Adults with Incapacity (Ethics Committee) (Scotland) Amendment Regulations 2007 (SSI 2007/22)<br />Contaminants in Food (Scotland) Regulations 2007 (SSI 2007/29)
Notification of Marketing of Food for Particular Nutritional Uses (Scotland) Regulations 2007 (SSI 2007/37)
I welcome everyone to this afternoon's meeting of the Health Committee. I have received apologies only from Euan Robson, so I assume that other folk will join us.
Members indicated agreement.
Regulation of Care (Scotland) Act 2001 (Minimum Frequency of Inspections) Order 2007 (draft)
Item 2 is also subordinate legislation. We will take evidence on the draft order, which is subject to the affirmative procedure.
Fife Council is a provider of a large number of services to vulnerable people. Those include services that we provide directly and services that we purchase from the private and voluntary sectors on behalf of the residents of Fife. The council strongly supports the care commission and recognises the importance and value of the commission's role in ensuring the delivery of high-quality services to vulnerable people. We do not treat inspection lightly, either as a provider or as a purchaser of services.
Thank you. I understand that Kenneth Leinster will respond to members' questions—you did the easy bit and he will do the hard bit; that is the kind of division of responsibilities that I like. I know that Helen Eadie wants to comment, because Fife is her patch, but I will bring in other members first.
Councillor Gunn's comments were sensible, but I remember that the care commission told us that it will inspect a service if it receives a complaint about it or if changes have been made. I was concerned about that, because staff are low paid and many establishments have high staff turnover. Should the commission always be informed about changes in staff?
The commission said that it will investigate if a complaint is made, but often complaints are not made, because the people who are looked after and their relatives are frightened to complain. People let things go for a long time before they make a formal complaint. If, during a two-year gap between inspections, the care commission inspected only if it received a complaint, there would be a problem. That is one of the reasons why Fife Council's adult services committee felt strongly about the matter.
Age Concern supports you on that. It highlighted the problem in its evidence.
There is no reason why Councillor Gunn or Kenneth Leinster should know the answer to this question—in which case, fair enough—but is there a minimum period between school inspections? MSPs receive copies of inspection reports, but we do not know how long the inspection cycle is.
I know that school inspections are not annual, but I do not know how long the gap is between inspections. School inspections are different—
I appreciate that, but I am thinking about the frequency of some other inspections that take place.
That information is in paragraph 6 on page 11 of paper HC/S2/07/03/05, which mentions the proportionate model of inspection. The date of the next visit is determined on the basis of the inspection report, so it might be decided that an inspection will be made a year or two years later. That is mentioned under "Caveats" in the submission from the Convention of Scottish Local Authorities.
It is on page 13 on the copies that have been circulated at the meeting—do not ask me why. There is some information there about inspection frequency.
The witnesses mentioned that they are concerned that, under the draft order, the frequency of inspection would reduce even further. I understand that the point of the order is that the frequency is laid down and, therefore, any further reduction would be subject to a further order. Does that not alleviate the witnesses' concerns?
This could be the thin edge of the wedge. If you allow a reduction in the frequency of inspections to happen for day care of children aged three or over and for housing support services, that could be extended to inspections for other vulnerable people. That is also a concern.
I assume that Fife Council is in the minority on the topic. The COSLA submission says:
Councils do not have responsibility for inspections as such, because that duty was given to the care commission in 2002. However, given that local authorities are ultimately responsible for the care of anybody whom they place in any establishment, they have the right to assess the quality of care. We might do that if we had concerns, but we do it as a matter of course anyway, alongside advising the care commission if we have any concerns. Maintaining the minimum would be a combination of both: we would want to assure ourselves, but we would advise the care commission if we had any concerns and would expect it to inspect as it would normally.
You will probably also have new powers under the Adult Support and Protection (Scotland) Bill, which was passed recently. It will allow you to go in on individual issues if you choose to do so.
Yes, I think that that is the case. We always wish to identify services with which we have concerns and examine them in particular. That might be in relation to one person or more, but we would do it as a matter of course because we place many people in many different establishments.
I know that it is difficult to generalise, but what level of staff turnover would you expect in three years, particularly in housing support services?
I could not give you those figures off the top of my head.
If there is a change in manager in an establishment of whatever description, the establishment has a responsibility to advise the care commission of that change. However, establishments have no responsibility to advise the care commission if there is a turnover of staff below that level.
I ask the witnesses to expand on their written submission, relate their experiences and tell us why Fife Council is making the case that it is. I note that, although Fife Council is in the minority in its opinion, practically all the other organisations that have made submissions have made it clear that, if the committee recommends today that the draft order be agreed to, they want certain caveats to be in place. Will the witnesses comment on those two aspects?
There are two elements to this. First, Fife Council is a very strong supporter of the care commission. We always support what the care commission does and we recognise the value and importance of the inspection process. Therefore, we do not want to see any diminution of that process.
I have been advised that council nursery schools, which are also covered by Her Majesty's Inspectorate of Education, are inspected every three years. The proposal in the consultation paper is that day care for children aged three and over and child care and nursing agencies should be inspected a minimum of once every two years. That is still a higher standard than currently applies for nursery schools. Does that sound right?
Yes, that sounds about right. However, an HMIE inspection is different.
Yes, that is an HMIE inspection and nursery schools will still also be inspected by the care commission. Is your concern that, although the proposal is expressed as a minimum, it will become the standard?
Yes. Such an approach could also be extended to other vulnerable groups.
You are worried that the proposal might be extended to other groups and that the minimum frequency will turn out to be the standard.
Yes.
If it could be proved that the frequency of inspections would not fall below one, would the witnesses be in agreement with the proposal and would they be in agreement if the inspections were unannounced?
What do you mean by "fall below one"?
The minimum of one inspection in three years.
That is what the order says.
If the minister guarantees that the frequency of inspections would never fall below that level, would the representatives of Fife Council still be concerned?
Yes, I would still be concerned because that is too long.
In any case, as the minister cannot bind future ministers, he could not give such a guarantee. All that he could say is that as long as the order subsists, the number of inspections would not fall below that level, because that is what the order says. He cannot bind anybody in the future. Any proposals for change in the future would have to be dealt with on a case-by-case basis.
Thank you for the opportunity to make an opening statement.
To pick up on the fact that a management changeover triggers an inspection, does the care commission monitor staff turnover in establishments, and does it consider the percentage of staff turnover as a potential trigger as well?
Jacquie Roberts may like to answer that.
Yes, we do. We conduct an annual assessment of all services, so we are in touch with all services at least once a year. Part of that annual assessment involves staff turnover levels. That would be one trigger that would make us more likely to inspect a service than not.
So if you saw huge staff turnover in a particular institution, an alarm bell might go off about what is happening.
Absolutely.
What percentage would trigger an inspection? Would it be 5, 10 or 20 per cent? Staff turnover would not be taken on its own, would it?
No, it would not. It would be taken in conjunction with information such as disciplinary action, a change of manager, the nature of the client group—whether it is a group of more vulnerable people—and other information such as whether the service had had complaints or requirements in the past year. A number of factors would be taken into account.
This question is for Jacquie Roberts. If the hours of trained nursing staff were cut by half an hour so that they did not communicate with one another in the changeover from the morning to afternoon sessions, would that trigger an inspection?
Forgive me, but I think that your question relates more to care homes for older people, and there is no proposal to change the minimum frequency of inspection in care homes. That information is important, but following it up could mean giving care homes, which already have two inspections a year, even more scrutiny than that.
There are responsible trained staff in all the establishments in question, and their hours could be cut so that they did not overlap at changeovers.
Are you thinking about nursery education, for example?
Yes, something like that.
It is rare that there would be nurses in nursery education, but if there were significant staffing changes, they would definitely be taken into account in making a risk assessment and deciding how much scrutiny to give the service.
Providers would need to notify you of that change.
Yes, if there was a change of manager or other significant changes. However, we will routinely assess every single registered service at least once a year for a number of factors. They have to complete an annual assessment form with us.
Will you still do unannounced inspections?
Yes. Indeed, for day care services for children, it is routine to make the inspection unannounced.
We talked with the previous witnesses about the HMIE inspections that currently take place in nurseries and pre-school education establishments. They are done on a three-yearly basis or more often if felt necessary. Will there be a link between the care commission and HMIE to ensure that such inspections do not happen at the same time?
Absolutely. The proposal requires a sophisticated programme with HMIE for the years in which we would go into establishments together, the years in which HMIE might not have an inspection, and the years in which we would go in without it. The whole system is built in an integrated way, and we have an integrated team in which people from HMIE and the care commission work together to go into the establishments.
The same principle applies to sheltered housing providers. There are other inspection regimes, and the dovetailing will continue in the same way.
I note that when you appeared before us in 2005 you discussed a pilot of lay inspectors. How has that inspection pilot gone?
It is going very well. We have an increasing number of lay inspectors, the majority of whom are users of care services. We are gradually building up the number of inspections; the lay inspectors are becoming a valuable resource to the care commission because they see things in a different and enlightening way.
When you gave evidence in 2005, we talked about the idea that an inspection of a residential unit in which children are cared for provides a valuable opportunity for young people to speak to another adult who is not directly involved in the home. Will that be threatened in any way?
No. The proposals for lay assessors will almost be enhanced by the draft order because it will give us the chance to redeploy resources for promoting the work and ensuring increased service-user involvement in the regulation process.
The discussion in 2005 centred on Annie Gunner's point that services that self-assess will have to pay for self-assessments and therefore feel that they are not getting any return for the fees that they have to pay. That was related to the debate about the care commission's need to be self-financing. Will the order impact on that at all?
I do not think that it will directly impact on it.
We expect services to self-assess because that is a way of promoting quality assurance within an organisation. In addition to that, we will validate those assessments and turn up unannounced. A service might be meant to have an inspection only once every two years but, because we will inspect a sample of services more frequently than the minimum that is set out, we could turn up the following week to validate the information that a service had submitted to us.
Is it fair to say that the main thrust of the draft order is to enable you to do more unannounced inspections?
Basically, the proposed changes will free the care commission to do more inspections of providers for which there is, or appears to be, a greater need for inspection, as well as to develop and spread best practice. In essence, they will allow the care commission to do its job positively and to address concerns with providers.
Jacquie Roberts talked about going into services to validate self-assessments. Are such validation inspections separate from the inspection cycle under the draft order that we are discussing?
Yes, they are in addition to that cycle. We built that in as a protection.
Self-assessment is an annual process.
So you will go out and validate a certain percentage of the self-assessment reports, but that process will not, under the draft order, count as part of the inspection cycle.
No, it will not; it will be carried out in addition to the inspection cycle.
Have you any sense that the proposals in the draft order could lead to more inspections by councils?
That is certainly not the intention behind the proposals. It is important to say that the care commission spent a lot of time considering the minister's proposals when he first wrote to us. We responded about where we thought there was less risk and how we could build in the additional regime of calling in unannounced in order to validate information. Our response was that we should try the changes in a careful and planned way in services in which we think there is less need for annual inspections. It would be a mistake and a shame if local authorities were to fill that gap by going in to check those services. The Health Committee noted that in its regulation of care inquiry.
That is why I asked.
Are the self-assessment reports available to relatives or local authorities on request? Are they published?
The self-assessments are not published, but we could consider doing that, as we are in the middle of enhancing our care services register. The self-assessments are being returned to us electronically or on paper. We would have to look into publishing them. All the inspection reports and information about upheld complaints and any enforcement action are available on the public register for any member of the public to see.
I appreciate that. I do not know whether the convener agrees that the care commission could consider making the self-assessments publicly available so that the people who compile them take them seriously. If that information were to be shared with relatives or a local authority, there would be a baseline.
The proposal is interesting and we will certainly discuss how to develop it.
The submission from Community Care Providers Scotland says that measuring all the national care standards could take several years. That is cause for concern: if it takes several years to measure all the standards, we need reassurance. My impression is that Community Care Providers Scotland wants a caveat that that issue will be addressed in your plans and policy proposals. That organisation is concerned that local authority activity could step up, as other members have said.
Before Jacquie Roberts addresses that point, I will take the opportunity to say that there is no way the draft order will lead to any reduction in the minimum frequency other than in the four sectors that are specified. The powers that the committee agreed in 2005 mean that any proposed reduction in the minimum frequency—for community care services, for example, which have not been addressed today—would have to come back to the committee and be approved by Parliament under the affirmative procedure. That point is important. There is no thin end of the wedge. Every proposal to reduce the minimum frequency must be subject to approval by affirmative resolution.
It was said that examination of standards takes years. We have examined all the standards in quite a proportion of the services, because we have been operating for more than four years. We are moving to the concept of a grading scheme, whereby each year we will consider batches of standards that meet different concerns. We need the flexibility to focus on the matters about which we have most concerns. Community Care Providers Scotland made its submission in 2005 and it strongly supports the way in which we are going.
We move to agenda item 3, for which Ms Roberts is welcome to stay at the table. The clerk has reminded me that you cannot speak from now on, but you are welcome to stay.
No.
Motion moved,
That the Health Committee recommends that the draft Regulation of Care (Scotland) Act 2001 (Minimum Frequency of Inspections) Order 2007 be approved.—[Lewis Macdonald.]
Motion agreed to.
Mental Health (Safety and Security) (Scotland) Amendment Regulations 2007 (draft)
Agenda item 4 is consideration of a second instrument that is subject to the affirmative procedure. We will take evidence from the minister before I invite him to move the motion. He is joined by David Herd and Fiona Tyrrell, who are Scottish Executive officials.
Thank you, convener. I will endeavour to take even less time than you have suggested.
I expect that Jean Turner has questions on the regulations, but I invite other members to ask questions first. Will you confirm that we are talking about the unit at Stobhill?
Indeed.
I wanted that confirmation in order to remind members why the regulations could be controversial.
I do not think that there is any controversy surrounding the need to rehouse people in medium-secure units, although there is controversy about Carstairs, which is, I gather, bulging at the seams.
The regulations relate to the medium-secure unit at Rowanbank, which requires greater security conditions than those in low-secure units around the country. When the unit opens later this year, it will have a capacity of up to 60 beds. We expect half dozen or so of the patients from the west of Scotland who are currently in the Orchard clinic in Edinburgh to transfer pretty much straight away to Rowanbank. We expect a similar number—or perhaps slightly more—from the west of Scotland who are in Carstairs and for whom an appropriate level of security would be closer to medium-secure than to high-secure to transfer. At the moment, 15 such patients in Carstairs are simply waiting to be transferred to conditions of lower security such as those in a medium-secure unit. Approximately half those patients are from the west of Scotland and would therefore go to Rowanbank. Those are the numbers that we are talking about in the first instance.
Will patients be moved into the low-secure unit before being allowed out into the community? I thought that was the whole idea.
I think that is right. There is a process in that regard, which is to do with the fundamental proposition that recovery is possible for many people with mental illness who in the past were regarded as suffering from permanent conditions that would prevent their return to the community. However, before any patient from the state hospital or elsewhere can return to the community, the paramount consideration is that there should be no significant risk to public safety—that test will apply whatever level of security is attached to the patient. Fiona Tyrrell might comment on how patients are assessed.
The Scottish ministers retain the right to supervise transfers of restricted patients, who are people who have committed serious offences. Ministers are particularly concerned to ensure that risk is taken into account in plans for transfer and care. Multidisciplinary care planning would be part of any proposal to transfer a patient from the state hospital to a medium-secure unit or from a medium-secure unit to another location, whether that was Stobhill hospital, a unit in another health board or the community.
I assume that a patient who left hospital would not necessarily be housed in the area near the hospital. Could the person be housed anywhere on the west coast?
Yes, because the person might have come from Ayrshire and Arran, Dumfries and Galloway, Glasgow or anywhere on the west coast. It is more likely that the person would go back to their home area, unless there were particular reasons why they should not.
Minister, am I right in thinking that the approach is part of a reconfiguration of services across Scotland? I understand that there is to be a medium-secure unit to serve the north of Scotland in Perth—which is not very far north.
I imagine that the convener has an interest in that matter. The intention behind the organisation of forensic mental health services is that the state hospital will continue to provide a single unit for high-security requirements and that, on completion of the network, three medium-secure units will serve the west, the east and the north. The unit in the north will be at the Murray royal hospital in Perth and will have about 32 medium-secure beds. We expect it to open in 2009, which will complete the network of medium-secure units. Currently, the Orchard clinic is providing that service for the whole of Scotland, so the creation of the units, first at Stobhill hospital and then in Perth, will allow the Orchard clinic to concentrate on the south-east. As I said, a number of people in Carstairs ought to be housed in a medium-secure unit, so our approach will allow that to happen, too.
Members have no further questions, so we move on to item 5. The Subordinate Legislation Committee made no comment on the draft Mental Health (Safety and Security) (Scotland) Amendment Regulations 2007. Do members want to debate the regulations?
No.
I invite the minister to move motion S2M-5560.
Motion moved,
That the Health Committee recommends that the draft Mental Health (Safety and Security) (Scotland) Amendment Regulations 2007 be approved.—[Lewis Macdonald.]
Motion agreed to.
I thank the minister and his officials for attending the meeting.
Meeting suspended.
On resuming—