Gap in regulation of care services putting vulnerable people at risk

Concerns about the lack of quality assurance and regulation of certain social care services including ‘supported living environments’, day care centres and care support provided in people’s own homes have been escalated to us by local Healthwatch from around the country in recent months.

Where these services do not provide personal care, i.e. helping people wash and dress themselves, there is currently no requirement for them to be registered by the Care Quality Commission or direct oversight by the local authority unless there is the safeguarding issue. We know that local authorities are frustrated that these providers often fall outside of the potential action they can take to protect vulnerable adults. Yet, the care provided by these services often strays into providing higher levels of support, particularly as people’s needs increase over time.

These services are mostly used by people with mental health issues, severe learning disabilities and the elderly. This means they are often vulnerable and are unable to speak up if things go wrong.

We understand from our conversations with both the CQC and a number of local authorities that they share our concerns in this area, particularly as use of these sorts of services is likely to grow over time with people taking more responsibility for choosing their own care support through initiatives like direct payments.

While we recognise that supported living and personal budgets are making an important contribution to giving people more choice and control over their lives, it is crucial that respect for people’s autonomy is balanced with quality assurance and safe care and support.

We wrote to the Department of Health to formally raise our concerns that:

• Users of these non-regulated services (including self-funded and personal budget holders) have no means to make an informed choice of service based on quality and have no way of raising concerns about the quality of services they receive
• Safeguarding mechanisms (including under the Care Act 2014) do not always cover these services impacting on the safety of all service users – in particular vulnerable users

Given the risks to those currently receiving such care and support, we asked the Department of Health what proposals they have for addressing this gap in regulation and to help keep people safe and when we can expect action to be taken. The response from Jon Rouse, Director General of Social Care, Local Government and Care Partnerships, loosely outlines some of the work that the Department of Health are leading on to address these concerns.

We are now calling on local councils in England to get in touch with their local Healthwatch if they have concerns over regulation in these areas, so that we can continue to gather evidence and work with the new government to ensure appropriate measures are put in place to address this issue.