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Agenda item 2 is the continuation of our evidence-taking on the Regulation of Care (Scotland) Bill. Our first set of witnesses is from the Carers National Association. We took evidence from the organisation during our inquiry into community care and quoted that evidence copiously in our report—Isobel Allan would have done quite well if she had been paid a fee every time we used her words. I am sure that what we hear this afternoon will be used just as much. I ask our witnesses to make a statement, to be followed by questions from the committee.
We are pleased that the bill is now before the Parliament. We have followed the bill's progress since the publication of "Aiming for Excellence: Modernising social work services in Scotland" and the policy paper, "The Way Forward for Care". We want to talk about the general principles at this stage, rather than the technicalities, which are outwith our orbit. In particular, we want to bring evidence to bear on the issue of values.
Not if we carry on in this job.
The elements that I have outlined present a tremendous challenge for the Scottish Parliament, for social work services and for the users and carers who will benefit from the change. As our submission states, we think that carers are key partners in the delivery of care. That fact needs to be built securely into the bill and its outcomes. We therefore welcome the proposals in the schedules that explicitly identify carers as one of the five key interest groups—we did not mention that in our written submission, but we believe that it will play a major part in ensuring that the bill does what it is supposed to do.
In general, do you agree with the bill and believe that it is necessary? At stage 1, the committee must decide whether it agrees with the bill's general principles and whether the consultation process has been satisfactory and effective. What is your opinion?
We agree with the bill's general principles and believe that the provisions for the commission and the council are necessary. Good consultation has taken place, but we suspect that some of the consultation may not bear fruit and that, because of that, the resultant act may not have the best chance of delivering what it is meant to deliver.
Could you expand on that?
We fear that the training component for social workers and social care workers will have no significant carer content. We foresee some problems with the development within the council of the functions of the Central Council for Education and Training in Social Work and the Training Organisation for the Personal Social Services. In particular, we foresee problems with the timing, given that the council is to be set up by the end of this year.
Your submission says that concerns have been expressed about
My understanding of TOPSS is limited, so please forgive me if I get some of the dates and so on wrong. Although TOPPS, which recently produced a submission for the committee, came into operation in 1997, carers and users have been invited to join the TOPPS committee only since September last year.
What do you consider to be the main implications of the bill for carers and users?
The setting up of the national care standards will be a key component. Carers are focusing on that, as it will give them rights of access to the complaints procedure and will help them to understand what they should be getting back from services and what they should be putting in. The commission element of the bill has the most meat for carers. The council will reprofessionalise the work force, enhance its status and boost its morale, which should have benefits for carers.
I do not know whether this point is relevant but, as a carer, I can say that for most carers the most important item on the agenda is respite. The bill does not spell out provisions for respite and I had great difficulty finding out where respite would slot into the system. I wonder whether further provisions or clarification could be added to the bill in an amendment at a later stage. It is important that the elements concerning respite be defined more clearly so that they can be interpreted more positively.
Where in the bill would you like respite care to be written about explicitly? Should there be anything else in the bill?
I do not want to pre-empt what will be said later, but I think that there are great differences between respite care and residential care. The soon-to-be-replaced inspectorate, which visits residential units with respite units attached, does not have a mechanism for accessing carers' feelings about respite units. The criteria are geared to the person in residential care. Carers are never consulted or involved. Even if they were, the mechanisms that would be used would not apply to carers. Something new needs to be devised.
Does not the setting of national care standards offer an avenue for allaying your organisation's fears?
Yes.
The bill addresses care homes and support services. Because terms such as "respite" are not used, carers are concerned that those services will sink. It is right to say that care standards will be the key. However, although the national care standards committee is doing some great work, concern remains that residential or home care respite will be added on at the end of a process that deals with standards of residential care. The consultation on the second tranche may address that concern, however, so I do not want to be critical at this stage.
You are putting down a marker.
Yes.
Does your organisation have a view on the creation of two separate bodies, the Scottish commission for the regulation of care and the Scottish social services council? Should there be just one body?
It is an excellent idea to have two bodies. I have high hopes for the bill. Carers have been sidelined for far too long. Since the establishment of the Scottish Parliament, we have gained a better image and have been brought to the forefront. The bill and the national care standards will ensure that that continues. It can only be good if carers are consulted, because we have been sidelined for many years and often still are, especially in relation to domiciliary care and hospital care for users. I will be very disappointed if the bill and the standards do not improve the situation greatly.
Our organisation does not take a position on this question. I think that there should be two bodies. Social care staff need the new council to address work force issues; care standards and the regulation of care are slightly separate from those. The Scottish commission for the regulation of care has the potential to steward future care provision, operate as an ombudsman and represent consumer interests, so it would not be helpful to conflate the two bodies. The right approach is being taken.
I want to ask about something to which you do not refer specifically in your written evidence. As you know, from 2004-05, the activities of the commission and the council will be self-financing, through the fees that they will charge for the services that they provide. What implications will that have for carers and the services to which they have access?
We did not address that point in our written submission because we are not service providers and had other matters to deal with in our three-page paper. There are concerns about who will pay for the costs of regulation and whether those costs will be passed on to service users and families. That question is linked to the debate on the Sutherland recommendation on free personal care. To some extent, the ability to pass on costs may be limited by the expansion of free personal care. People in service delivery, and in particular voluntary organisations, will be concerned because they will not want to upset service users by increasing bills. There will be serious discussions with the local authorities and other funders to determine how the costs will be soaked up. The requirement for the council and the commission to be self-financing will raise the unit cost and ultimately will have implications for the cost of services.
Is the definition of personal care that is contained in the bill significant?
I do not want to be responsible for any further definitions of personal care. The bill gives an open enough definition to encompass the Sutherland recommendation. That is helpful at this stage. Many of us will question—if not meet with hostility—any attempt to contract that definition. At this stage, the definition is not a problem. The problem that the member outlines is simply that costs will rise and somebody will have to meet them. If local authorities have to pay, they will have to recover the costs from charges or from the grant from Government. If they do not find the money from those sources, they will have to raise it elsewhere or limit services.
What are your views on the provisions for national standards? I am not clear from your earlier answers whether you suggest that standards for areas such as respite care should be stated in the bill or whether you are happy with the proposal in the bill that ministers should set down care standards for those things that are defined as care services in the bill. Should the bill be amended or should we wait for those issues to be addressed by the long-term care bill?
I do not want to make policy on the hoof. The national care standards committee is doing the work on standards. The concern is what would happen if the national care standards committee produced standards that did not apply to residential and home care respite provision. When the care standards are known, carers will be confident that the process will deliver the standards of respite provision that they want met. Care homes and support services may each encompass respite care, but that is not spelled out. Isobel Allan was asking an open question. Perhaps respite care should be addressed explicitly, but we need to know the outcome of the work of the national care standards committee before we can make that judgment.
Is there a particular problem with the regulation and inspection of home care services?
Yes.
It is difficult to set and ensure the application of standards for the care of people who are being supported in their own homes rather than in a residential home.
The standards will apply to the agencies and are therefore at least once removed from the experience of the service users. Systems need to be introduced to detect sensitively what services are received by users and their families and carers.
Is it suggested that inspectors should visit people in their homes to speak to those receiving the services and their carers?
I would rather that the carers answered that question.
I would be happy to be consulted by inspectors on my views as a carer. My daughter has used a respite service for more than 10 years but I have never been approached by an inspector.
Is that view common among most carers?
I can answer only for myself. I know something about the system, but carers are not always aware of their rights. For example, one has the right to a copy of an inspection report, as it is a public document. It is all about information. There is so much in the system that is good and meaningful—past guidelines as well—but we must liaise better and communicate with each other. The service providers should make carers aware of their rights and of such documents. I would be more than happy to be involved with an inspectorate, as long as it did not invade my daughter's privacy or mine. Inspection would have to be conducted sensitively.
By agreement.
Absolutely, and not just with my agreement, but with my daughter's.
We do not want an inspection of premises.
You mean a sudden inspection, when an inspector just turns up at the door.
That is right—when the dishes might not have been done.
No one would want that.
I do not know whether you are aware of the intention to reduce the number of inspections of care homes from two to one a year, or whether you have any experience of relatives or others going into care homes—you might know carers who have such experience. Do you feel that there has been a rapid decline in the confidence of carers and the public in the quality of such establishments and that too much time might elapse between inspections? Do you think that inspections should be announced or unannounced?
Two inspections a year are undertaken, of which one is announced and one is unannounced. As a carer, I feel that, after such inspections, carers should be made aware—whether they are using residential or respite care—that such an inspection has taken place, so that they can access the inspection report.
Do you think that there should be only two inspections a year?
I am speaking as a carer. I hope that this is not my cynical side coming out, but I think that an inspection is more meaningful if the inspector arrives unexpectedly. Apart from the inspection, there must be a mechanism to access everyone's views—not just those of the residential users, but those of the respite users as well. If the respite users cannot offer that input because of their vulnerability or through lack of communication, the matter must be referred to the carers. That is not happening at the moment.
I have not for many years had the experience of a relative being in respite care, but carers have come to me and asked what they can do about what they consider poor care in residential or nursing homes. I have asked them to lodge a complaint with the registration and inspection bodies, but they have been loth to do that because it might have an effect on the person who is being cared for.
Are you content with the complaints system that is proposed in the bill?
Yes. I like the fact that a complaints system is being proposed.
Isobel Allan and Ena Murray are talking from direct experience. There is always a fear that the number of inspections will be reduced, but we need to be careful that inspection does not become a kind of punitive arrangement. That is not what inspection is about. If good feedback systems are in place and they feed carers' and others' input into the system, some of the territory can be covered that might result from the loss of one of the annual inspections. I am not saying that the number of inspections should be reduced to one, but that there might be a more thorough inspection. I do not have any evidence to show whether the way the inspections are carried out is good, bad or indifferent—that is down to the experience of the carers—but we do not want inspection to become a punitive exercise.
The problem is not just the inspection, but the feedback to carers of information from the inspection. A difficulty also arises when a carer lives in one local authority area and the person whom they care for accesses a respite unit in a different local authority area. I know that the system may change, but at present the inspectorate does not always provide inspection information to a different local authority. Mechanisms should be in place to ensure that the feedback of inspection information is as comprehensive as possible.
Your submission talks about placing greater emphasis on user and carer feedback and involvement. How might those factors be taken into account and link into the announced inspection?
Putting carers in the balance of interests nationally will help immensely. It has the potential to change the culture and is a terrific starting point. Locally, we would not want to be prescriptive, as there are lots of good ideas about how to get feedback and conduct consultation, but we need to determine best practice. Whether that is lay inspection or carer panels—similar to the user-panel model that exists in Fife—we need to be aware of the potential of such exercises to develop feedback.
Do you think that if a minimum requirement is laid down at a national level there will be a greater chance that people in authorities that are poor at consulting users of services and carers will be encouraged to participate at a local level, because they will know what the playing field is like before they start?
Yes, but the bill should not be about setting minimum standards. It should be about setting standards that are achievable and goals that people can move towards over time.
A member of the inspection board would be welcome in most people's houses, although they would not go in without the householder's permission. On domiciliary care, the main concern among carers and many users is that no one listens to them. They are told what they are going to get, but they are not asked about what is needed.
On the related issue of user feedback, a number of people have raised as a potential problem the proposed structure of no more than about five or six regional offices, although people may work from home or in smaller satellite offices. There will be a national care standards umbrella but five or six regional offices, rather than people working locally. We understand that, at present, there are local advisory committees and people are able to build up local experience and relationships with the health board, local authorities, care homes, carers and so on. Do you think that about five or six regional offices is a suitable number, or would you prefer a larger number?
I know that Ena Murray has a view on that.
There should always be a local link; otherwise, the service could become too centralised. Service users need a local link—a local contact—with someone who knows the local area.
Have areas been omitted from the bill that you would like it to include?
At this stage, we are concerned about definitions and about whether the system has the capacity to link to the long-term care bill that may appear in the next two or three months.
I thank the witnesses for their contribution and for the written submission that they gave us in advance.
I will start off.
No, it was fine. Do you want to add anything before we question you, Bryan?
Yes. I believe that committee members have copies of our submission. I would like to highlight some key points in it that have been raised during our consultations with agencies over the past couple of years. You may want to question me on some of the issues.
As we understand it, the lack of clarity concerns which Scottish minister the body should answer to. There is still a lack of clarity, but it is different from the lack of clarity that you described. A lot of that is going round.
Thank you; that still helps.
Before we start asking questions, I warn everybody that a fire alarm test may occur. Unless the committee wants to, there will be no need to evacuate the building.
From the training perspective, the areas in which I have been working and consulting are most pertinent to the people whom I have been talking about. Agencies have different concerns—every time I talk to somebody from an agency they give me a different perspective on the bill. In responding to the committee, we have tried to raise as much interest as we can. I hope that many responses have come in; if so, I ask the committee to look to those responses to find out which issue each service sector feels is the main issue for it.
My impression—from reading your submission and from what you have said so far—is that you are concerned about the idea of a qualifications-based register, not only because it will cost money and will take longer to produce than the Executive thinks, but because it will somehow threaten voluntary organisations, which might find themselves falling outside such a concept. Are you in favour of a qualifications-based register?
We are not against a qualifications-based register, but what came across in the consultation process was that people wanted a fully inclusive register. The major concern was that there might be pockets of care that were, for some reason, never included on the register. Care staff might operate unregistered for many years, simply because they belong to a small and innovative service area that will not be covered by the register and which might have to be brought under regulation later on.
We are not trying to say that the voluntary sector would not support the highest quality training for its staff—if that was the impression that we gave, it was not what we meant. We do not want to be seen as some sort of second-grade service.
Are you concerned about the practicalities of a register, how quickly it will be done and how much it will cost?
Yes.
You made it clear that the cost of regulation and inspection should not be passed on to those who are involved in the delivery of services. Is that because you are concerned that they will pass it on to the users?
Yes. I am not saying that any of the providers would want to pass on the cost to service users, but if there was no other mechanism to meet the costs, that might be the end result.
You indicate clearly that you think that the Executive should take responsibility—at least in part—for the finance of the two new bodies. What should be the ratio between increases in fees and Executive funding direct from the Scottish block?
The projections for the increase in fees seem very high. The fees seem to be set to rise way beyond the rate of inflation for the next few years. Some kind of link between inflation and the cost to providers of registration would be fairer.
So, you would rather peg the increase in fees over the next period, and ask the Executive to find the money to fund the whole operation—
The bottom line is that I hope that the Executive will fund it all, but given that that is unlikely—
That is very unlikely.
We are mainly concerned that the care standards committee will be more reflective of the thoughts of the very large providers—that is partly to do with the structure of the committee and who was invited on to it. We have always been concerned that the smaller providers need a voice in the system. A small local provider might not be able to achieve what can be achieved through the Scottish Association for Mental Health and Enable—there is a need for balance.
How serious is the problem that you highlight about the financial viability of a service being part of the inspection certificate? Is that, because of the nature of their funding, a threat to some services?
Concern about such matters has been described to us by some organisations. They might not know until late March—sometimes later—what their funding will be from April onwards. Generally, such services are funded. Often things go wrong and there can be cuts in services—a lot can depend on what part of the country the services are based in. However, there is a more general fear about a new system in which financial viability will be considered more closely in relation to certification. If a provider cannot prove that they will still be around in April and May, will that be taken into account?
All councils in Scotland will move to three-year funding. Is it your proposal that the voluntary sector should also have—as the minimum—three-year funding?
Absolutely.
What are your concerns about the composition of the boards?
What is contained in our submission was not a proposal on boards, and I apologise for wording it as such in the submission. Any suggestion of change to the make-up of the boards is a result of the problems of the Scottish Qualifications Authority. We feel that it is important to have an inclusive system in which service users, carers and providers can be involved in the work of the council and the commission. We appreciate that there must be sound financial management of those bodies, but we are concerned about losing out if we move to a system in which people are picked because of their managerial ability rather than their competence and in-depth knowledge of care.
We very much identify with what the Carers National Association said about tokenism in relation to service users and carers on boards. We have seen such tokenism quite a lot in the past few years; it is well-meaning tokenism but it is, nevertheless, tokenism. A service user or carer may be involved in a committee but they do not have the same sort of support mechanisms as other people on that committee. There is sometimes no attempt to demystify jargon for users and providers, and they may not have attended the pre-meetings that other committee members have attended. They cannot operate equally. We have to consider other mechanisms for stakeholder input into boards.
I see no reference in your submission to the proposal that there should be five regional offices for inspection teams. Does your organisation have a view on that?
There must be some kind of regional system. As the carers who spoke earlier said, local links are important. My understanding was that the local link would be with the inspector, if not the regional office. There is the possibility in future that there might be home-based contracts for inspectors who work in certain areas. We still hope that there will be an opportunity to have local links and local relationships. At some stage however, the size and shape of the regional offices must be rationalised.
Do you think that—with the reduction to 5 regions from the 32 local authorities and 14 health boards that currently have responsibility for registration—the inspectors will become more distanced from those who are being inspected and from members of the public who might wish to complain?
They might; I cannot say that that would not happen. A lot will depend on how the regional bodies operate. I hoped—this was my understanding—that the local link would be with local inspectors and that there would be continuity. Local providers would know their local inspectors and would understand how the system worked. Margaret Jamieson might have a point—I would certainly not argue against having more regional offices.
You said that one inspection visit a year might be too infrequent. However, you state in your written evidence:
First, we hope that new services would be inspected within a year—they should not operate for a full year before an inspector's second visit. I beg your pardon, Shona; could you repeat your other point?
I want to find out whether you believe that once a year is generally sufficient for inspections.
That has been a concern. There was a lot of discussion about it during the consultation exercises. There was a fear in some areas that, if people had not managed two visits per year under old systems, and if there was a change to one visit per year—with work being expanded to fill the gap—that new arrangement might start to slip. People voiced that concern, although I hope that that would not happen.
Should that one visit be announced or unannounced?
It should be an announced visit, but clearly the opportunity should always exist to visit unannounced. I have worked in private care in other parts of the United Kingdom, and was quite shocked by the way in which some companies used to be able to keep two different sets of books on how many staff they had and on who was on duty at various times. I am not suggesting that that has ever been the case in Scotland, but it reminds us that unannounced visits can help address any such problems. If inspectors could turn up and ask to see the books and the staff on duty, and could understand the staff's qualifications in relation to their roles and tasks, unannounced visits would be a necessary part of a robust regulation regime.
Are there any omissions in the bill that you wish to highlight?
No. I do not think that there are many omissions, although I am sure that other agencies will have other views on what they would like to see included. Given that the intention is to have legislation that will stand for 30 years, the bill represents a good attempt at striking a balance between being too prescriptive and being too loose.
We can safely say that more work will be done in that area.
It is difficult to assess the extent to which that pendulum might have swung. We are concerned that there should be professionalisation of staff, but we do not want that to be the main plank of the legislation. The backdrop to the bill must be protection of the public.
You suggested that registration would be possible before a given service came into being and that you think that the first inspection should take place within 12 weeks of initial registration. Why 12 weeks?
That is a good question. I suppose that the answer is that 12 weeks seems better than six months. I learned of the case of a nursery service that had been registered on the basis of its staff's qualifications and its equipment, but not on the basis of the quality of care that was being delivered. The inspector was not due to return for a year. I felt that that was not right, and that an inspection within 12 weeks was necessary. Perhaps that is the right time delay; perhaps it is wrong. In any case, an overview should be given as soon as possible after a service starts running to establish whether standards are being met.
Are you happy with the complaints procedure as set out in the bill?
Yes. A lot of detail is still required on how accessible that should be, on how it might work and on how the phone lines would work, among other things. However, the proposed procedure represents a move in the right direction. Anything that opens the door to people who want to discuss their feelings about the service that is provided for them or their family must be a good thing. Whether that takes the form of a complaints procedure or of a suggestion box, the main consideration is that people have their say.
Thank you for coming and sharing your views, and for your written submission. It was helpful to receive that in advance.
Meeting adjourned.
On resuming—
We will now take evidence from the Coalition of Carers, whom I wish a good afternoon and thank for their written submission and for coming this afternoon. If you would like to make a short statement, please do so. We will then ask questions.
Thank you for this opportunity to comment on the bill. I would like to introduce Margaret Hendry and Ann Anderson, who are both carers. They will also make some comments.
I am Margaret Hendry. I look after my mother, who will be 94 in April. I have been looking after her for about six years. She cannot now really do anything for herself, so 24-hour care is needed. I do the vast majority of that, but I need to have other carers in to let me have a bit of respite. Quality and continuity of care is absolutely essential; in fact, there cannot be quality without continuity. One might have the best carer in the world, but if that carer is not there regularly, the relationship can be broken, when instead somebody different comes and there is a need for the cared-for person to meet somebody new. Quality and continuity go together—I assure members that there cannot be quality without continuity.
Throughout all the points that we have made, the carers have focused on the standards of services that are provided in the home. That is a clear priority for carers and everybody sees that as the most likely area of growth in services. Carers have made the point that the quality standards for carer support that have been discussed and agreed in England have not yet been discussed and agreed in Scotland. They hope that they could be added either to the bill or to the development of care support standards more generally.
Thank you. So, generally speaking, you are in favour of the bill. Do you believe that the consultation so far has worked well, or could it have been better?
Carer organisations and professional staff, who were more aware of the consultation than were carers, felt that there was a long lead-in time and that it was an appropriate and satisfactory process.
What are the main implications of the bill for carers and people who use services?
Could you repeat the question?
What are the main implications of the bill for carers and people who use services?
I am pleased with the bill, particularly on registration, implementation and standards. That is nothing but positive. The issue is how to make progress. There will need to be a lot of innovative thinking, particularly about care in the home, which is very diverse and needs many skills and types of people to provide services. Care in the home is a delicate matter because there is one person and one carer. The bill fits well with residential and day centre care, but many people will be cared for in their homes. The frail elderly are staying in their homes. I am sorry, I have probably gone on too long.
Are you advocating that the bill should be extended to encompass individuals who receive care in their own homes?
Does the bill not refer to that at all?
It is not as specific as that.
I am not talking about the care that is given as basic support, such as the care that I give; I am talking about care that is brought in from an agency, local authority or voluntary organisation. I am sorry if I did not make that clear.
That is fine. You are talking about the care that individuals receive in their homes.
May I pick up on the care that is supplied through agencies? I would like to be assured that local authorities—which in my opinion will have to increase their use of agency workers because there are not enough social home care workers in local authorities—will have responsibility for the training and supervision of agency workers. Local authorities should not be able to say that it is the agencies' responsibility to ensure that their workers have the relevant qualifications and supply the kind of care they are paying for. I would like to be assured that agency workers will be supervised in the same way as local authority home care workers.
Our understanding is that agency workers will be bound by the same regulations and code, through the Scottish social services council, as everybody else, depending on what tranche they are in. We have to bear in mind the fact that there will not be a big bang: we will not have an unregulated service one day and then, the next day, a regulated service. Things will not happen that quickly. However, agency workers will be covered by regulations and there will be no difference in that respect between agency and local government workers. The important thing will be the professionalism of the individual member of staff.
We would love to know the answer—especially in the case of an elderly person or, indeed, any person who is in receipt of care and lives alone. Those people have to speak up for themselves, but they may not fully understand the mechanisms for complaint if they are not happy with the service. If there is a resident, non-paid carer—usually a relative, or a friend or neighbour—that person is the voice for the person who is receiving the direct care and that person makes decisions about any problems. I am concerned about people who do not necessarily have that regular contact with a live-in carer.
I would like to add a couple of points that carers have made to try to resolve this problem. Much hinges on the recruitment and employment conditions of agency staff. Carers often say that they come across a transient work force—people who may come to a city such as Edinburgh or Glasgow for three or four months, sign up with a care agency, do a bit of work and then move on. Some agencies are so desperate that they will take on staff on the basis that, whenever those staff have time, they will ring in and say that they are available.
I agree. The problem is that the work force is so diversified. There are multifaceted tasks and the work force includes people of different ages and experience. The first step should be to regulate it in such a way as to establish a better way of doing things at the start.
You mentioned the transient nature of the work force. In previous evidence sessions, we have discussed the fact that the national care standards are not only about medical care; they are about quality-of-life issues. One of the matters that you would consider in a care home would be turnover of staff. You would be worried if there was a significant turnover of staff, yet you are saying that when people are being dealt with in their own homes there is significant staff turnover. It may be worse, because there is one carer there and possibly another member of staff. A large turnover of staff in a care home may be two or three people in a large staff.
Margaret Hendry has put her finger on the button about how difficult this is going to be. Customer satisfaction surveys are of limited utility. When I was a home care manager, my experience was that when our department sent out a survey, the response was, "My home help is lovely; could she come more often?" There may have been a fear behind that—that if they said the wrong thing they would lose their home help—or they may have been grateful for what they received although it might not have been up to the quality that it should have been.
Would you like to ask your other questions?
It has been suggested that the bill might be in danger of being out of tune on carers. You covered the point thoroughly in the introductory statement when you said that the definitions need to be changed and that the role of the carer is as a service provider rather than as a service recipient. Do you have any further comments to add to that? I think that your comments were quite clear.
The key role in the bill lies with the inspectors and how they work. I detect that what you are saying is that if the inspectors go to the council or the agency and check the books, qualifications and how many people are on the rota, they will not really find out what the service is like. Although they could not go unannounced into people's homes, they could arrange to meet carers in their home to discuss the service from their perspective. Are you suggesting that that mechanism should be written into the bill?
Yes, definitely.
When we talked to carers about an inspection of their home, some of them laughed and said, "Think about how often other public services are inspected—perhaps once a year. What chance is there of ever seeing an inspector in my own home?"
You are saying that the proposals in the bill to involve carers, such as ensuring that they are represented on the commission and the council, do not go far enough and will not guarantee that there will be quality monitoring on the ground.
The ways in which quality monitoring will be guaranteed are not spelled out clearly enough.
You would like something to be specified in the bill.
Yes, if that is appropriate for the bill. Carers have said that it would be good to specify that there should be carer representation at every level in the commission and in the inspection mechanisms. In a nutshell, carers would welcome the incorporation in the bill of a stronger and more defined role for carers as partners in the provision and regulation of, and compliance with, standards. Carers would like to make a contribution to that.
Maybe there should be a statutory duty on regional offices to consult carers in their area on services. If you can suggest something better, please do.
There should be something like that.
Following on from Shona Robison's point in response to what you said about continuous assessment, the question is how to involve carers and service users in the most effective way. One could claim to have fulfilled a statutory duty by sending out forms once a year and asking people to fill them in. However, Shona Robison is right: people have to be made aware of why they are being asked for their input. That should be done as part of a continuous monitoring service so that it is not regarded with cynicism and fear. There could be a mechanism by which a senior member of staff sits down with people and takes a more verbal approach.
Yes. That is what I meant when I said that carers are not always sure whether our concerns would most appropriately be addressed in the bill or in the mechanisms that will follow, such as the guidance notes or local arrangements.
Are there any omissions from the bill? There do not have to be any.
No. This gives us another opportunity to say that it is clear that carers thought the bill a very comprehensive piece of work.
I have a question about section 4, on information and advice. The bill says:
You are correct in your assumption: the meaning of section 4 is clear. However, we can seek clarification from the Executive on how it envisages that advice being delivered locally. That would be of assistance to the committee, as well as answer your question.
That was not an issue when we consulted carers and care organisations and no alarm was raised over it, but if there are ways of further clarifying the fact that respite services are included in the bill, the opportunity should be taken to do so.
We will ask for clarification on that point as well.
I read recently that the agencies that currently supply a great deal of the care are not regulated at all, although they will be coming under regulation. Am I right in thinking that?
I am advised that that is a fair reflection of the present situation. As I said earlier, the introduction of the council is intended to professionalise the services across the spectrum of social care almost irrespective of whether someone works for an agency or a local authority. Whether a nurse is working for an agency or for the national health service, she is a nurse, and to practise as a nurse she has had to do certain things and is thereby a professional. The general aim of the bill is to ensure that that approach is taken in the social care sector. It is not about social workers as a defined group, but about the wider spectrum of social care providers.
It is a wide spectrum, ranging from a nurse through to a young person who is just learning.
We are at the beginning of the process—we are at stage 1, during which we consider the general principles of the bill and whether relevant groups and individuals have been consulted in the most effective way. A lot of work remains to be done at stage 2, when we will get into line-by-line consideration of the bill. The Executive tends to take on board some of the issues raised during stage 1, including the lead committee report, which we will prepare. Three other committees of the Parliament are also considering the bill, so the Executive will be bombarded with lots of good ideas. Your evidence will form part of that process.
Thank you, convener.
I would like to add to what Graeme Millar has said about the inspection process. The new system will offer an opportunity to reconsider that process. A particular point in our paper concerns the use of lay people in inspecting services. Good role models are out there, for example, the school inspections, the work of which is paralleled in other inspectorates in different ways. As a matter of principle, we feel that not only professional inspectors should be involved in inspecting care provision.
Who would those lay people be? I presume that parents would be involved in inspection of a school, but how would you get a list of appropriate people for inspections?
The schools inspectorate advertises for anyone who is interested in becoming a lay inspector. Those people do not have to be parents.
So inspection of care provision would be open to whoever put themselves forward?
Yes.
Rather than just to carers?
Obviously there is a place for carers and service users, who very likely would be interested. However, I think that we would argue that it should be open to anybody.
Would the list be under the control of the Scottish commission for the regulation of care?
Yes.
So people would apply to the commission, which would then either approve the application or not? Is that an additional role for the commission?
Carrying out inspections using lay inspectors would be quite common and, yes, the commission would have control of who was chosen.
I would like to ask about your ideas on annual reports. How are they different from what is suggested in the bill? In the bill, people have to report every year to the minister and things have to come before Parliament. How is your annual report different?
The section that deals with the annual report says that the commission and the council will have a duty to report to the minister on the carrying out of their functions. I know that other parts of the bill talk about a wider information role, but we are saying that the annual report is a tool for providing a strategic overview of the way in which service provision is working.
Would you like section 4 to be beefed up? Should it say specifically that an annual report should be made available to the public and to the Parliament, giving a strategic overview of the quality and availability of care services across Scotland? That could lead to an annual debate.
We are not saying that there should necessarily be an annual debate, but the annual report should contain formal proposals—from the commission or the council to the policy makers and the purse-strings holders—about changes that they envisage following their inspections. The report would not simply be saying, "We have done this." It would be saying, "We have done this, and we think that these things should change." That may be implicit in the bill, and we may have missed it, but we would like it to be more explicit.
On the positive side, where good practice is identified, as it often is in certain sectors in certain areas, the annual report could be used as a communication tool to the whole sector, pointing out the good practice that we have identified and recommending that others start to work to those standards. Using the report as a tool would allow the sector to become more dynamic.
Would taking on those additional roles—vetting the lay inspectors and producing an annual report—involve extra expense for the commission? How would that impact on the proposal that it should be self-financing through fees?
I would expect any annual report to be a report of the sector at one moment and to reflect good and bad practice. I therefore do not think that our suggestion would involve any increased cost; nor do I think that there would be a great deal of expense in involving lay members. They are often willing volunteers who may have been carers in the past and who may have experience to offer.
Should the commission and the council be funded purely through fees, or through fees and direct funding from the Scottish Executive?
We have not taken a view on that.
In the past half-hour, we have discussed whether we have a view, but we have not taken a view. If the bodies are to work, they must be adequately funded. The income may be a balance of the sources. We do not have a policy on that.
In regulating care and the work force, the inspectors will have legal obligations as to how they report their inspections. If standards are very bad, the matter will have to be dealt with in court. How does a lay inspector fit into that system? They would not have the same legal obligations and would not be charged with ensuring that national standards were applied throughout Scotland. Surely their report would be rather subjective.
I have not given that issue a great deal of thought. I am unsure why care inspections should be any different from school inspections. In the school inspection model, a team that combines professional and lay inspectors normally conducts the inspection.
Would the lay inspectors be part of the team, not separate?
Yes. The lay inspector would not be an amateur. They would be well informed about what they were looking for. Lay inspectors would receive a fair bit of induction and training. They support the professional inspectors, who must consider issues in a certain way. The lay inspectors provide a broader perspective in the inspection team.
I do not remember whether it was the minister or another witness who suggested to the committee that some inspections might be conducted by one inspector, once a year. An inspectorate team is not planned.
The answer to both questions is no. In my experience, it would be difficult to find an individual who could manage a full inspection across the social work and medical field of a nursing home. I would expect more than one individual to do an inspection. However, even if only one inspector were used, lay involvement would be more likely when the inspector had identified a problem and needed a team to examine it. I am just thinking of the issues as I sit here. I would be surprised if the total responsibility were placed on the shoulders of a true lay inspector.
You are probably aware that it is proposed to reduce the number of inspections in care homes from two to one. Will that afford consumers adequate protection? Should the inspection be announced?
We have considered that, and we think that it is reasonable that there should be a minimum of one announced inspection and one unannounced inspection. In some cases, you may have to have unannounced inspections month after month until a problem is resolved. Having unannounced inspections would be sensible. Organisations would get a formal, tick-the-box type of inspection each year, but if concerns were expressed, it would be up to the inspector to decide whether to go in unannounced to find out if there was a problem. It may be that two formal announced inspections in a year are too much, because it is rare that the environment in homes changes rapidly. However, there should be an announced inspection and an unannounced inspection in no more than 18 months.
Just to be clear, are you saying that there should only be an unannounced inspection where a problem has been highlighted, or should there be an unannounced inspection regardless?
There should be two inspections per year, one announced and one unannounced.
For everybody?
Yes. That would keep managers on their toes.
You say in your submission that potential complainers should be encouraged. I do not know if we agree with you, having sat through our surgeries. Are you satisfied with the complaints procedure as outlined in sections 6 and 45 of the bill?
We welcome what is in those sections. We are not recommending that people complain, but if they do, we recommend that they complain in a sensible, logical way, and do not rant and rave and whinge. A complaints mechanism is also an assessment of the quality of the service that is being provided. As I said earlier, we would always encourage service providers to stop complaints at the front end of care delivery, however that manifests itself.
We welcome the complaints procedure. In our responses to earlier consultations we said that it was important that there was such a procedure, because in some circumstances it is difficult for service users, particularly disadvantaged service users, to complain to those who are providing services, so providing another channel for complaints and feedback about a service is welcome. It is important that once somebody has made a complaint, through whatever system, it is dealt with by the right person in the right way. It is also important that there are good links between professional regulatory bodies.
You suggest that there should be public interest representatives on the Scottish commission for the regulation of care and the Scottish social services council. How would that work in practice? Can you give us some examples of the kinds of people or organisations that you have in mind for such posts?
So far, the list of representatives is a list of stakeholders. One of the purposes of regulation, particularly with regard to the Scottish commission for the regulation of care, is to increase public confidence in care services. You can advertise and encourage people who have a general interest in the area but no particular stake in it to be represented on the commission. Such people, who are used in other forms of regulation, do not have a particular stake, but they have a general interest. They can be encouraged to act in a fairly disinterested way, and they add to the balance of the regulatory mechanism. They would increase public confidence in the system.
So you are talking about people who would be like non-executive directors of health trusts. Is that the kind of representative that you are talking about, as opposed to local councillors, MSPs, the Scottish Consumer Council or the Carers National Association?
Yes. I mean somebody who is encouraged to come on board by public advertisements, and who knows that they are there in the public interest. That does not exclude any of the groups that you mentioned, but representatives should be drawn from a wide group. The list of stakeholders consists of those who deliver services, and those who receive services and their carers. Public confidence would be improved if you had a category of people who were there in the public interest. They are not there because they provide or receive services, but because they have a general interest in maintaining public confidence in the regulation of care.
Our other point is that the majority of representatives should not be service providers. That stance has been adopted in other sectors, such as the Clinical Standards Board for Scotland and the Financial Services Authority, so that they are perceived to have a degree of independence.
Would you like the bill to lay down that there should not be a majority of service providers?
Yes.
We say in our submission that at the moment it is up to ministers to give advice on the balance of members. That is an onerous task, and will be subject to criticism. It would be appropriate for the Parliament to give a broad view on what the balance might be, and for that to be implemented by the Executive.
There are many areas that will require a lot of background to be filled in after this bill is passed. If we are saying that it is a fundamental point that there should not be a majority of service providers, that could be laid down in the bill, and the precise balance could be worked on in the background.
That is a fundamental point. It would help to increase confidence in the bill in the eyes of the public and service users.
Do colleagues have any other questions? I have one final question. Are there any omissions in the bill, or are you happy with it? Is there anything else that you wish to say before we finish?
We discussed that, and we would be stretching ourselves to find any omissions at this stage.
Please do not stretch yourselves. It is the end of a long day, and you have stretched yourselves enough.
It has been a longer day for you and your colleagues.
Thank you.
Thank you, colleagues, and thank you to the Scottish Consumer Council and to all our victims today.
Meeting closed at 16:32.