Social care - Independent Review of Inspection, Scrutiny and Regulation: call for evidence analysis

Theme 5 – How will systems of inspection, scrutiny, and regulation support the social care and support workforce?

When referring to respondents who made particular comments, the terms 'a small number,' 'a few' and so on have been used. While the analysis was qualitative in nature, with the consultation containing only a limited number of quantifiable questions, as a very general rule it can be assumed that:

'a small number' indicates up to 5 respondents

'a few indicates around 6-9

'a small minority' indicates around more than 9 but less than 10%

'a significant minority' indicates between around 10%-24% of respondents

'a large minority' indicates more than a quarter of respondents but less than half

and 'a majority' indicates more than 50% of those who commented at any question.

The call for evidence noted that one of the aims of this review is to ensure inspection, scrutiny, and regulation works towards making the system better for everyone, including people who use services and those who work in them. The review was keen to understand views on how this might be achieved for those who deliver social care and support.

The first question about this theme asked:

Q16: How do we ensure there is compliance and consistency with workforce registration requirements?

A total of 65 call for evidence respondents commented on this question.

Recruitment to the sector

A significant minority of those answering this question – across all sub-groups and at events – referred to the need for an easy and clear process that would encourage individuals to work in the social care sector. Comments included the need for transparency in registration and the requirements for specific qualifications and a registration process that is easy to initiate and maintain. Small numbers also noted that there is a need to review registration categories, job titles and roles so that social care can be positioned as a highly skilled and diverse career. Offering access to, and clear communication with, inspectors and regulatory organisations as well as employers was also seen as being important.

There were a small number of suggestions from call for evidence respondents and those attending events for additional funding opportunities to be made available for mandatory qualifications. Given the pressures of demanding working roles and the need to complete training and achieve qualifications, it was seen as important that all individuals within the social care and support workforce have adequate opportunities to complete their qualifications. A representative body noted their support for regulatory mechanisms that seek to professionalise the social care and support workforce and build value in the various roles available but felt there is currently too much focus on compliance and fitness to practice and the potential to be struck off the register.

There were also a few calls for higher levels of support for the social care and support workforce, with suggestions for mandatory supervision sessions to record and assess work completed or for a framework for compliance so that there is clarity over what is required of them to fulfil their role.

Some of those attending events also commented on the need to address recruitment and retention issues within the social care sector. One way of helping with this issue was perceived to be a duty upon providers of social care support services to develop and improve the social care and support workforce in terms of training opportunities. An example provided by one call for evidence respondent was of the high numbers of childminders leaving the workforce due to high levels of bureaucracy and duplication of quality assurance. This respondent suggested there should be one single or shared national inspection system that would rationalise existing frameworks and reduce outcomes reporting.

Flexibility around qualifications

A significant minority of those answering this question, across all sub-groups and at events, focused on the issue of having greater flexibility around qualifications and equivalencies with qualifications being portable across different parts of the social care sector and reflecting the need and wider scope of social care support. A small number of these respondents felt there should be consistent compliance in standards, with minimum standards adopted by all and incidents dealt with in a consistent manner (at present the way in which incidents are dealt with can vary with different regulators). One regulator commented that there are currently several professional workforce regulators which can lead to inconsistencies in standards for the social care and support workforce and can make compliance a confusing issue. An HSCP suggested that the different regulators need to be able to work together effectively.

Registration

There were a few references to the disparity in registration requirements for those working in different sectors, with suggestions for everyone in the social care and support workforce to have the same qualifications regardless of the sector in which they work. This would help to reduce barriers that exist when changing jobs and ensure that all social care support providers provide training support to their staff. Linked to this issue, there were a few calls for greater flexibility around qualifications so as to allow for the social care and support workforce to be better able to access opportunities across different service types. One attendee at an event suggested there should be a minimim level of standardised training in terms of skills and qualifications for all individuals working in the social care sector.

A few respondents attending events also commented on the inconsistency of registration within the care sector and felt that the social care and support workforce should be required to register so that all can adhere to the same care standards. One of these noted that it can be challenging to achieve registration; another that registration should be immediate on joining the care workforce.

It was also noted by a very small number of respondents that some roles such as personal assistants are not registered by SSSC and that there should be a consistent approach to registration for all people working within the social care sector.

Role of SSSC

A significant minority of respondents referred to various aspects of the role of the SSSC. Issues raised by small numbers of respondents included:

• Calls for closer working between different bodies including the Care Inspectorate and SSSC so they can develop joint strategies which would allow social care and support workforce requirements to match up with change in practice ambitions. There were also a very small number of suggestions that consideration should be given to other registration organisations such as the Nursing and Midwifery Council (NMC) or the General Teaching Council for Scotland (GTCS) and the processes they follow
• SSSC and providers of social care support should jointly develop a high level strategy for skills development
• There should be immediate registration with SSSC for anyone joining the social care and support workforce. At present support staff have up to six months to register with SSSC but then can move to another provider of social care support shortly before the end of the six month period when the period of registration starts again
• There should be a requirement for the social care and support workforce to provide proof of annual training undertaken
• SSSC should have increased opportunities for intervention with providers of social care support who fail to meet workforce registration obligations
• Review SSSC investigation processes so that there is a balance between robust safeguarding and the consideration of the social care and support workforce
• Have a single Code of Practice for the social care and support workforce so there are clear and consistent expectations for all

There were a small number of references to the SSSC's consultation on next steps for the register for the future, which was seen to link to this consultation.

Small numbers of respondents – mostly HSCPs – referred to the role for providers of social care support, with suggestions for registration and statutory duties to be imposed upon all of them. This would also include a responsibility to ensure that the social care and support workforce is registered. A few individuals attending events also noted that providers of social care support should offer more support to their workforce.

As at earlier questions, there were a number of references to the inspection process, with comments on the need to co-design services, for consistency through the inspection process and for the collection of regular data and consistency in follow through.

While there were some requests for consistency in registration across the workforce, there were a few comments on the cost of this, although there was little consistency in these. A small number of respondents called for an end to registration fees or for employers to pay for this cost. A representative body also noted the inequalities within the workforce regulation system in that some social care staff are registered and their costs are paid by their employer, some social care staff are not required to register, and others have to register and pay their own registration fees.

Q17: How can we ensure that people who work in care and support services are able to contribute to inspection, scrutiny, and regulation processes?

A total of 67 respondents to the call for evidence responded to this question.

Involvement of the workforce

The key theme emerging in response to this question, across all sub-groups and from individuals attending events, was of the need to involve the social care and support workforce. This included involving them in the inspection process and in co-design of inspection, scrutiny, and regulation processes. There were a small number of references to the role of trade unions in supporting and representing the care workforce.

Respondents cited a number of ways in which the social care and support workforce could contribute their views. These included focus groups, workshops, face-to-face meetings during inspections, annual surveys, online questionnaires and engagement events. It was also noted that services providing social care support would need to provide adequate time and resources for higher levels of staff involvement.

Involvement in the inspection process

A significant minority of respondents referred specifically to the inspection process and the need for the social care and support workforce to have a greater understanding of what this involves. This included:

• Greater awareness of the role of regulators and inspectors
• Inspectors being open and valuing the social care and support workforce and their views
• Inspectors building relationships with the social care and support workforce outwith inspections to help them develop confidence in regulators, the inspection process and its outcomes
• Ensuring it is easy for the social care and support workforce to be involved in the inspection process
• Providing access to feedback platforms
• Allowing the social care and support workforce to share good practice and to view the inspection process as an opportunity to reflect upon challenges, successes and learning
• Providing feedback to the social care and support workforce via a range of different channels; setting up systems that allow for constructive feedback loops
• Consistent inspection processes, with knowledge and understanding of specific sectors within the care arena

However, a small number of respondents noted that it can be difficult to obtain feedback from individuals within the social care and support workforce, given current workload pressures and a lack of time to be involved in the inspection process.

A small minority of respondents also noted the need for offering anonymity to individuals within the social care and support workforce and ensuring there are anonymous reporting mechanisms that allow them to communicate confidentially with inspectors. Allied to this there were some comments of a need for clear whistleblowing policies to be in place within providers of social care support.

Cultural change

We have already noted that inspection, scrutiny, and regulation is felt to be a challenging experience by some in the social care and support workforce and social care providers. A significant minority of those responding to this question, both in call for evidence responses and at events, noted the need to change views of inspection, scrutiny, and regulation so that it is seen as a positive concept for continuous improvement. Linked to this, there were a small number of suggestions for the language used to change so that it can be easily understood and does not appear to be focusing on negatives. Demonstrating positive experiences and outcomes was seen to be one way in which the social care and support workforce could be encouraged and motivated to participate. Alongside this, it was felt by a few respondents that a quality improvement approach and a greater focus on self-evaluation and reflection would help the social care and support workforce to perceive inspection, scrutiny, and regulation in a more positive light.

Other issues and suggestions noted by small numbers of those responding to the call for evidence and at events included:

• A need for systems to be in place that allow for regular input from the social care and support workforce
• Creation of a Board of Scrutiny with social care and support workforce involvement
• Consider offering secondments and work experience opportunities to the social care and support workforce
• Healthcare staff should be able to enter the social care and support workforce without losing pay and conditions
• It is unclear what processes exist for agencies or contractors to raise concerns
• There needs to be consistency in the care values across the social care sector
• There needs to be anonymity for anyone in the social care and support workforce who wishes to make a complaint; and a system for whistleblowing
• There should be guaranteed contracts on completion of training

As noted by a representative body:

"The national overview that the Care Inspectorate have of practice is invaluable to leverage across Scotland to support improved service delivery. The development of improvement teams (outwith the regulators) that work alongside local areas to address their unique needs, cogniscant of the workforce challenges they may be facing, would itself foster a different relationship between workers and the scrutiny / regulatory process, hopefully encouraging more engagement. If the likely outcome of their engagement with regulators is perceived to be meaningful support and assistance, the incentive to contribute increases."

In summary: Theme 5 – How will systems of inspection, scrutiny, and regulation support the workforce?

There is a need to ensure that it is easy to join the social care and support workforce, with a simple and transparent registration process and clear information on the requirements for any qualifications. There were a few calls for more support for the social care and support workforce. Suggestions included additional funding to be provided to help workers achieve mandatory qualifications and support from providers of social care support in terms of training and achieving qualifications. It was also suggested that there should be a duty on social care support providers to ensure staff are registered and achieve the required qualifications.

There were requests for greater flexibility around qualifications and equivalencies, with consistent compliance with standards. While there were calls for consistent minimum standards across the care sector, there were some comments of a need for proportionality, depending on the work / role being undertaken. There are differences in regulatory requirements and it was felt that closer working between different regulators would help to ensure consistency.

There was general agreement of the need for organisations and regulatory bodies to have systems in place that involve all those working within the social care sector, before, during and after the inspection process. This would contribute to improved outcomes within the sector as well as creating a more positive working environment and encouraging others to work within the sector. Inspection, scrutiny, and regulation is perceived to be important, there were also some requests for a greater focus on collaboration, self-evaluation and outcomes and sharing of good practice. These would help to reduce any fears associated with the inspection process.