A new system

At-a-glance report cards are to be introduced for every nursery, childminder and care home for elderly people from the start of April 2008 in a new move to make these services more transparent and accessible.

The Care Commission, Scotland’s national care regulator, which is bringing in the new regime, believes it will be easier for people who are likely to use the services to check a provider’s quality and performance and decide whether or not to use it on that basis.

Under the old system, providers faced two inspections a year, one announced and the other unannounced. The resulting reports were published on the Care Commission’s website with recommendations if standards were not met and requirements if regulations were not met.

The new system will aim to be easier to understand by introducing a simple ratings guide focusing on between three and five separate areas, including care and support or information; environment; staffing; and management/leadership.

Unlike in England, which is bringing in hotel-style star ratings, Scotland’s facilities will be marked from one to six, with six being excellent and three to four being adequate. The scores will be backed up with more detailed background and explanation.

In response to Care Commission findings that users want more input into how care services are run, providers will have to demonstrate that they have consulted with users and relatives if they are to have any hope of achieving top marks.

Is excellence possible?

The Commission argues, reasonably, that responsible care providers will welcome the new inspection regime since they are making best efforts to comply with National Care Standards as things stand.

However, with 15,000 inspections of care services being carried out in Scotland every year and the consequent demands on providers’ resources, it is also reasonable to expect that the standard of the inspections themselves is consistent, objective and of high quality.

Already there have been indications that the inspection regime bar is being set unrealistically high and providers have been given to understand that the “excellent” marking will rarely, if ever, be awarded. The rationale for this is that providers will always have something to strive for.

But this is just as likely to act as a strong disincentive. Managers and staff in care services do not take inspections lightly. They are eager to provide the best possible care and environment, not just on the day of the inspection but all year round. How dispiriting, then, to be warned that no matter how hard they try, it will not be good enough.

There is also a justified concern that a temporary failing in just one of the five areas could drag down the marking for an otherwise excellent establishment - and that the reduced marking would feature on the Care Commission’s website for long after the failing had been addressed.

The risk of inconsistency and subjectivity

The Commission must take steps to deal with subjectivity of opinion among its inspectors. There is ample anecdotal evidence of identical practices which are highly praised by an inspector in one establishment and roundly condemned by a different inspector in another establishment.

Providers will meet and willingly exceed the standards that are required of them but there must be consistency of application of these standards. There is no point in a perfect aim if you are aiming at the wrong target.

The Commission is keen on consultation and dialogue and it is important that this dialogue is not one way. Much more thought needs to be given to the appeals process whereby providers can dispute inspection findings.

There is very little evidence that appeals have ever altered inspection findings and a suspicion among providers that any appeal will result in more and more stringent inspections. This must be addressed.

Quality is paramount.

Everybody is in agreement that the quality of care is of paramount importance but, as the new inspection regime looms, providers might be forgiven for feeling that it is more likely to guarantee the quality of inspection performance targets.

If providers and inspectors work in partnership, there is no doubt that standards can be maintained and improved. However, that partnership should be based on mutual respect, collaboration and understanding. That way everyone will truly benefit.

Deepak Poddar is Managing Director of Little Einstein’s nurseries.

Tags: Care Commission, Inspection, Nurseries, Standard-setting