Passing On The Torch Of Regulation

Care Appointments caught up with the outgoing Convener of the Care Commission, Mary Hartnoll, to get her views on the performance of the organisation since its inception

Mary Hartnoll’s tenure as Convener of the Care Commission is drawing to a close. She has been in post since the Care Commission’s inception and has overseen the early years of the regulatory body’s existence.

During that time much has changed within the Scottish care sector and the Care Commission itself. We asked Mary what first attracted her to the post.

“I had retired as Director of Social Work in Glasgow in 1998 but it was the challenge of leading a brand new organisation that brought me out of retirement.”

Mary’s long and illustrious career began with her practicing as a social worker, working with children. She was later to serve for 25 years as Director in the then Grampian Council followed by two years in Strathclyde, before the reorganisation of local government boundaries saw her post move to the City of Glasgow Council until her retirement.
Was the very real need for an organisation like the Care Commission another factor in Mary’s decision to come out of retirement and take up the post as Convener?

“I had been responsible for regulation in Grampian and in Glasgow so I was always aware that regulation was needed. I’m now heading for a more permanent period of retirement!”

There are those who believe that there are too many bodies overseeing the running, regulation, registration and results of care sector organisations in Scotland, leading to a duplication of duties, an overlapping of responsibilities and a consequent wasting of resources.
This, however, is not a view that Mary subscribes to:

“The Care Commission was set up at the same time as the Scottish Social Services Council (SSSC) – I’m a member of the Council and Morag Alexander (Convener of the SSSC) is a member of the Care Commission. Consequently, we are able to ensure that there is no overlap.

“Social Work, however, overlaps onto every area of life, a good example of which is that after the recent bonfire of quangos in England, 4 super quangos were set up – social work is involved in three of them. However, the overlapping of responsibilities is something that always needs to be kept under review.”

We wondered how Mary would quantify the Care Commission’s contribution to the sector during her time in post?

“In the last 4 years we’ve been able to inform people who are being regulated of what is expected – care service providers are now much clearer on what is required of them. We have also raised people’s expectations of the standard of care they expect.

“Involving service users and their carers has been a major success for the Care Commission. Service user involvement only happened in patchy form before – a few local authorities were very good at it, but most others found it less easy to achieve and almost none of the health boards did it at all. This has been a major move forward – but the challenge is to do it even better.{mospagebreak}

“Another example of where we have made a difference is in the kind of detail: after our inspections on cleanliness and hygiene in care homes we discovered that around 10% of homes had problems in this area. By the time we inspected them again, 5% had put it right, while 5% still had some work to do. All of this was there in the inspection report.”

Increasing expectations and raising standards were recurring themes during our chat with Mary.

“Complaints have gone up and we’re pleased about that because it means that, first of all, people feel they CAN complain, which is important, and that standards are clearly going up. It’s hard now to think back and realise how diverse regulation was before the Care Commission came into being. People were very poorly informed of what to expect when they got a care service. Typically, people who are getting care services are disadvantaged at the point when they receive the service and the issue of how people can become more aware of what they ought to receive and what they are entitled to receive, irrespective of whether they are paying for it or not, is a major one. This is what the Care Commission has addressed.

“Also, we have the issue of National Care Standards. It should be easy for someone who’s going to adopt a child, or get a child adopted or work in early years childcare, to understand the standards and know what to look for when they come to choose their service. So our job hasn’t just been about raising standards but about communicating how to interpret and understand these standards.

“Of course, there is still much work to be done – parents of early years children know a lot more about standards than old people in care homes.”

And what of those working in the sector, how have they benefited?

“Our link with the Council is important here – the driving up of levels of qualifications and registration. A good example of this is residential care, once considered the ‘Cinderella’ Service, which now has a much more professional standard of qualifications, and consequently, workforce. Clearly this is closely linked with the requirement for the workforce to be regulated.”{mospagebreak}

We asked Mary what she believed to be the principle challenges for the Care Commission in the future.

“Looking to the future I don’t think people who are younger now would want traditional care homes when they get older – the likelihood is that the next generation will want something quite different and future regulators will need to develop services that match their needs. That is a real challenge.

“The challenge of the workforce not being properly trained is being addressed in almost all fields except for first-line care of older people. However, there is a lot of work and thinking going on as to how to address this, with Modern Apprenticeships being one option that will help.

“What is also very important is to tackle the issue of qualification of new people entering the sector and getting them to understand that qualifications are vital.

“Returning to the subject of care for older people, the fact we are living longer and the consequent increase in the number of older people means that people who are coming into care homes or receiving care at home are making increasing demands on that part of the sector and the majority of coal face staff there are working without much in the way of qualifications, but in many cases, a great deal of experience. The challenge is to meet the changing needs of the sector and develop the kind of innovative service people need to stay at home and for regulation to enable this to happen. We have to try to be as innovative as we can while keeping the basic safety level there.”

Of course, the search is underway for Mary’s successor, with a recruitment advertisement appearing in this very issue of Care Appointments Scotland. We asked Mary what qualities one needs to make a success of the role of Convener of the Care Commission.

“The word Leadership is the one that most comes to mind. You also need to be able to demonstrate that you have a commitment to the care sector. Importantly, you have to have the ability to lead the board of a large organisation towards achieving its objectives – in this case delivering improvement in services. The Convener is the strategic leader and is responsible for achieving what the Care Commission was set up to achieve. The new Convener will be someone who will lead the Care Commission for the next five to six years.”

In terms of priorities, what will be at the top of the next Convener’s list?

“The priorities will be to ensure that the Care Commission achieves the outcomes that service users – and their carers – want. Service users were involved in preparation of the National Care Standards and they encapsulate what people want. What is still a challenge is how you make sure that the regulation process achieves that objective.

“The issue of possible changes in regulatory responsibilities is important – there needs to be absolute clarity on what the Care Commission does in order to continue to work cooperatively with other bodies and to avoid any crossover.

“The board was set up as something entirely new – now 5 years on, another major challenge for the new Convener will be to establish what is going to take it forward.”
We wondered how Mary thought the next few years of the Care Commission’s activity might dovetail with the recommendations of 21st Century Social Work Review?

“The 21st Century Social Work Review is very much in line with current thinking so it will do nothing other than making things more straightforward in dealing with regulation. While the Care Commission doesn’t regulate social work itself, there is a big area of interface with social workers who are commissioning care services – the dovetailing has to be at that level.”{mospagebreak}

As well as recruiting for someone to fill Mary Hartnoll’s shoes as Convener, the Care Commission are also looking to appoint new Members. We asked Mary what attributes suitable candidates might have.

“All of the Members have certain common purposes – they are recruited because of their commitment to the aims of the Care Commission and to ensure good governance. The exceptions are the three members who are appointed to represent the interests of the care service users or their carers – their appointment has helped to ensure greater involvement of service users. One was in care herself in Glasgow, one became disabled when pregnant and the third was a carer who faced a number of difficulties.

“My priority has been to get a balanced board – I wanted to get people who represent service providers; people who’ve had experience of management within care service providers; people who’ve been members of a voluntary sector board as well as younger AND older people and those with experience of budgets!”

As Mary looks back on her time as Convener it’s clear that she does not regret the decision she took to come out of retirement back in 2002.

“It’s been a good experience for me – I’ve worked with a very committed board and a very committed staff team. Now someone has to come in and say ‘what are the outcomes?’”