Contact: Andrew Brooker Ext: 7281 email: [email protected]

1.1 The Department of Health is undertaking a wider review of regulation of health and social care. It states that it will look at function before form and will include, but not be limited to, the remit of the Healthcare Commission, the Commission for Social Care Inspection, the Mental Health Act Commission, Monitor and the health functions of the Audit Commission.

1.2 The review will not include bodies solely responsible for individual professional self-regulation.

1.3 The terms of reference will be

· To define the objectives for regulation and inspection in health and social care

· To examine the functions needed to achieve these objectives

· To review experience here, in other sectors and abroad to identify predictors of success for added value from regulatory systems

· To identify where changes might have the greatest impact on frontline staff, and improve the assurances for users and the general public

· To put forward proposals for the form in which these functions can be discharged

1.4 The Department of Health has identified a number of key issues on which it would like feedback. These are set out in Section 3, along with Hampshire County Council's responses.

1.5 The wider review will be carried out by the Department of Health from September 2005, reporting to ministers by Christmas 2005.

3. Key issues

The Department of Health has asked for feedback on the following key issues, which are written in italics. The response from Adult Services follows each question.

3.1 What role can regulation play in achieving the Government's objectives for health and social care?

Regulation can contribute to the protection of service users and minimise risk. It can also contribute to national standards by helping to improve services. It should focus on dignity, quality and the best possible outcomes for individuals.

3.2 What are the key issues you believe need to be addressed through the review?

To establish what functions are needed for a comprehensive regulatory function and how they can be best arranged. To ensure that the proposals are cost-effective but robust and cover all risk, not just what is perceived as high risk. To ensure that inspection criteria take account of outcomes.

3.3 In your view, what should be the main purposes of regulation and inspection? What are the appropriate success criteria and critical factors to ensuring both effective and proportionate regulation and inspection?

The main purposes are driving up and maintaining standards and protecting service users, focusing on dignity and quality.

3.4 In your view, what are the strengths and weaknesses of the current systems of regulation and inspection in health and social care? Are there lessons to be learnt from the regulation of other UK sectors or from other international health and social care sectors?

The strength of the current system is its comprehensiveness. The weakness is that there is little flexibility. Lessons can be learnt from other sectors as long as they are viewed in the context of the UK health and social care sector.

3.5 What steps can the Department of Health and regulators take to reduce the overall burden of regulation and inspection on organisations and staff providing frontline services, without compromising the safety or wellbeing of patients or users, the quality and efficiency of services or the Government's 10 principles of inspection?

Any steps would have to be taken extremely carefully and after a thorough risk assessment. The document states that inspection needs to be proportionate to risk but how will that be established? How does one know that service providers will continue to provide a good quality service if their inspections are less frequent? How does one maintain the user perspective? There is also the point that quality providers often see inspections as an independent quality check, rather than a burden.

3.6 In the light of anticipated changes in the health and social care systems, what regulatory functions need to be undertaken? Which of these functions do you believe sit best with independent regulatory or inspection bodies?

Regular inspections of care homes and care agencies need to take place by independent regulatory or inspection bodies. There also needs to be a discussion about what further areas need to be covered and what areas do not. One example of this is day services.

3.7 Which organisational model and what statutory powers do you believe would most effectively discharge those functions and achieve the best outcomes in terms of costs and benefits? How might stakeholders (eg patients, public, professionals) be involved in the regulatory process? How do we ensure that the regulatory system is able to cope with continuing change in health and social care?

A user perspective is very important, focusing on what matters to them, and greater significance should be given to this. There should be a focus on outcomes. There should be scope for relatives to give feedback. The annual quality assurance assessment by providers would be useful as long as it is looked at independently. Improvement plans will also be useful as long as they are adequately monitored.

3.8 How should the regulatory framework for health and social care best fit with others in the public sector, in particular, local government?

Regulatory functions should complement each other and not overlap. The remit of each framework should be clear.

4. Other issues

4.1 The review should strike a balance between ensuring value for money is ensured in the regulatory system, and ensuring that the proposals are adequately resourced. A lighter touch system that did not have adequate resourcing to support it when needed would not be acceptable.

5. Timescales

5.1 Hampshire County Council's response has to be with the Department of Health by 15 November. Any further comments that are made at Policy and Resources Committee will be sent to the Department of Health separately.

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1 Published works

2 Documents which disclose exempt or confidential information as defined in the Act

None