Review of care service definitions: challenges and recommendations

Findings from the review of care service definitions independent research project commissioned by the Scottish Government.


6. Implications of changing definitions

Stakeholders commented on the risks of changing the definitions. Insight into these areas was more general and speculative; they often did not reflect specific changes but expressed certain worries in the sector, especially surrounding regulation, workers' rights, and how any changes might affect the flexibility of the sector.

Key themes in this section focus on the impact of recommendations on service provision, care quality and assurance, attitudes, workers (regulated and unregulated) and people accessing support.

6.1 Restricting service provision

Dangers of overprescribing

Stakeholders felt that a risk of changing the definitions would be that of over prescribing which would then impact services by reducing flexibility. Coalition of Carers argued that the danger of defining things too narrowly affects both what gets funded but also how things are funded and it can lead to inflexibility for those accessing services. An example given was of carers support and what is deemed a short break. The focus should be on individuals' needs and on allowing them the choice to do things creatively.

PA representatives also highlight that for many disability campaigners who advocated for freedom and choice over the services they use, over regulating the definitions would lead to individuals feeling a step back had been taken and a sense of restricting what they could provide.

Regulation: care quality and assurance

Stakeholders recognised that changing the definitions would significantly impact regulation of services and workers. IJB representatives highlighted that any legislative changes have implications for care assurance, and all local authorities have established strategic and operational care assurance processes which would need to adapt to the new changes.

SOSCN highlighted that one way to regulate the current unregulated sector would be to set a minimum standard in an alternative way to the current model of registration. This could then impact those accessing services to be able to make informed decisions about the quality of care and standards of each provider: 'it might mean that they have to have evidence of X, Y, Z level of basic training on the UNCRC child protection'.

Similarly, CCPS also considered the English model of voluntary registration, but argued this would need resource consideration. The Care Inspectorate expressed concerns however, that a 'regulation light' option would come with 'assurance light' too and expectations around this would need to be carefully managed. Union representatives, similarly, were concerned about the regulatory implications of changing legislation particularly regarding the ability of any organisations to enforce the legislation and ensure that the rules are respected and the challenges of self-regulation.

The Care Inspectorate warned against having generic definitions that could lead to complex regulatory documents to support them. They argued for legitimising expectations as a regulator, so that those providing the service would know what it was that they were expected to do. Another possible implication of generic definitions would be that information provided to local and national government by the Care Inspectorate for research and analytical purposes might be diluted if granularity was lost through broader definitions.

IJB representatives also highlighted the potential risk the changes could have to providers, as the definitions expand their coverage this could further put financial strains on organisations needing to adapt their operations to the new regulations. Similarly, several stakeholders highlighted that regulating activities like summer sports clubs and family childminders would trigger onerous obligations for providers around policies, procedures, staff qualifications and care planning.

Moreover, SSSC expressed concern about potential implications for overlap with the Care Inspectorate and blurring of boundaries between service regulation and workforce regulation, particularly if SSSC began to register roles which are not working in a service regulated by the Care Inspectorate.

Changes to attitudes and perceptions

Some stakeholders, especially providers, highlighted that the definitions could have positive implications on how people currently perceive services. This was specifically important for services like secure care. The five heads of secure care services that were interviewed argued that making the definitions more centred on the element of wellbeing might help counter some of the stigma that those using the services feel: by adding emphasis on care and wellbeing, as opposed to punishment and consequence.

Similarly for the childminding definition, stakeholders argued that adding 'registered' to the term 'childminder' in the definition could add legitimacy and tackle negative perceptions of childminding as a lesser, more informal way of providing care to children.

Perceptions of staff and people accessing support were highlighted as important to address, particularly around the experience of moving between definitions. One stakeholder described the 'hoops of regulation' and that tipping into 'a slightly different regulatory basket... doesn't make sense to people'.

The point was also made about potential changes to the attitude of the public towards regulation. Current regulation and inspection processes were seen to provide public and political assurance which might need to be reconsidered if the definitions and regulatory frameworks were to shift.

6.2 Implications for workers

Regulated workforce

Scottish Care argued that the definitions should allow more flexibility among social care workers: if 'the descriptions are an illustration of practice' then that practice needs to be 'freed up to enable the workforce to be much more dynamic in both its description and its scope of practice'. A possible risk of this might be 'muddying the key skills of a care worker' and a lack of clarity around the distinctiveness of the role, though this risk would need to be balanced against the benefits of increased flexibility and autonomy.

SSSC suggested that broader definitions could have a positive impact on developing qualifications by allowing for alternatives like 'a hybrid qualification that allows people to work across healthcare and social service settings' or 'an apprenticeship that allows for work across children and adult services'.

Unison also discussed the challenge of how a wider definition would fit a wider group of jobs which would help with the current issue of compartmentalisation. They considered how this might lead to an increase of workers registering with SSSC which could positively impact quality of care. On the other hand, they warned against low paid workers being exposed to an overarching regulatory 'machinery' and having to pay more fees which could act as a deterrent to working in the sector. A widely held concern across stakeholders was the operational pressure an increase of worker registration would put on regulatory bodies and their lack of capacity for this at present.

Some also cautioned against current practices where providers go around the registration requirements of legislation to create roles which might not always be subject to regulation. Stakeholders were concerned that whatever revisions are made to legislation can impact upon employment terms and conditions and wages which ultimately has an impact upon the quality and delivery of service. Some cautioned against the consequences, including those unintended, of such changes.

Unregulated workforce

Stakeholders outlined several impacts on the unregulated workforce of changes to definitions, both positive and negative. On the positive side, registration could mean increased access to training and support and, overall, a more skilled workforce. However, requirements around regulation, fees and qualifications might put people off working in the sector, negatively impacting recruitment and retention.

6.3 Implications for people accessing care & support

Some touched on the positive implications of extending the definitions to include areas that are not currently regulated when it comes to those who access care and support. NDNA indicated that if there was a new definition of day care for school age childcare, this could then mean that parents – especially parents of children with disabilities, could access childcare tax credits, because eligibility is linked to the organisation being regulated under this definition of day care. So if it was broadened, or expanded or changed to include this, that could also give parents more choices about childcare and help with the costs of it.

Several stakeholders argued that while those using services might experience little impact in terms of awareness and knowledge of the definitions, they might be impacted in terms of the flexibility of the worker to meet their needs.

PA representatives highlighted that changing the definitions to include a broader range of issues like addiction services and mental health support could have positive impacts on those 'marginalised communities' accessing services by making a wider range of options available to them.

Similarly heads of secure care argued that changing the wording for secure care could help young people achieve better outcomes and not feel as stigmatised. If the language used was more focused on nurturing and caring elements of secure care as opposed to punishment it might help to shift the focus onto recovery and being safe: 'for the young people themselves who use the service… to make it sound a bit more human.' Stakeholders felt that changes to the current definitions would allow services to deliver better person-centred care with a higher degree of flexibility. Thus, when considering how those receiving support would be impacted by the changes, stakeholders reflected on a range of positive implications rather than risks. However, the opposite was the case for social care workers or providers, alluding to the wider tension in the sector between achieving positive outcomes for people and the operational challenges that come with regulation. Stakeholders had a range of concerns regarding the operational challenges of changing legislation on areas like registration, the potential future burden of increased regulation, and the impact on workers. These challenges, however, would also impact those accessing services – e.g. if providers and workers are dis-incentivised to operate by an increase in levels of regulation this could also lead to less choice of providers. The risks and implications for those needing support are intertwined with all areas of the sector which could require a transformative change.

Contact

Email: nicola.forrest@gov.scot

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