Social care - Independent Review of Inspection, Scrutiny and Regulation: recommendation report

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

One of the key aims of this Review is to identify and set out recommendations to help ensure inspection, scrutiny, and regulation works towards making the system better for everyone, including for those who work to deliver social care support. The Review was keen to understand views on how current support systems and arrangements for the workforce might be improved, built upon, and further strengthened, for the benefit of all.

To better understand the current landscape in relation to supporting and valuing the workforce whilst also seeking to ensure that the people who access social care support are safely cared for by appropriately qualified and trained staff, the Review considered two key questions under this theme:

• How do we ensure there is compliance and consistency with workforce registration requirements?
• How can we ensure that people who work in care and support services are able to contribute to inspection, scrutiny, and regulation processes?

Some elements of how compliance and consistency in the registration of the workforce should be achieved are addressed earlier in this report. In Theme 2, recommendations are made about ensuring there is a universal requirement to obtain registration with a regulatory body for all social care support staff, appropriate to their role and setting, and that a bespoke system of registration is developed for Personal Assistants. This theme considers in more depth different elements of registration and how people who work in the social care sector are able to contribute to, and are supported by, processes of inspection, scrutiny, and regulation.

The Review heard that some people would like the registration process for the social care sector to be as consistent, thorough and quick as possible. Those delivering social care support also indicated that they would like to see more flexibility and clarity in relation to training and professional development, alongside greater involvement in inspection processes and decisions affecting the workforce.

The Review also heard concerns about the cost of registration and about inconsistencies within the workforce registration system. For example, some social care staff are registered, and their costs are paid by their employer, some staff are not required to register, and others have to register and pay their own registration fees.

The Review heard that many of the workforce issues raised are currently being explored and addressed through different workstreams and initiatives. However, the challenges are in some instances complex, with no quick solutions.

Based on feedback gathered during the Review, it is apparent that improvement work is not necessarily being translated into noticeable change for everyone working in the social care sector. Therefore, the Review has set out recommendations to strengthen the support in place for those delivering social care support, whilst identifying where further exploration is required and acknowledging the various initiatives underway to improve processes and conditions.

Workforce registration

In addition to the findings and recommendation made in Theme 2, the Review consistently heard about the pressures across the social care support system in relation to staffing. Strong evidence was presented that workforce challenges underpin many of the issues faced in the social care sector. Whilst the Review was asked to focus on the regulatory and inspection framework, it is impossible to separate the relationship between workforce, the capacity to improve and the crucial role of regulation and inspection in the improvement agenda.

The analysis of the call for evidence detail and information from stakeholder engagement events found there was a view that:

… 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.

Once a person obtains employment in the social care sector, they must get their PVG scheme membership, start in their role and apply for registration with the SSSC as soon as reasonably practicable. For those that need to register, to maintain registration they must follow the SSSC Codes of Practice, maintain continuous professional development and for some roles, complete certain qualifications.

It was highlighted to the Review that it is crucial to have a registration process that is transparent, easy to initiate and maintain. It was felt that easier and clearer processes, with an increased emphasis on the benefits of registration would better support those working in the sector and potentially encourage those who might be interested in doing so.

There was a view that there should be immediate registration with SSSC for anyone joining the social care workforce. At present the full registration process can take up to three months and an employee must be registered within six months. An employer commits an offence if they employ someone after six months who is not registered without reasonable explanation and the CI can refer an employer who commits a breach to the Procurator Fiscal. However, an individual could potentially still move to another role shortly before the end of the six month period when the period of registration starts again. This creates a risk of people slipping through the safety net of registration.

Some work in this area is currently underway by the SSSC’s Future Proofing Programme which covers three interconnected pieces of work:

• the current SSSC Register;
• qualifications and skills; and
• the SSSC Codes of Practice.

The work of the Future Proofing Programme includes simplifying the process of registration, increasing the emphasis on the value of being registered, along with focusing on the standards, skills and qualifications needed to deliver high quality care. The Future Proofing Programme started in December 2021 and is expected to conclude in 2024.

Through the Future Proofing Programme, the SSSC are seeking to implement a three-month rule for registration to reduce the timescale from starting work to employment. To make registration immediate would require registration before starting employment which would mean that employers may be unable to fully assess fitness to practise over a probationary period. Shortening the time scales while ensuring that fitness to practise assessment remains robust, is an approach the Review welcomes.

It was also suggested by some that higher levels of support for the social care support workforce is required. Suggestion included supervision sessions to record and assess work completed or a framework for compliance so that there is clarity over what is required of staff to fulfil their role. Added to this was support for a single Code of Practice for staff so there are clear and consistent expectations for all.

The Review also heard evidence about the Workforce Register and the 23 different categories that are currently used to register people. There was a view that this demonstrated a rigidity which did not support flexible working across services and that those employed in areas that provided more than one type of support needed to register more than once. This is also supported by the findings of The Review of Care Service Definitions: Challenges and Recommendations (November 2021) as outlined in Theme 2.

It is the opinion of the Review that the Future Proofing Programme work underway by the SSSC has the potential to contribute to more effective registration practices that support the workforce and those using services. For example:

• a reduction from 23 categories of registration to 4, will support the streamlining and simplification of the registration process:
• a streamlined Code of Practice for members of the social care workforce should assist improved understanding; and
• a focus on the benefits of registration will potentially encourage uptake.

Powers of intervention and enforcement

Similar to other issues considered by the Review, some of the challenges relating to the registration of the social care support workforce are legislative. For example, the Public Sector Reform (Scotland) Act 2010 requires the CI to take the relevant codes of practice into consideration when inspecting services, but the SSSC are unable to compel agencies to share information required to investigate complaints against staff or compel employers to follow their codes of practice. This leads to disparity as sometimes the reason staff do not meet the requirements of SSSC registration is due to employers not providing the training needed.

There is also some complexity and potential overlap around where responsibilities lie between the SSSC and other professional regulators. Currently, if a manager is registered with another professional regulator, the law specifically excludes them from registration with the SSSC, except for social workers who can be dual registered. This can lead to duplication or a lack of clarity around jurisdiction and intervention if issues arise with a provider around complying with the codes of practice.

A further exploration of how well current arrangements in relation to powers of intervention and enforcement are working would help to identify where changes or improvements might need to be made to ensure that providers are fully meeting requirements. Therefore the Review recommends:

Recommendation 34 – It is recommended that Scottish Ministers should review the powers of intervention and enforcement currently in place, where providers fail to meet workforce registration obligations or fail to follow the codes of conduct and consideration be given as to where powers of enforcement should lie.

Valuing and involving our social care support workforce

A key theme emerging from the Review’s engagement events and call for evidence was the need to involve the social care support workforce more in decisions that affected them and to more fully value the critical role they play in improving outcomes for those using services. This included involving them in the inspection process and in the co-design of inspection, scrutiny, and regulation processes.

The Review heard that demonstrating positive experiences and outcomes were ways in which staff could be encouraged and motivated to become more involved and feel that their contributions are valued.

The Review heard that here should be a greater focus on collaboration, self- evaluation, outcomes, and sharing of good practice. The Review was also told there is a clear need for organisations and regulatory bodies to have systems in place that involve all those working within the social support care sector and linked services before, during, and after the inspection process.

Greater involvement of the workforce would help to reduce anxieties associated with the inspection process. Building professional, supportive and advisory relationships outwith inspections would also help to further develop confidence in regulators, the inspection process, and in their role in promoting improved outcomes. As noted by a representative body:

If the likely outcome of their engagement with regulators is perceived to be meaningful support and assistance, the incentive to contribute increases.

To successfully promote a culture of collaborative endeavour and improvement the Review considers it essential that the workforce are supported in their roles. An example was shared from the Regulator of Social Housing in England where improvements led to a more collaborative approach and:

• a library of best practice;
• anonymised, recommended improvement;
• annual sector risk profile – looks at issues ongoing in the sector; and
• appropriate helpline for organisations – communication line to discuss issues and ask for support.

The Review is also aware that the SSSC develop and provide resources to support the workforce, including advice for employers in relation to responsibilities around fitness to practice and for employees requiring wellbeing support whilst being involved in the fitness to practise process.

During an inspection one element of a service that the CI will look at is quality of staffing, which includes their qualifications and training. At present no account is taken of other factors such as the quality of support provided to employees or fair work practices.

Through the work of the Fair Work in Social Care Implementation Group, a draft Effective Voice Framework (EV) has been developed for the Adult Social Care sector that recognises the important role that trade unions play in harnessing that voice to communicate with both employers and government. The framework sets out a number of basic standards by which both employees and employers can measure themselves.

Whilst union recognition and participation are not an absolute essential criterion in delivering an effective voice for workers, the framework highlights the benefits that this offers in that context. Work is currently underway on the phase 1 delivery ahead of a national roll out of the EV Framework.

There is the potential that the EV Framework, or something similar, could be used to assess the quality of support provided to employees, in the same way the CI assess the level of support provided to people who use social care support. Inspection for services could be extended to inspection of employment aligned to Fair Work practices, that enable employers to show they are Fair Work compliant. There would be a lot of legal complexities to address. However, the Review is supportive of a move toward employers and commissioners being aligned to a framework that enables them to demonstrate that they abide by Fair Work principles as better services can be directly related to better staff engagement and treatment.

Therefore, the Review recommends:

Recommendation 35 – It is recommended that regulators and providers examine ways in which the workforce can become more actively involved in the inspection process, on a basis of mutual trust and respect.

The Review is also aware of the Skills Delivery Landscape Review Final Report - Fit for the Future: Developing a Post-School Learning System to Fuel the Economic Transformation (SDLIR) (Scotland). SDLIR was initiated to ensure the public body landscape for skills remains fit to meet the challenges and opportunities of the future. It has set out fifteen recommendations that include:

• Improvements to national and regional skills planning and the establishment of associated employer network board.
• The creation of a single national funding body and a single qualifications body.
• Scoping and designing a digital training record.
• A comprehensive audit of post-school qualifications and pathways.

Whilst the SDLIR does not have direct input to systems of inspection, scrutiny, and regulation in relation to supporting the workforce, the recommendations it has made, should be combined with the Muir Review.

This Review notes the work of Fair Work in Social Care Implementation Group (co-led by the Scottish Government and CoSLA). The group has developed a set of proposed “Minimum Standard” terms and conditions for Adult Social Care Workers and these cover a range of issues from basic pay to maternity and paternity leave, sickness pay, pensions and development time.

The Health and Care (Staffing) (Scotland) Act 2019 aims to enable high quality care and improved outcomes for people using services in both health and care, by helping to ensure appropriate staffing. The Act was passed by Parliament in 2019 but implementation was paused due to the pandemic. All the provisions within the Act will come into force in April 2024.

The Review has been encouraged to see collaborative working and a variety of timely and ambitious initiatives underway to help address workforce challenges such as staff attraction and retention, as well as workplace cultures. Nonetheless, based on some of the feedback shared by stakeholders, it is clear that there is work to be done to continue to progress and embed improvements. Many of these workstreams or initiatives are relatively recent and the benefits may take time to be fully realised. However, the Review would like to ensure that progress continues at pace, and that tangible and positive change is delivered across the workforce and therefore recommends:

Recommendation 36 – It is recommended that Scottish Ministers align the social care workforce in a coherent model, based on fair work, to support the sustainability of the workforce and to help drive continuous improvement.

Professional development and training

The Review is absolutely clear of the critical importance of a well-paid, well-respected and well-trained workforce with clear career development opportunities. This would support the culture change necessary to shift from a sector often seen to be on the brink of crisis and where the Review heard inspection, scrutiny, and regulation is often considered as punitive, to one that focuses on human rights and driving improvement.

Whilst the Review heard support for benchmarking standards across the sector, it was noted that there was a need for proportionality, depending on the work or role being undertaken. The Review also heard that if people are able to move on to better paid roles elsewhere that do not have training and qualification requirements, this can be a hindrance to retention in the social care workforce. The Review also heard that the skills necessary for the workforce should be part of the planning and design of social care support. In addition, there was a view that there was a need to take a collaborative approach in developing a high-level strategy for skills development.

Figures in the Scottish Social Service Sector: Report on 2021 Workforce Data, tell us there are 200,000 individuals employed in the social service workforce in Scotland spanning the public, third and independent sectors and all areas of social care support. The Review heard that there is an inconsistent approach to training and development. In some sectors training is portable, whilst in others it is not. Additionally, whilst the onus is on the employer to provide in-service training and development, where required, it is challenging to enforce on a fair, effective, and equitable basis.

The Review heard there is a need for greater flexibility around qualifications and consistent compliance with standards. Added to this were suggestions for a minimum level of training to support individuals in acquiring the skills and qualifications for working in the social care sector. This would better equip the workforce to be able to access opportunities across different service types.

The Review was told of the importance of qualifications keeping pace with policy and practice. Consideration should be given to how staff can be supported in achieving mandatory qualifications including through improved support from social care providers with regard to training opportunities for staff. There was a focus on different models of training. For example, where people who use social care support services have a role in contributing to and informing training, and also where recognition or accreditation of prior learning and experience is made available and that this is encouraged.

The Review was made aware of the Construction Industry Training Board (CITB) for Scotland, England and Wales. The CITB’s role has been to help the industry attract talent, and to support skills development. The CITB is a Non-departmental Public Body (NDPB) and is accountable to government ministers and ultimately to parliament.

This is a model the Review thinks has potential to be further explored by SSSC and the Scottish Government as an exemplar for the further development of social care support in Scotland and accountable to both the sector and to the Scottish Parliament. Equally there could be a collaborative model developed with other nations of the UK. Therefore, the Review makes the following recommendations:

Recommendation 37 – It is recommended that Scottish Ministers should review the sufficiency, quality and availability of resources for training, development and improvement.

Recommendation 38 – It is recommended that steps are taken to ensure that nationally recognised qualifications that reflect the skills required to work in the social care sector are developed and are portable across the social care sector.