Social care regulators north and south of the border

England and Scotland have differing approaches to regulating social care and their own plans for improving operations

Just as England’s healthcare regulator, the Care Quality Commission (CQC), launched its recent consultation changes in its regulatory model, the Scottish government announced that all care homes in Scotland will now be subject to an unannounced inspection at least once a year.

Both countries have stated their intent to tighten up their operations, but what can England learn from the Scottish model and vice versa?


Heavy criticisms of the CQC, most recently for failing to detect malpractice at the private Winterbourne View hospital for people with learning disabilities, have prompted plans to simplify and strengthen its regulatory model.

The organisation, which regulates more than 50,000 healthcare and adult social care services in England, launched a three month consultation in September on proposed changes in its judgement framework and enforcement policy.

The key changes would include: identifying areas of non-compliance rather than focusing on compliance; assessing the level of concerns after the judgement about non-compliance; and creating a more transparent enforcement process with an ‘enforcement escalator’ to ensure providers achieve compliance.

The CQC also told Guardian Social Care that it will continue to carry out a mixture of planned and unannounced inspections, and that the number, which totalled 7,350 in 2010-11, is likely to rise as it leaves its “transitional period”. It began operating in April 2009.

It will aim to inspect acute hospitals and care homes every year, rather than once every two years as now. This would involve more targeted inspections taking into account the nature of the care provided and the level of information the CQC has about the service and risks to people. The commission has said that inspections will be unannounced unless there is very good reason to notify an organisation about its intentions.

This approach is likely to be widely welcomed and could help the commission shake off accusations that it has failed to act on information received on organisations.

Its job may also be helped by the government’s pledge of £7.2bn extra funding to local authorities over the next four years to help cope with the growing demand for services for vulnerable people. But its consultation document includes a caveat that “expectation of regulations must be realistic”.

“Every part of the system – from providers, to commissioners, to professional regulators – has a duty to make sure that poor care is identified and addressed,” it adds.


The Scottish government announced last month that all care homes will be subject to an unannounced inspection at least once a year under regulations to be introduced to parliament. This is intended to ensure that standards and quality of care do not deteriorate between inspections.

Inspectors at Scotland’s regulator of adult and children’s services, Social Care and Social Work Improvement Scotland, known as the Care Inspectorate, will also be able to increase the number of times they visit a care home over a year if they become concerned about performance. The government has pledged to put in place “the necessary resources” to support the additional inspections and to enable the Care Inspectorate to maintain current staffing levels.

Under the current model in Scotland, all high performing care home services with a low risk assessment are subject to at least one unannounced inspection every 24 months. If a care service does not fall within this category or has a high risk assessment, it receives at least two unannounced inspections every year. The proposed changes would see all care homes receive at least one unannounced inspection annually.

When announcing the plans, Nicola Sturgeon, Scotland’s health secretary, said: “I believe that in general care services in Scotland are of a good quality and respond well to the needs of both older people and the people who care for them. I also believe that the arrangements in place for the regulation and inspection of care homes are fundamentally robust.

“However, I have also been clear that there are aspects of the care regime in Scotland that are worth further consideration.”

Sturgeon has been vocal about her dislike of England’s approach to health and social care, particularly the coalition’s NHS reforms.

Over the past year Scotland has invested heavily in health and social care services, including spending on telehealth and the recently launched National Dementia Strategy, which will be backed by funding of more than £500,000 this year.