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Number of Responses
1. Around 14,000 copies were issued of the consultation paper on maximum registration fees from 1 April 2005 to a wide range of contacts. These included all registered care service providers, user groups, charities and umbrella organisations. 136 responses were received, as follows:
Local authorities | 25 |
Health bodies | 3 |
Independent sector providers | 80 |
Umbrella bodies | 10 |
Professional organisations | 4 |
Other | 2 |
Not specified | 12 |
Total | 136 |
Content of responses
2. Several of those who responded simply acknowledged receipt of the paper, or noted its contents. Once again, support was expressed across most care sectors for the role of Care Commission, the principles of good regulation,the National Care Standards and the role they have in helping to improve the quality of care services across Scotland. Most of the main issues raised in the substantive responses were the same as those raised last year. These were as follows.
3. A number of respondents continue to believe that the Commission should not be self-funded from fees and that the cost of the Commission should be met by the Executive. Some (mostly local authorities and independent care home providers) commented once again that they considered the funding to be circular and that resources to fund regulation fees were ultimately provided by the Executive through other programmes ( e.g. provision for care home fees). There was concern that these other funding programmes had not been increased to take account of the proposed fee increases.
4. Most of those responding considered the proposed increases to be excessive and pointed out they had commented in this vein in response to previous papers. The Care Commission in its own response suggested that the transition to full cost fees over 3 years was too short and that it should be made over 5 years. A number of providers of care homes for older people indicated that the problem was compounded by local authorities not paying the rate agreed by COSLA for clients they placed in independently run care homes.
Response - Ministers considered a number of options for phasing the move to full cost recovery. 3 years (of which 2005-06 is the second year) was considered reasonable in that it underlined Ministers commitment to moving to a full cost recovery regime but allowed providers time to plan (both financially and operationally) for the move. Fee levels were agreed between the Scottish Executive, COSLA and the independent care home sector. Local authorities received sufficient funds from the Scottish Executive to enable them to meet these fee levels right across Scotland.
5. There were a number of concerns about the levels of registration fees proposed for specific services. For some of the national organisations running a number of services, this was related to the fact that the Regulation of Care (Scotland) Act 2001 (the Act) requires each service, including each branch of a service, to be registered separately.
Response - This issue was raised by respondees mainly in relation to the provision of housing support services and care at home services, where the delivery arrangements are often complex and disparate. The Commission has worked closely with the sector in determining the criteria for determining a branch, which relate to the management structure of the provider. They are also considering an integrated fee regime which reflects the fact that these services are often delivered alongside each other. This arrangement applies to any situation where more than one type of service is being delivered by the same provider.
6. An increased number of respondents compared with last year, particularly those providing services for older people, considered the subsidy of early years services to be unfair.
Response - The subsidy for early years services was laid out in the Financial Memorandum associated with the Regulation of Care (Scotland) Bill when it was first introduced in the Scottish Parliament in December 2000. Subsidised fees for childcare provision is part of the Scottish Executive's Childcare Strategy. Ministers are committed to ensuring that children have the best possible start in life and the Scottish Executive supports children and their families in a range of ways of which subsidised regulation is only one.
7. Some respondents said the cost of increased fees would be passed to local authorities and that the authorities have not been funded for them, while others said that providers would pass the costs on to users or reduce services.
Response - The Minister for Health and Community Care has announced further additional investment of £94 million to enable Local Authorities to increase fees paid to independent providers for care home places from 1 April 2006. (£37 million in 2006-07 and £57 million the following year.) Local authorities offered a 2% increase in fees from 1 April 2005 out of their existing budgets. This will maintain stability in the independent care home sector and security for care service users. Additional public expenditure on the sector will have reached over £240 million between 2001-07.
Local authorities delivered £245m of services through the voluntary sector in 2002 and the trend toward third party delivery grows. To provide for an increase in the quality of service and the workforce arising from regulation by the Care Commission and the Scottish Social Service Council, provision of £10m and £13m for local authority expenditure has been made in this area in the overall GAE settlements for 2006-07 and 2007-08 This additional provision is to ensure that when contracting with the voluntary sector, there is provision for the increase in the quality of service and workforce required.
8. Some respondents were concerned that there did not appear to be any public accountability for the fees charged, or the funding currently being provided to the Care Commission by the Scottish Executive.
Response - the Care Commission is a non-departmental public body. The Commission must produce a 3 year Corporate Plan, agreed with Ministers, and publish an Annual Report which reports progress against targets set in the Corporate Plan. The Corporate Plan comprises a detailed Business Plan with targets for the coming year and outline planning for two subsequent years. The Plan can be found on the Care Commission's website. The audited Accounts published with the Annual Report lay out income and expenditure over the year.
Ministers meet the Care Commission twice per year and officials meet the Care Commission's Senior Management Team every 2 months. Among the topics discussed are progress against targets and spending against the profile agreed for the year. The Annual Report and Accounts for 2004/05 are available on the Care Commission's website as is its Corporate Plan for 2004/07.
9. Several responses questioned what was included in the fees and the quality of the service they received.
Any person who is not satisfied with the way in which the Care Commission has carried out any of its functions under the Act can make a complaint. Details of how to do this are on the Care Commission's website. A complainant who is still not satisfied after the matter has been investigated by the Care Commission may then make a complaint to the Public Sector Ombudsman.
Conclusion
10. The issues raised will be considered along with information the Care Commission is currently gathering on the activity required to regulate care services. Possible options for fee structure and charging will be considered with the Executive over the coming months. The outcome of that work will be taken into account by Ministers and will help inform the consultation on fees levels and structures for 2006-07.
SEHD - CCD2
February 2005