Framework for the registration of Health & Adult Social Care Providers
Response from The Association of Supported Living on the Consultation on the Framework for the Registration of Health and Adult Social Care Providers
We welcome the opportunity to respond to such a major step in the registration and inspection of both adult social care and health services. It is important to ensure that the approach for the future is right in terms of both approach and detail, that it is consistent with government policy and practicable to those receiving care and support and those providing it.
Our comments relate to chapters 2 and 3, and not to chapter 4, which covers primary care, and follow the questions as set out in the consultation format.
(pp 95-96)
* Do you agree with the introduction of a generic set of registration requirements, to be supplemented by compliance criteria?
We have no overall objection to a generic set of registration requirements, but the detail of the current requirements shows a preoccupation with the prevention of harm and a focus on people’s care and support which seems dominated by a health-led approach. At this stage, we simply do not know whether the compliance criteria, which we understand to be subject itself to consultation, and which is intended to show more sensitivity to the varied settings in which the requirements will be applied, will alleviate our concern. On the current evidence, the generic approach will not be supportive of the ethos of promoting independence which has been a consistent feature in the growth of supported living
* Are the areas covered by the registration requirements…. the right ones to provide the assurance of the essential levels of safety and quality that we are aiming for?
* Does the wording of the registration requirements in Annex A provide appropriate coverage of these areas?
In our view, the areas and the detail attached to each shows an emphasis on safety, which is not balanced by a proportionate emphasis on quality, as it would normally be experienced by people in receipt of social care. “Risk” is referred to 115 times in the consultation document, and on no occasion does the reference appear to be in a positive context.
We are fully supportive of the need for appropriate levels of safe care and support, and the process of risk management in general, but we feel that the areas covered by the requirements should be based on two essential pillars of existing policy – the promotion of independence in social care, and the promotion of health and wellbeing in health care. We are very disappointed that there is only one area which makes any reference to independence, community inclusion and freedom of action, despite these goals being key to a number of recent government policy initiatives, particularly concerning disabled people. The requirements certainly do not reflect either the principles of Valuing People or the likely priorities under Valuing People Now. It is also entirely unclear how the areas will help promote the process of personalisation, which is also a key theme of recent policy.
Our conclusion therefore is that there should be a reordering of the areas. Area 11 currently covers promoting independence, and whilst we appreciate that the areas may not be in order of priority, the impact of the current order shows a preoccupation with clinical conditions.
We also believe that there should be a review of the areas in order to introduce measurements of empowerment and user feedback that do not appear currently.
* Are there any overlaps or unintended consequences that will not be picked up by other parts of the system?
We do not know whether the consequence was unintended, but we are very concerned about the proposed expansion of the definition of personal care to include prompting. This expands the definition of personal care set out in the National Minimum Standards for Domiciliary Care. We do not see prompting as personal care and do not think a change is necessary. We feel it will bring into regulation some forms of support to people which have shown no signs of being harmful to date
* What are your views on the transition arrangements for existing providers to enter the new registration system?
We have no strong views on these arrangements, as long as they do not cause the consultation on the compliance criteria to be truncated in any way
* Do you agree with our proposed list of regulated activities in Annex B to be included within the scope of registration?
The list seems very comprehensive. Our concerns are more focused about the overall emphasis and detail.
* Are there any high risk services not covered?
We cannot identify any.
However, with regard to people buying their own care packages, it may be helpful for CQC to consider further their role in protection in such circumstances, without resort to regulation. It may be that there is a broader advisory role for CQC, or a means of informing people via the website about what standards they should expect when they are paying for a support service.
* Have we proposed any inappropriate registration of lower risk services?
Potentially, through the proposed expansion of the definition of personal care (see above)
* What are your views on the exclusion of non-urgent patient transport services under the “emergency and urgent care” activity topic?
No comments to make
* What are your views on the proposals for the registration of agencies who supply workers to other registered providers, under the “Personal Care” and “Nursing Care” activity topics?
We feel there is an anomaly in this proposal that only those agencies that provide nurses and care workers to people in their own homes would continue to be register as domiciliary care agencies and that employment agencies that supply workers to other registered services including domiciliary agencies will not have to be registered. The emphasis has been on safety and protection and these agencies are providing workers to provide care and support to some of the most vulnerable people albeit through a registered service therefore we believe the same rules should apply and that employment agencies should also be registered giving greater protection to people using services and the registered service providers.
* Are activities for registration described at the right level of detail, given that they will be underpinned by more specific and legally enforceable regulations?
We believe that it is difficult to answer this without first seeing the compliance criteria which will be published later
* Is there a risk of inappropriately deregulating high risk activities in this approach?
We see no indication of this
* Have we determined the right situations in which to register a manager?
We have no difficulty with the proposals in this regard
Thank you for the opportunity to comment
bob.tindall@unitedresponse.org.uk
on behalf of the Association for Supported Living