advocacy services in Glasgow, greater Glasgow and Fife on this matter and feel that we are against anything that would reduce the meaningfulness of inspections. However, we would go with the proposals if there were caveats.
Like Annie Gunner, we broadly welcome the proposal, but take a "Yes, but" view of it. Although we accept the amendment, we seek certain conditions with regard to where and how risk assessment processes would be carried out.
We are also joined by two representatives from the care commission.
The care commission is in favour of the amendment, because it wishes to improve safeguards for people who use care services. We believe that having greater flexibility to target resources at services that are not providing a certain level of care will enhance the commission's ability to provide scrutiny.
Now that everyone knows where everyone stands, we will move to the discussion of the amendment. It appears that the consumers are unhappy with the proposal; that the providers are happy with it; and that a few folk are ambivalent or take a "Yes, but" view.
I will ask the Scottish Executive witnesses some general questions that refer to something that the convener said in her opening remarks. Why are the measures being introduced in an amendment at stage 2 instead of having been included in the bill as introduced? The amendment is substantial and would require more consultation and discussion than many measures that are in the bill already. Exactly what is being proposed? What will the new framework be? Because we have not had much time to consider the amendment, I am a bit confused about that. Does the Scottish Executive envisage that the new framework will be cost neutral, that it will cost more or that it will cost less? It is important that those issues be fleshed out, because we have not had the same opportunity to scrutinise the amendment that we had for other parts of the bill.
On the timing, the important point is that the regulatory system is relatively new, and the need for the proposed measure did not crystallise until it was too late to get it into the bill as introduced. However, ministers felt that it was sufficiently important to introduce it as an amendment at stage 2 rather than hang on until the next legislative opportunity, as we do not know when that might be. Ministers thought that the bill provided a good opportunity to make this important change at an early date.
You did not answer the question about costs.
I am sorry; I answered your first question, and your second question was about the new framework.
Why would ministers want to decrease but not increase the current statutory frequency of inspection? Would bodies that are opposed to the amendment not think that it could work either way? At the moment, the amendment seems to be about taking something away; it is not about varying the frequency in favour of those who receive care.
The point about the statutory minimum frequency is that it is a minimum that the commission is obliged to deliver regardless of the circumstances. It can always inspect more frequently at any time if it has concerns. Therefore, ministers did not think that it was necessary to introduce any provision to increase the minimum frequency but, unless there is a provision that enables ministers to reduce it, the care commission will always have to inspect every care service at the specified minimum frequency. There is no problem with the commission inspecting more often if that seems the appropriate thing to do.
However, ministers would not be able to increase the frequency by order, although they are giving themselves the power to decrease the current statutory minimum frequency.
That is right, but ministers have powers of direction and, in principle, they could direct the care commission to inspect care services more frequently. At present, we cannot direct the care commission to inspect less often than the statutory minimum frequency, because ministers cannot tell the commission to break the law.
A significant cost issue has been raised in evidence from a number of organisations. It has been said that the good providers, which are inspected less regularly, will have to pay for the not-quite-so-good providers that you will want the commission to inspect more often. Consequently, there will be detriment to good providers.
What you describe already happens under the present regime. The commission inspects various service providers at more than the minimum frequency, but all providers pay it the same registration fees, annual continuation fees and so on. If the amendment were agreed to and the power were exercised, it is likely that cross-subsidising would increase in affected care services, because there would be more headroom for the commission to inspect some providers more frequently, while keeping the others at the new, lower minimum frequency. There is nothing intrinsically new in that—the principle is already established. It is important to make the point that the annual continuation fee covers a great deal more than inspection. It also covers complaints, which are a major part of the commission's work.
The cost to some of the smaller organisations of preparing for and undergoing an inspection is not insignificant. The savings from not having to do that twice a year will balance out the feeling that good providers are subsidising poor services.
This is a significant issue for members of Community Care Providers Scotland. Although I agree with Adam Rennie that cross-subsidising already happens, we believe that the amendment stretches it to breaking point. Fees are paid annually, so if there are to be inspections at a less than annual frequency, we may end up paying a fee for no activity. That undermines the Executive's policy on fees. All the regulatory impact assessments that were produced said that fees are based on the level of activity that a provider receives, on a value-for-money basis. I agree that cross-subsidising is nothing new, but our opposition to it is not new either. When the committee discussed the original provision, many of the same issues were raised. I do not want to hijack the entire discussion, because there are other matters that we need to consider, but this is a significant issue.
We want to make it clear that, if a provider does not have an inspection because a risk assessment determines that it does not need so many inspections, that does not mean that there will be no activity or contact. We will require all care services, regardless of the frequency with which they are inspected, to be subject to an annual assessment. When carrying out risk assessments, we will need to consider providers' performance and the improvement that they have made. We will also need to take account of the views of service users. That will not be done through inspection visits. In the case of some services, such visits are not required, because the services are provided in people's homes. Visiting the office of an agency that provides a service does not tell us what the service user is engaged in. We will also consider issues such as how many complaints there were. There will be complaints investigations even against services that are assessed as performing well in inspections.
I want to summarise. Inspection is only one part of the activities that we undertake, and it is dangerous to assume that we scrutinise services only through inspection. It is important to take a broader view of our activities. We would not support the proposal if we did not think that increased flexibility in the inspection regime will enable us to spend more time investigating complaints and more time with the people who use care services. To use the words that Mr Mallinson used, what we are after is more meaningful scrutiny. The proposal is not about reducing any form of scrutiny; it is about targeting more wisely and meaningfully and spending more time with the people who use care services.
Under the new regime, might there be services that will go for a whole year with no inspection?
That could be the case, but we would recommend that only on the basis of a risk assessment, one element of which would be consideration of whether another scrutiny body was going in. For example, Her Majesty's Inspectorate of Education inspects day care services for children. Under the proposals, we will be able to create a much more intelligent regime and, as David Wiseman pointed out, we will still receive information from those services.
What Jacquie Roberts says makes remarkable sense, but we would have preferred a fuller evaluation of all the powers and responsibilities of the care commission rather than just one element—the frequency of inspections—being drawn out. We do not wish to see the creation of multiple tiers of and timescales for inspection. In particular, we do not want a system in which a less frequent inspection regime applies to a whole organisation. The regime must be based on individual services. As a large voluntary care provider, we provide a huge number of services and the system needs to be associated with each of those services individually rather than with the organisation as a whole.
As we heard from the Health Department, the amendment does not seek to change the frequency of inspections but it will give ministers the power to do so, if they wish, after consultation with the care commission and any other relevant persons. Will that be done on the basis of one organisation, one home or one facility? An important point has been raised about who will make the decision and how wide it will be.
The consultation duty will fall on ministers and the first consultation will be with the care commission—that is clear. The next consultation is the one that you are asking about. The Executive has a standard procedure for consulting a wide range of organisations and individuals and we use that procedure for all sorts of purposes. It is standard procedure for legislation to provide that ministers must consult such persons as they consider appropriate.
I have a question for Jacquie Roberts. Would the care commission take into account the other performance monitoring arrangements that are already taking place? I am picking up a point that was made by Community Care Providers Scotland about local authorities stepping up inspections if the commission was stepping down. Inevitably, local authorities have some responsibilities in relation to the protection of vulnerable people and the proper scrutiny of how the public pound is spent, and there is scope for the care commission to take more account of other performance monitoring processes that might already be in the system. Rather than simply duplicate those processes, the commission could be more co-operative in its approach.
That is precisely what we wish to do. We would base our risk assessments on existing knowledge of the types of service—that would be one level of risk assessment—and on individual services. We have a number of questions—which David Wiseman could read out to you—about the sort of risk assessments that we would be considering. We would take information from the local authorities, from the care managers and from other scrutiny bodies. The new Social Work Inspection Agency would have information about services delivered in a given area. That is the whole point. Any consultation would have to include not only the providers but other stakeholders in the commission of services, particularly the people who use the care services to ensure that they feel that they can still make complaints to the care commission if they have concerns about the service.
I want to ask the care commission what is happening to the recruitment and role of lay inspectors.
We are in the middle of a pilot of the lay inspection process, and we have piloted the use of lay inspectors in a number of areas in the care commission and in a number of different types of care services. When the care commission came into being, we inherited a position in which the use of lay inspectors had not been consistent throughout the country. We are trying to find the best model for involving lay people in the inspection process. The early indications from the pilot are that lay inspectors bring a perspective to the inspection that adds to the process. As well as bringing an extra dimension to inspection, lay inspectors have been very much accepted by care providers. However, we cannot yet fully evaluate the pilot.
From the inspections that you have done so far, what percentage flag up issues that you think need to be pursued? What percentage would you designate non-problematic? We will not hold you to the figures; we are just looking for a broad-brush, across-the-board idea.
I can give you three broad-brush figures from samples. From the sample of care homes for older people, we would be looking at following up 45 per cent of homes because they are not meeting all the regulations. We make requirements in the report and ask care homes to submit an action plan. For childminders, the figure is about 44 per cent, whereas for day care for children it is only 18 per cent. That shows already that we could reduce the frequency of inspections for some of the services that we regulate. As I said, at the moment we are not recommending any change in the frequency of inspections in care homes for older people or for childminders—we would also be considering the vulnerability of the age groups and the vulnerability of the people concerned. We are looking for greater flexibility to work more intelligently where it really matters.
The submission from Community Care Providers Scotland says:
It is true that the care commission board decided that we should focus our inspections for all services of a certain type on a specific number of the standards. If we have concerns about a service, we look at all the standards and regulations. That is the routine. If we inspected against all the standards all the time, that would probably take us 10 times longer. We are trying to target our attention. For example, one year we might be particularly concerned about health and safety, especially fire safety, in care homes, in which case we would devote more time in that year to looking at those issues.
A number of people have their hands up. We will hear from Councillor Jackson, then Helen Eadie.
My question is for Jacquie Roberts. Jacquie, you have mentioned care homes for older people on a number of occasions and you said that you would not reduce the frequency of visits, on the basis that a large percentage of complaints concerned such homes. We have a particular issue with residential child care units and would like to see the number of visits maintained on the ground that they provide an opportunity to young people to speak to someone independently. What is your view on that?
We agree. The figures that I was talking about were about 36 per cent or 38 per cent of care homes not meeting the regulations. We agree—again on the basis of a risk assessment—that, in those cases, service users are more vulnerable and need to have as much external scrutiny as possible.
I have a related question. If one aggregates services to older people with services for those young people, what percentage does not meet the regulations?
There are 1,740 care homes, which account for 11.7 per cent of our registered services.
Are those homes for older people?
That is all care homes—for older people, children and some adults with learning disabilities or sensory impairment.
I note that some of the messages in the correspondence that we have received in our in-boxes about this subject are suspicious that the proposal is driven by concerns about resources rather than quality. In my local authority area, people are most concerned about the protection of vulnerable adults and children; they remember when residential homes were regulated by local authority staff and feel that we should maintain that baseline provision. I am reassured to hear that you are directing some thought towards that.
I would like David Wiseman to respond to that, because we are doing some detailed work on how we will make information about the quality of services available to providers and service users.
We are in the middle of developing a framework that will allow us to look in much more detail at quality against the national care standards. It is important to measure the outcome for people who use care services. Saying that a particular care service is a one, two or three-star service might not be as useful as saying how well the service performs against quality standards. To someone wanting to use the service, some aspects of the national care standards might be more important than others. We want to know the strengths of the service and the areas in which it might have to improve, but the approach has to be a bit more sophisticated than offering one, two or three stars.
How do you monitor staff turnover?
We request information on staff turnover from providers. We do a pre-inspection return every year, during which we ask for details on qualifications and staff turnover. Organisations have to tell us if there is a change in manager—
May I cut you off there? A pre-inspection return presupposes an inspection. Under the new regime, that may not happen.
No. Under the new regime, we would want such information as part of the assessment process every year. As I said, we would need to have an annual assessment.
So, you are saying that although some organisations may not get an inspection, they would still have to go through the pre-inspection.
Yes.
So a certain amount of the bureaucracy associated with inspections will continue.
Some of it will continue, but bureaucracy can lead to information that is crucial to making decisions on priorities.
Self-assessments are going ahead for pre-inspection returns. Providers do that, but there is an issue over whether we should pay a significant fee for work that we do ourselves.
All right. I will bring in Shona Robison, who was, I think, involved in the original legislation that led to the status quo.
Yes. I wanted to make a comment before asking a couple of questions. During the passage of the Regulation of Care (Scotland) Bill, the level of inspections was a contentious issue. A number of us wondered whether the existing inspection regime would be adequate and we argued for two unannounced visits rather than one pre-arranged visit. It concerns me slightly that, within a relatively short period, we are back round the table discussing the matter.
I chose the example of the complaints and inspection activities competing because the inspection activity is a statutory requirement each year. By January, February and March, we have certain things to complete in order to meet the statutory requirement. If the number of complaints suddenly went up or if we received a serious complaint that we needed to investigate, that would inhibit our inspection activity. That is the sort of competition that I am talking about. It does not help us to look at where the risks in services really are. We have to carry out certain routine inspections, but we should not only be about routine inspections.
One of the difficulties that you will face will be in convincing the public that the agenda is not resource driven—given some of the high-profile cases that have been in the public domain, that is a real concern. The fact that the issue has suddenly arisen without much notice may not help to reassure the public. The proposal is almost like an add-on to which not an awful lot of thought has been given.
Could you come to a question, please?
What we are dealing with is a fluid situation; we are learning stuff as we are going around the table.
You are taking a very long time to ask your question.
I am suggesting that what we are doing is not the best way—
It is the situation that we are in at the moment and you are going on a wee bit, Shona. Focus a bit.
Can you say whether your intention would be enshrined in some kind of long-term policy?
Your question was addressed to Jacquie Roberts, but it is mainly a matter for the Executive, as it would be ministers who would need to consult the commission and the public and bring forward the orders. The decision on whether any particular care service category would be the subject of an order would be for ministers. However, as Jacquie Roberts has made clear, the amendment obliges ministers to consult the commission closely beforehand.
Do you have a follow-up question on that point, Shona?
No, that is fine.
The submission from the Scottish Pre-School Play Association highlighted a point that has been touched on. It says:
Under our current system, the individual care commission officer who is responsible for the regulation of the service receives that information and makes a risk assessment in consultation with their team manager about the relative risks of that service. The commission has the capacity to consider the information that is available and has three years of experience and inspection reports to look back on.
An establishment that seems to be perfectly good could turn into one that is not so good immediately after a form has come in and staff have visited it. How can it be checked up on? If the period between inspections is lengthened, the fact that the establishment is not so good might not be picked up on as quickly as it was. I am trying to examine that issue.
The proposal requires us to be provided with information when there have been significant changes, for example. Therefore, we will be required to be informed of a change of manager, which is a potential trigger point for us, as a manager can be crucial to the provision of quality in a service. Obviously, a change of manager means that we must look back and ask whether we should go in and dig deeper.
Everyone around the table recognises that any number of inspections will not guarantee that there will never be a problem in any service at any time. Staffing is a particularly important issue. A national workforce group, which is chaired by Euan Robson, is currently considering the whole social care sector and its recruitment and retention difficulties. There may be one, two or 30 unannounced inspections, but that will not guarantee that there will be no problems.
I speak on behalf of service users and their carers and want to say something about what Alan Dickson has said. There is confidence in the care commission at the moment, but that can be lost. I return to what Shona Robison said: keeping public confidence is important. Service users and carers have made complaints to the care commission and have done so uncomfortably, as they have reported on facilities that they are using, but it is important to understand that many people do not complain.
I will bring in Andy Sim, because he might pick up on some of the same issues.
Alan Dickson makes a good point, as does Lesley Aitkenhead on trust and confidence. Without regular contact with inspectors, care home residents' perception of their ability to complain will be eroded. We know that there is a problem around complaints. Care home residents are still afraid to make complaints, because they do not have security of tenure. They can make a complaint and it can be upheld, but the next week they can be evicted from their care home. That is the worry that people have.
Your written evidence states that you
Will Mallinson asked the care commission about lay assessors and received a good response. He might like to pick up on that.
Would the care commission like to pick up on that?
David Wiseman also wants to come in on this point. We are not talking about reducing the attention that is paid to people who use care services. We are talking about greater flexibility. One of the proposals is to spend more time with service users. If we do not have to go through a lot of routine processes, we will have more time to build even greater confidence.
We use announced and unannounced inspections in the process—both have a part to play. It is important to recognise that we are not talking about reducing contact. We are talking about reducing the number of inspections in certain cases where there is risk assessment. That will mean that we can develop a lot more contact in some areas, particularly with carers and people who use care services.
Andy, do you want to come back on that?
I do not think that that is what I was saying. I was saying that tightening other areas of regulation might reinforce the rights of care home residents. I was not making a criticism of where the care commission is going, but the concern is that the proposed reduction of the number of inspections could undermine trust.
I would like to hear more from the people round the table about what we do in the round. As has been said, we should not believe that one inspection—or even 30 inspections—would be a cure-all. The process is hit and miss and pretty negative. My observation is that it allows some care home operators to transfer their responsibility for standards on to somebody else and to say, "Well, it's not really my responsibility, so we'll wait and see what the report says before we institute any action." There seems to be a defence of something that is four years old and which is a moveable feast. The purpose of the process is to examine how the legislation is working, because it was made four years ago, so I would like some feedback on what could be done to improve the situation and to support flexibility.
Perhaps somebody from Age Concern Scotland can answer that.
There was a report in the Daily Record about 15 months ago about a lady whose relatives made 10 complaints, of which nine were upheld. She was evicted, or put out—often the situation is not described as an eviction, but will be referred to as a case of the home not being able to meet the resident's needs, the resident exhibiting challenging behaviour or a number of other euphemisms that mean that the care home does not want the resident there. Another advocacy organisation in Edinburgh brought me the case of a chap who was threatened with eviction after making a complaint. That threat was made in front of somebody else. The case was resolved, but partly because there was an advocate there, so there was a safeguard.
I can back that up. Eviction is a real threat for many people and we have seen an increase in the number of residents who have been threatened with eviction.
Do you have evidence of that?
Could you supply that evidence to the committee?
Yes.
If that is the case, it is quite important for you to provide us with the evidence. Duncan McNeil is right to say that the issue is serious.
I was given permission to present evidence about somebody's case, so I can give that to the committee.
I invite the witnesses from the care commission to comment.
We have quite a lot of evidence of cases of a breakdown in the relationship between relatives and care home providers and of the resident being moved to another care home. I do not have any direct evidence of people being evicted because of the level of complaints, but I know that there are examples of relationship breakdowns.
I want to pick up on that point. I speak for Capability Scotland, and I am sure that I also speak for many of the organisations represented by CCPS. It is not a question of waiting for the care commission or a local authority to judge whether or not our services are appropriate for our service users. We are determined to do that work ourselves and to have our own audit procedures and quality assurance. Indeed, that is a requirement on us and in any case we would be constrained by the care commission's request for information. One of the key roles for the majority of providers, particularly for large organisations and local authorities that require a large number of services, is monitoring their own service provision.
On Duncan McNeil's comment that some care providers might want to hand over responsibility for quality assurance to the care commission, local authorities or anyone else, our submission makes it clear that we want much more harmonisation between the regulatory process and providers' own quality assurance systems, many of which are quite sophisticated, to ensure that the question is not simply whether someone turns up on the doorstep once every six, 12 or 18 months. We want a system that is validated by the care commission, which means that there will be constant monitoring.
Does Duncan McNeil want to come back on any of that?
No.
In response to Annie Gunner's comments, I fully accept that the care commission is responsible for regulation. However, as Alan Dickson pointed out, we can make sense of this matter only by examining all the broad areas of performance monitoring, including providers' own quality assurance mechanisms. Local authorities are required to review the situation of individuals who are in the care of or are receiving services from particular providers. We cannot duck that obligation. When we commission a service to a service specification, we have an obligation to ensure that the service is being provided to that specification.
Does Annie Gunner want to add anything to that?
No, thank you. I just welcome that statement.
Is anybody waiting to jump in on any specific topic?
I would like to follow up Duncan McNeil's useful question on the capacity and flexibility of providers to improve services on their own behalf. We have identified a number of the elements that make that possible. Clearly, the providers' own service improvement framework is important. There is an onus on them; they should not place the onus on the regulatory bodies. There is the care commission's inspection regime, with its recommendations and requirements and, where appropriate, the local authorities' quality assurance frameworks. However, the real capacity and flexibility to make improvements comes from the resources that are available to the provider. Unsurprisingly, that leads us into the cost implications of a full cost recovery policy for registration and inspection. I know that it is not quite the subject of this debate, but it is difficult to see how we can achieve the quality improvement that we are all aiming for when full cost recovery limits providers' ability to achieve it.
It is clear from the evidence that significant contention surrounds that issue, which is not central to the amendment although we are not ignoring it. The Health Committee is about to embark on an inquiry into care in Scotland, and I invite witnesses to consider whether it might be appropriate to raise some of those issues in that context.
I meant that the care commission is not only about routine inspections. I was talking about inspections being part of a much bigger range of regulatory activity. We have been asking how scrutiny can contribute to improved services. We believe that that can be achieved through greater flexibility and by considering scrutiny to be much wider than inspections. That is how we will improve.
You were not suggesting that the care commission should opt out of conducting routine inspections altogether.
No.
My second question is for COSLA. Your written submission indicates that you are, quite rightly, representing the majority view, although a minority of the councils that you managed to get responses from did not want a reduction in inspections. I am not asking you to name those councils; that would not be fair. How many councils did you manage to get comment from and how many comprise the minority?
We got comments from 19 or 20 councils. You will appreciate that it was quite a rushed consultation.
Yes, I appreciate that.
Looking closely at what we received from councils, we feel that the minority view is a view mainly on care homes for the elderly and, to a lesser extent, residential care for children, whereas the majority view relates largely, but not exclusively, to care services such as nursery classes. In the time available, we could consult only officers—directors of education and social work. There was not a coherent, politically approved response.
How many of those consulted took the minority view?
Six or seven.
The good thing about today's meeting is that it has given people a chance to express their views. I have certainly understood where people are coming from. Had some of those who took the minority view been here today, they might have changed their response to us, given the evidence that has been presented, in particular by the care commission.
I hope that copies of the Official Report of today's meeting will be sent to all the councils that responded.
I suspect that the issue is the definition of key services. On the whole, our care at home services involve one or two clinical nurse specialists working from a hospice as part of the multidisciplinary team that is based in the hospice. The care that is delivered in a patient's home is advisory, supervisory, supportive care, not physical, hands-on care.
The issue is probably as Susan Munroe has described—at least, that is my excuse, and I am sticking to it. Earlier I made the point that a number of different organisations will provide different forms of services of a different size and on a different scale in different parts of the country. I speak on behalf of an organisation that is quite widespread. As we said earlier, organisations need to be able to show that their systems, processes and quality procedures are embedded in and cascaded throughout the organisation. However, I am concerned that, if an organisation is seen simply as a quality provider, there is a danger that a specific service could go off the rails, given the points that were made earlier about high turnover of staff and so on. I am concerned that we could find ourselves in a difficult position as a result.
There is also an issue about levels of service provision. I work for Marie Curie Cancer Care, which has two hospices in Scotland. There is one service provider, but I do not believe that the hospices should be regarded as one service and have one inspection. They should be registered and inspected separately. However, all the services that are delivered by each hospice should be regarded as one service.
Your comments have resolved an apparent conflict, which is useful.
I have a question about the process. I am still not clear why this issue was not flagged up earlier. Were discussions happening behind the scenes? Did someone suddenly realise that there was an opportunity to change the regime?
The Smoking, Health and Social Care (Scotland) Bill was proceeding in accordance with its timetable. As I said earlier in response to a question from Kate Maclean, the idea of amending section 25 of the 2001 act emerged during the passage of the bill. Ministers had to decide whether to include the provision in the bill or to leave it until a later legislative opportunity.
I wondered why the issue was not sufficiently important to be raised at stage 1.
Do you mean in the course of the stage 1 debate?
No, in the course of the evidence gathering sessions that took place in the run-up to the stage 1 debate. Why was the issue not in the draft bill?
It was not in the draft bill because the decision had not been taken at that point to go ahead with the legislation. I think that I am right about that, although I would have to check the timing. It happened quite late in the day. We were certainly not sitting on a complete amendment and letting the bill proceed without it, with the intention of producing the amendment at a later stage.
Perhaps Linda Gregson has a comment.
Adam Rennie is right. Other areas of the country were producing reports on better regulation. The care commission had been in place for a relatively short time but we were not sitting on the idea. We needed time to crystallise our thinking about what we needed to do.
Had the representatives of the consumers who are here picked up any rumours that something was in the offing? If so, can they remember when they picked them up? Perhaps they did not pick up anything.
We echo what Shona Robison said. We only knew about the amendment about a week and a half ago.
So you have not been involved in any conversations about the amendment.
No.
Were any of the other consumer representatives involved? I appreciate that some people are consumers and providers. No one seems to have been involved until now.
I wanted to mention something that has been raised a couple of times today: the national care standards. If inspections and assessments are to be measured against those, they need to have some teeth, because providers know that they are for guidance only. That might require to be considered with the legislation.
Have any of the consumer representatives who voiced concerns at the beginning of the session gained reassurance or otherwise from what we have heard this afternoon?
Yes. I have been reassured by what Jacquie Roberts and David Wiseman said, but I still come back to the fundamental point that more work needs to be done before the decision is taken.
I agree. For example, I do not understand how a mental health service user can inform the care commission, or how the care commission will pick up on stuff if it is making just one inspection per year. I have not got to grips with the process. The care commission seems to be relying on people making complaints and I am not sure about that. The inspections will need to be more thorough.
We were broadly supportive in the beginning and I will talk to those colleagues who expressed concerns and give them chapter and verse on what has happened here to see if that will change their minds at all.
It is reassuring that there are no proposals to hit older people in care homes with fewer inspections. However, there is still a worry that that could happen in future.
I invite the witnesses from the care commission to make a final, brief comment. As you have responded throughout the discussion, I do not think that you need to give a long response, but perhaps you could pick up on some of the concerns that have been expressed.
It is important to emphasise again the different types of services that we inspect. We have had a lot of pressure from people in the housing sector—we regulate housing support services, in particular sheltered accommodation for people with lower levels of vulnerability—and the child care sector, who say that it is not right to have a one-size-fits-all approach. It is important to note that the legislation will enable us to consult on what we might do for different types of services. We absolutely do not want to lose the concept of unannounced inspections and we are about to go into a big public consultation about how we do registration and inspection. The amendment will allow us to consult on the minimum frequency of inspection, which is a small part of the work that we do.
Thank you. I do not want everybody from the care commission to say something if that is not necessary. Does Adam Rennie wish to make a final comment?
Yes. The strong message that I have heard is that consultation is desirable even if, as in this case, we think that we have good reasons for our proposals. That was a learning point for me. Our thinking was that the proposal will acquire meaning only when it is applied in relation to particular care services. Many of the comments that have been made were about care home services for older people and there will be consultation on that. As Jacquie Roberts said, the proposed power is an enabling power. I can see that we will have to go back to the drawing board next time we have a bright idea. Nevertheless, I think that it is important that we do this.
It is always salutary to be reminded that what is self-evident to us is not necessarily self-evident to everybody else. Even things that we think are self-evident need to be tested. I remind members that they will have the opportunity to debate the matter with the minister on 31 May. I expect that some of the issues that have arisen in today's session will be raised at that meeting.
Meeting suspended.
On resuming—