National Care Standards Commission Regulations 2001

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Jacqui Smith: I thank the hon. Gentleman for his support for the overall purpose of the new regulatory framework. That confirms what I said at the beginning—that there has been little dispute about the principles.

The hon. Gentleman asked, first, whether the commission would assist with the planning of capacity. It will provide advice to the Government and will report back on standards and on the state of the various sectors that it inspects and regulates. Therefore, it will play an important role in helping the Government and local health and social care economists to consider the capacity that is needed, the changes that are taking place, both good and, in some cases, less good, and the way to respond.

The hon. Gentleman also asked whether information would be available on inspections. The NCSC will enable much more public access to information about inspections, so that general and specific information about quality is available. Whether that will be more appropriately put on the web or elsewhere is a more detailed question for the commission administrators, but they will certainly want to be aware of the most appropriate forms of communication.

The hon. Gentleman asked how we would ensure that requirements for staffing levels were met. The Government decided, rightly I think, not to include fixed staffing ratios in the national minimum standards, because they believed that providers should have the flexibility to determine the appropriate balance of staff in relation to users' needs. The Government will also consider how we

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can provide guidance on the appropriate staffing levels.

Mr. Burstow: That was a widely welcomed change, but, given that that standard specifically refers to assessments of users' needs, will the single assessment procedure being introduced by the Department be the one to which that standard refers and what will be the time scale for implementing that new process? In other words, in assessing staffing levels at the start, will we be relying on out-of-date assessments?

Jacqui Smith: An assessment of service users' needs will depend not only on individual assessments of those needs, which, in the case of older people, may appropriately be done through the single assessment process. It will also depend on the nature of the range of users and the number of types of users in a certain home or with a certain provider.

The assessment of services is expected to be kept under regular review. Standard 7 requires a service user plan to be available to meet the specific needs of each service user and to be reviewed once a month to reflect changing needs. That will be linked to regular assessments and will form the basis of the guidance that I mentioned earlier and of analysis by inspectors of the extent to which the staffing in any home reflects users' needs.

The hon. Gentleman also raised the important question of how to ensure that we put service users at the centre of provision. Standard 33 of the standards for care homes for older people is important. It will ensure that quality assurance and monitoring systems are based on the views of service users. Homes should publish and make available service users' surveys and feedback should actively be sought. That will be linked, in the case of services commissioned by local authorities and social services departments, to the increasing requirements in performance management assessment. Performance indicators and other measures should include an assessment of service users' needs as an important indicator of the performance of social services departments.

Mr. Burstow: Certainly, those standards as they apply to the providers are very welcome. Will similar standards apply to the commission itself, in terms of the way in which it consults on operational matters and complaints about the way in which it has discharged its duties? How will such complaints be followed through?

Jacqui Smith: The hon. Gentleman is right in that it will not be the commission's role to assess service users' needs in relation to the care provided, except inasmuch as that impinges on inspection, regulation and standards. That is the role of commissioners or providers of services. However, it will be important for the commission to ensure that the voice of users is represented in the way in which it is organised and carries out inspections. The objective is clear, but the board and the NCSC must consider the most appropriate way of achieving it.

The hon. Member for Sutton and Cheam (Mr. Burstow) also mentioned the frequency of inspections. The regulations set out a minimum frequency of inspections, but the 2000 Act provides

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that a person authorised by the commission may enter and inspect premises at any time, and I believe that that can be announced or unannounced. The commission is resourced to carry out inspections more frequently than the minimum if necessary, so that it can carry out adequate inspection where there are concerns about users' safety.

The hon. Gentleman also mentioned over-medication. That is partially addressed by the standards for care homes for older people, which recognise the need for policies and standards surrounding medication. The Department has provided a budget for the NCSC that assumes that it will have 66 full-time equivalent pharmacists. The commission is currently discussing with pharmacists how to resource that function and how to achieve the right balance of directly employed pharmacists, freelancers, and those under contract with health trusts. The precise numbers are, therefore, not yet finalised.

On long-term funding, I made it clear in response to the hon. Member for North-East Hertfordshire that the Government's objective was a self-financing system, but that we were undertaking it in a phased way precisely because we recognised the need to ensure that the regulatory process was proper and effective and did not undermine providers' capacity. Additional resources of £38 million are available to provide permanent support for the NCSC's functions.

The hon. Member for Sutton and Cheam also asked about the regulatory impact assessment and the issues surrounding cost. The RIA concentrated on the key issues affecting cost—for example, environmental standards—and additional costs. Respondents to the consultation were asked to provide data, if available. Few of the 500 responses to the consultation provided a concrete response and of those that did, none offered significant additional information on costs over and above those that the Government had assumed for environmental standards. The costs of the registration regulatory framework, separate from the implementation of standards, are minimal. They are already covered by extra support to local authorities and health authorities to compensate for higher commissioning costs and will result in benefits for providers.

Mr. Burstow: I, too, have read those parts of the regulatory impact assessment. Has any consideration been given to the fact that the Government's argument is that the 150 local authorities and 80 or so health authorities have been inconsistent in the way in which they discharge their 1984 responsibilities, so there will be differences? Ironing out those differences will necessitate extra costs for a period, but seems not to have been reflected in the regulatory impact assessment.

Jacqui Smith: That is partly because little evidence was provided during the consultation. Nevertheless, we are also looking for improvement in quality. Not surprisingly, the Liberal Democrats believe that the extra investment is insufficient, but one of the reasons why the Government are increasing resources to personal social services in particular and to health authorities in relation to the commissioning of care

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and fee levels is to ensure that we maintain and promote good service and high quality.

I hope that I have been able to reassure hon. Members that providers of good quality care have everything to gain and nothing to fear from the introduction of the new regulatory system and that users and patients have everything to gain from the improvements in standards that will come from the more consistent approach that will be created.

5.42 pm

Mr. Heald: In considering the regulations, all parties have wanted an increase in standards and quality of premises covered by the National Care Standards Commission. We hope that this series of regulations will have a light enough touch to provide a plentiful supply of good quality places in care homes. It is not correct to say, as the hon. Member for Sutton and Cheam, who speaks for the Liberal Democrats, said, that we seek to represent the interests of providers and care home owners. We want to consider the matter from the point of view of patients and to find the areas where there is mutual interest.

Some of the issues that we raised have brought useful replies from the Minister, but not all. The Minister was vague about the transitional arrangements for checks on criminal records. She said that there would have to be transitional arrangements, but she could not say how they would be promulgated or what they would be. That is crucial for patients as well as care home owners. It is clearly right that staff should be properly checked, and care home owners will be under an obligation in criminal

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law to do so. Yet we are simply told that arrangements are not yet in place and that something will have to be done; we are not even told how.

The financial burdens on care home owners of having to maintain documentation up to date is a substantial burden. However, as the hon. Member for Sutton and Cheam, who speaks for the Liberal Democrats, said, the Care Standards Commission may not have enough staff to enforce and inspect records rigorously. That would be daft, because we would end up with a system in which small businesses bore the burden of maintaining records when the Government had not provided the staff to check them. That would be the worst of both worlds—inadequate inspection and a great burden imposed. I do not think that those who are concerned about residential special schools would be happy with the answer.

The issues are inter-related and complex, and there will be a second round of discussions tomorrow in another Delegated Legislation Committee. Sadly for me, my hon. Friend the Member for West Chelmsford (Mr. Burns), will lead for the Opposition on his return. I shall certainly report to him that our discussion today was not entirely satisfactory. However, it is not necessary to divide the Committee.

Question put and agreed to.


    That the Committee has considered the National Care Standards Commission (Registration) Regulations 2001 (S.I. 2001, No. 3969).


    That the Committee has considered the National Care Standards Commission (Fees and Frequency of Inspections) Regulations 2001 (S.I. 2001, No. 3980).—[Mr. Heald.]

Committee rose at fourteen minutes to Six o'clock.

The following Members attended the Committee:
Butterfill, Mr. John (Chairman)
Burstow, Mr.
Cameron, Mr.
Chapman, Sir Sydney
Cunningham, Dr. Jack
Etherington, Mr.
Fitzpatrick, Jim
Heald, Mr.
Smith, Jacqui
Smyth, Rev. Martin
Steinberg, Mr.
Stewart, Mr. David
Vaz, Mr.
Ward, Ms.
Wilshire, Mr.

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Prepared 29 January 2002