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We only need one regulator

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As we await the social care plan from the government, the debate about how any such plan should be funded continues. One of the biggest areas for providers has always been the overlap in roles of the ‘three amigos’: the NHS, local authorities, and the regulator, the Care Quality Commission (CQC). Indeed, in their role as commissioners of the current services, the first two amigos, the NHS – in the form of local clinical commissioning groups (CCGs) – and local authorities, now seek more information, monitoring and ad hoc policies than the regulator!

These two amigos also seek information in many different formats and different timescales, as well as interpreting monitoring differently. This leads to an endless myriad of overlapping forms, surveys and guidance, all in the name of social care.

According to the Institute for Government, there are 343 local authorities in England – all of which are very much doing their own thing, in their own way. Even after some mergers, there are also 106 CCGs. And each one of these 449 different entities has their own independent systems, guidance, service specifications, jargon… It’s a staggering administrative structure for small- to medium-sized social care providers to get to grips with. No surprise that contractual arrangements can run to reams of pages for those providing services to more than one local authority or CCG.

In contrast, their compatriot, the CQC, has clearly set out its standards, regulations and guidance, which all providers are able to follow.

The upsurge in guidance, constant changes from local authorities and their never-ending requests for statistical information – not to mention their ‘nil returns’ edicts – are simply detrimental in their scale to providers. In reshaping social care, the government should therefore seek to redefine the role and funding of those who commission services to reduce paperwork and bureaucracy, the sheer quantity of which is stymying the delivery of fair and equal access to social care.

Put simply: the government needs to reign in local authorities and the CCGs, which are increasingly seeking to act as regulators in their own right, despite the fact that the sector already has its own well-established regulatory framework overseen by the CQC. It the job of the CQC to determine and uphold the quality of care. By trespassing into their amigo’s backyard, local authorities and CCGs are adding layers of duplication to an already complex system. This simply wastes time and money the service providers (and the local authorities and CCGs themselves) don’t have.

The CQC rates providers. This should be good enough for both local authorities and CCGs. If government is serious of making social care fit for purpose, this is where it needs to start. It’s time to uncover providers from where they are buried amid the many strata of paperwork and allow them to do what they are trained to do! Then, perhaps, we may achieve a system that provides fair and equal access to social care for all who need it.

Under proposals put forward in the Health and Care Bill 2021, currently working its way through the Houses of Parliament, CCGs will be replaced by local “place-based” integrated care systems (ICS), which will take on functions from NHS England’s commissioning role and which will receive a single pot budget merged from the previous financial budget structure. The board of the new ICS bodies will include representatives of NHS trusts, local authorities and general practice and “others determined at local level”.

Very little is defined in the proposals, with no duty on the government to provide identified key services to everyone in England. We still await the social care funding proposals promised by the prime minister on his entry to Downing Street.

Parliament is back from summer recess shortly and rumours abound that social care funding proposals will soon be unveiled to the waiting public – but we have been here before and the waiting game is not yet over. Recent underspends on projected public sector spending may provide the chancellor some headroom; with winter pressures building on the NHS and waiting lists rising, it may however come down to a choice between the NHS and social care budgets.

The CQC has also launched a new strategy for regulation to improve care for everyone, designed to lead to a more flexible and responsive regulatory system. Let’s hope its amigos at the NHS and local authorities are listening and learning too.

However the new commissioning and regulatory frameworks work out in practice, W&P will continue to ride the waves of change to offer up-to-date advice and services to care providers. For more information on we can help, visit our website or contact us on: 01305 767104.

 

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