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

The Independent Review of Inspection, Scrutiny and Regulation (IRISR) of social care support in Scotland: recommendation report provided by Dame Sue Bruce. The IRISR explored how social care support and linked services are inspected, scrutinised and regulated in Scotland.

14. Recommendations

1. It is recommended that inspection, scrutiny, and regulatory bodies consistently apply a human rights-based approach that places people at the centre of the process.

2. It is recommended that matters of trust, respect, relationships, ethos and culture be placed at the heart of inspection, scrutiny, and regulation and should be reflected in reports.

3. It is recommended that inspection, scrutiny, and regulatory bodies must set out clearly in their annual report how they have led and cultivated a culture of openness and trust.

4. It is recommended that inspection, scrutiny, and regulatory bodies make appropriate arrangements to engage people with lived and living experience in co-designing engagement tools and developing the inspection and regulatory frameworks.

5. It is recommended that a system be put in place for people to have a formal role as lay inspectors in the process of inspection, scrutiny, and regulation, including young people with care experience. An appropriate level of renumeration should be made available.

6. It is recommended that inspection bodies’ approach to engagement must be flexible, inclusive and appropriate. This includes allowing sufficient time for responses to be made and making suitable arrangements for conversations to take place with individuals, family members and staff, ensuring consistency and accessible information is available.

7. It is recommended that independent advocacy is available for people to help them to exercise their rights, and when necessary, to provide support to navigate complaints and any escalation processes.

8. It is recommended that a co-produced and bespoke scheme of registration for Personal Assistants (PAs) which recognises their skills and role, and opens up access to training and development, should be developed. Such a scheme would expressly seek not to create barriers, and through co- production, would create positive opportunities for both the Personal Assistant and their employer.

9. It is recommended that there should be a universal requirement to obtain registration with a regulatory body for all social care support staff appropriate to their role and setting, and that this should be a condition upon joining the social care workforce.

10. It is recommended that inspection, scrutiny, and regulation should be extended to areas not part of the current system, including agencies who provide social care staff, to help drive continuous improvement and deliver better outcomes.

11. It is recommended that further development of stronger links between regulatory bodies across all areas within and out with the borders of Scotland should be established to ensure better regulation, transparency and accountability of providers of social care support services.

12. It is recommended that the best practice from other nations' regulatory landscape is explored and considered with a view to enhancing transparency and accountability, particularly in relation to there being a named, accountable link to registration, inspection and local employees.

13. It is recommended that The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 be reviewed to ensure consistent, effective and comprehensive applicability of the fit and proper person provisions across social care support services in Scotland.

14. It is recommended that Scottish Ministers make appropriate arrangements for market oversight and sustainability in the social care sector.

15. It is recommended that the list of care service types and set of corresponding definitions as set out in Schedule 12 of the Public Services Reform (Scotland) Act 2010, are assessed for fitness for purpose.

16. It is recommended that inspection, scrutiny, and regulation processes more fully take account of an individual’s experience of service delivery and their overall care journey to understand, follow and evaluate the person’s social care support experience over time and their impacts.

17. It is recommended that clear and accessible information about the agencies and their roles, responsibilities and accountabilities is provided for all those who require social care support services.

18. It is recommended that Scottish Government work with the regulators to clarify roles and responsibilities between organisations to streamline inspection activity, remove repeat inspections by different agencies and to reduce duplication and omission. This should include reviewing how joint inspections are currently carried out, encouraging more partnership working and joint inspections, and greater involvement of people in receipt of social care support in inspection, scrutiny, and regulation.

19. It is recommended that inspectors and regulators, whilst fulfilling their statutory duty to identify shortcomings in improvement, should also place equal weight on identifying good practice, innovation and improvement across the sector.

20. It is recommended that an emphasis on outcomes and continuous improvement becomes a central focus of inspection, scrutiny, and regulation.

21. It is recommended that there should be a duty on the regulator/inspector to work more closely with the provider on agreeing action plans and timescales for continuous improvement recommendations that are additional to regulatory requirements and improvement notices.

22. It is recommended that the Scottish Government updates and clarifies its expectations regarding the National Performance Framework (NPF) in relation to publicly funded delivery bodies, particularly with respect to outcomes for social care support services.

23. It is recommended that Scottish Ministers should review legislation to ensure that regulatory bodies have adequate enforcement powers.

24. It is recommended that a duty to self-report should be reviewed to ensure that self-reporting is inherently linked to continuous improvement, whilst also ensuring the regulatory bodies have appropriate powers to act when issues are identified.

25. It is recommended that there is clear and accessible public information about how to raise a concern and systems of complaints. Those systems of complaints should be easy to use, have accessible detail about routes of escalation with clearly defined outcomes that can include redress for people.

26. It is recommended that the Scottish Government should make arrangements to ensure appropriate oversight of regulatory provision of social care support and consider whether there should be separate arrangements put in place for Scotland, in this respect.

27. It is recommended that qualitative measures should be co-designed by the regulatory agencies and people with lived and living experience to ensure that they include elements of services that are important to people.

28. It is recommended that the sharing of data is examined, with the people at the centre of the process having access to their own data in formats that facilitate their understanding of it in order to support decision making and their involvement in this. This data should also be utilised for service planning and improvement, both strategic and operational.

29. It is recommended that data is utilised for social care planning and individuals, and their advocates have access to this to inform their choices.

30. It is recommended that there is a ‘duty to co-operate’ placed upon service providers to share data appropriately and equally upon regulatory bodies to work together to avoid duplication in their requests for information.

31. It is recommended that the type of data collected, and its purpose, is reviewed to ensure that the right data is collected for the right reasons, with a focus on data supporting performance management and service improvement.

32. It is recommended that a more tailored and contextualised approach is developed to how GDPR is used and interpreted within the regulatory landscape. It is also recommended that an Information Governance (IG) group is established to support the effective and proper use of information and engagement with IG experts.

33. It is recommended that a review of the Health and Social Care Standards takes place to ensure they are based on human rights, ethical commissioning and are outcomes focused. The Standards should be the basis on which social care support services are inspected, scrutinised and regulated.

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.

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.

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.

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

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.



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