Part 6: New scrutiny landscape & bodies - HIS and SCSWIS
6.1 It should be noted that the new scrutiny landscape and bodies, as described in this Part, are being created under the Public Services (Scotland) Bill. That Bill was introduced in May and is still subject to the approval of the Scottish Parliament following its passage through the Parliamentary processes. The Bill may be subject to amendment as it goes through Parliament. This Part discusses the functions and roles of the new bodies as provided for in the Bill at its introduction.
Background
6.2 Crerar had recommended five guiding principles for external scrutiny: public focus, independence, proportionality, transparency and accountability, which were endorsed by both the Scottish Parliament and the Scottish Government.
6.3 Crerar also considered that scrutiny should support self-assessment and that, in time as the level of scrutiny required reduced, there could be one scrutiny body for healthcare, social care, social work services and education. It was thought to be too soon by the Scottish Government to move to a single external scrutiny body for these services, and so the Public Services Reform (Scotland) Bill (" PSR Bill") makes provision for two new scrutiny bodies: one for healthcare ( HIS), one for social care and social work ( SCSWIS). HMIE continues for education, in modified form. All three bodies will be non-departmental public bodies ( NDPBs).
6.4 It is HIS (Healthcare Improvement Scotland) and SCSWIS (Social Care and Social Work Improvement Scotland) with which this Part is concerned as regards their future role and relationship with the MWCS:
- SCSWIS will be the national body for the improvement and scrutiny of local authority social work services and registered care services. It takes on the existing functions of the Social Work Inspection Agency, and those of the Care Commission in relation to regulation of registered care services (excluding independent healthcare services); and some functions in relation to integrated children's services from Her Majesty's Inspectorate of Education ( HMIE);
- HIS will be a health body and will be the national body for the improvement and scrutiny of all registered independent healthcare services and the NHS in Scotland. It takes on the current functions of NHSQIS along with the regulation of independent healthcare, currently the responsibility of the Care Commission.
SCSWIS - aims and functions
6.5 The aim of SCSWIS will be to scrutinise the provision of social care and support services in Scotland and the local authorities' delivery of social work functions. It will scrutinise the local authorities' strategic social work functions through service delivery to the outcomes achieved for individuals.
6.6 To deliver these aims SCSWIS will have core functions of:
- regulation (that is, registration and inspection) of care services , and
- inspection of social work services.
6.7 SCSWIS, at the request of Scottish Ministers, will be able to carry out inspections of all social services (including social work services and related children's services). They will be able to inspect across a range of services or by theme to look at for example, services for older people and for adults and children with learning disabilities. SCSWIS will be able to undertake such inspections in a more integrated and cohesive manner, and involving where appropriate other scrutiny and regulatory bodies, such as HIS, HMIE, Audit Scotland and the Housing Regulator, helping to ensure the quality of service to groups of users across the whole of their care pathway.
HIS - aims and functions
6.8 HIS's aims will be improving the quality of healthcare through supporting NHS Boards and independent healthcare providers in improving patient care, by bringing together the provisions of advice, and guidance, support for implementation and improvement and assessment, monitoring and reporting.
6.9 To deliver these aims, HIS will have the following functions:
- driving and supporting implementation of improvements in quality of healthcare across all sectors
- assessing the performance of the NHS and independent healthcare providers, reporting and publishing findings
- providing independent healthcare providers with a licence to operate and taking enforcement action when necessary standards are not achieved
- inspecting the healthcare environment regime
- providing advice and guidance on effective clinical practice
- facilitating improvements in patient safety
- clinical governance
- supporting, ensuring, monitoring NHS Boards in their duty of encouraging public involvement and promoting equal opportunities.
HIS / SCSWIS - relationship with each other
6.10 A number of HIS and SCSWIS' powers and duties are common or apply to each body. These are:
- involving service users
- working co-operatively
- improving services
- taking account of standards and outcomes
- joint inspections.
HIS / SCSWIS - relationships with others
6.11 The provisions in Parts 4 and 5 of the Bill, which establish HIS and SCSWIS and set out their functions, complement the new duties placed on them in Part 6 of the Bill, of "user focus", "co-operation" and "joint inspection" between a whole range of improvement and scrutiny bodies who are specified in the Bill - those bodies extend beyond HIS and SCSWIS working together to also include how they work with other specified bodies such as the MWCS.
User involvement
6.12 Part 6 of the Bill places a duty on a whole range of specified improvement and scrutiny bodies - which include HIS, SCSWIS and the MWCS - to ensure continuous improvement in "user focus" in the functions of external scrutiny. There is also a power for the Scottish Ministers to issue guidance and directions to support user focus, to which the specified improvement and scrutiny bodies will be required to have regard.
6.13 These provisions build on existing systems in place in many public bodies. SWIA, the Care Commission, HMIE and NHSQIS currently have systems for involving service users and ensuring user focus in their work. It is expected that such systems will be carried forward into SCSWIS and HIS. Nevertheless the provisions in the Bill will provide a legislative framework for embedding user focus in their work, but also including the MWCS as a "listed scrutiny authority" under the Bill which must also secure continuous improvement in user focus in the exercise of their scrutiny functions.
6.14 In addition, as above, Parts 4 and 5 of the Bill require that SCSWIS and HIS involve services users and carers in their governance arrangements.
Working co-operatively
6.15 It is intended that SCSWIS and HIS work effectively together, not just on planning improvement and scrutiny work but on all service improvement and inspection of services. They must be able to work jointly to inspect all the healthcare and social services provided to any group or groups of service users. Part 6 of the Bill therefore also contains a provision placing a duty on all scrutiny bodies which scrutinise local authorities, social services or health services to co-operate and to co-ordinate activity on the planning of inspections and shared risk assessments.
6.16 This duty to co-operate with each other and, where appropriate with Scottish Ministers, will apply equally to SCSWIS and to HIS, but also importantly, to the MWCS under the new arrangements proposed by the Bill.
6.17 The intention is to enable SCSWIS and HIS to work jointly across their service sectors to identify and promote best practice, to promote continuous improvement in services, to support the redesign of services and to focus on outcomes for all individual service users. But, in addition, a key element in the two new bodies working together co-operatively will be the development of standards and outcomes for services users which are consistent and compatible across the healthcare, social care and social work sectors. The Bill provides that Scottish Ministers can ensure the development of appropriate standards and outcome measures and that the bodies have due regard to these in their work. Each of the two bodies may also co-operate through sharing services, including accommodation, with the other body, and with other public bodies where this promotes economy, efficiencies or effectiveness.
Joint inspections
6.18 The Joint Inspection of Children's Services and Inspection of Social Work Services (Scotland) Act 200613 ("the 2006 Act") enables Ministers to request HMIE jointly with SWIA, the Care Commission and other improvement and scrutiny bodies (including NHSQIS) to undertake joint inspections of children's services. That Act provides the necessary legal powers to enable these bodies to work together jointly, to access and share information for the purposes of joint inspections and to share information under prescribed conditions with other inspectorates where the information is necessary for the conduct of their service specific inspections. It enabled, for instance, the successful piloting of inspection of child protection services to be carried out by joint teams, led by HMIE.
6.19 Joint working in other areas such as multi-agency inspection of older people's services has not been able to achieve the same level of integration, efficiency and effectiveness because of the issue of lawful access to the appropriate information by the teams carrying out the inspections.
6.20 Part 6 of the Bill now replaces that legislation. It makes specific provision for "joint inspections" which enable Scottish Ministers to request two or more scrutiny bodies to work together and with other scrutiny bodies on joint inspections of services for children and of other relevant services and for the joint inspection teams to work in an integrated way, sharing information where it is necessary and appropriate for the conduct of such inspections. Each of HIS, SCSWIS and the MWCS are listed in section 95 as being bodies which must, at the request of Scottish Ministers, conduct a joint inspection in relation to specified services for which that body has inspection functions.
6.21 HIS and SCSWIS will therefore require to work not only together, but also with other improvement and scrutiny bodies, including the MWCS, HMIE and Audit Scotland.