The Welsh Assembly Government`s Written Response to the Local Government and Public Services Committee’s Report of its “Inquiry into the Operation of the Public Services Regulation and Inspection Regime in Wales”

Purpose: To present the Welsh Assembly Government’s response to the Local Government and Public Services Committee’s Report of its Inquiry into the Operation of the Public Services Regulation and Inspection Regime in Wales.

Responses to the Report’s recommendations are set out below.  The recommendations follow the Report’s headings and numbering.

Overall response to report

1. On behalf of the Welsh Assembly Government, I preface the more detailed comments which follow by very much welcoming the Committee’s report. This report is an important contribution to taking forward inspections and regulation issues, especially within the context of the Making the Connections programme.

Regulation and Inspection as Mechanisms for Improvement

Recommendation 1 (paragraph 4.7).  The Committee recommends that:
The Welsh Assembly Government should seek to develop a measure of the level of improvement that results from the inspection regime and that it should be used to inform the inspection and improvement process.

2 Accept the spirit.  It is difficult to distinguish precisely the improvements resulting from the inspection regime from those arising from other sources, especially as the move to an increased role for self assessment continues. However, the Welsh Assembly Government will continue to encourage inspectorates to identify the improvements that have resulted from the operation of their regimes.
 
3 For instance, Wales Audit Office (WAO) inspections under the Wales Programme for Improvement for local government already contain assessments of how far (if at all) levels of risk have diminished as a result of the previous year’s assessment and action plan.  It will be easier to measure local authority performance using the new performance measurement framework, which includes a requirement for robust, objective regulatory assurance.

4. In relation to the health and social care sector agreement on a wide range of principles and practices has been reached between those who inspect, regulate and audit health and social care in Wales. This agreement (the  “Concordat between Bodies Inspecting, Regulating and Auditing Health and Social Care in Wales” – which I refer to in this statement as “the Concordat”) is designed to support the improvement of services for patients, service users and their carers while eliminating unnecessary burdens of external review.

5. Signatories to the Concordat include Healthcare Inspectorate Wales, the Social Services Inspectorate for Wales, the Care Standards Inspectorate Wales, the Wales Audit Office Healthcare Commission, Mental Health Act Commission, Welsh Local Government Association, Community Health Councils and the Health and Safety Executive.

6. The Concordat highlights the need for external review bodies to provide support and guidance to health and social care bodies and their staff to develop tools for self-assessment that can contribute to the continuous measurement and improvement of services. The Welsh Assembly Government supports the use of self-assessment tools and offers advice on developing the criteria for their use.

7.       Financial implications: None – assessment of the value added by inspection regimes is a matter addressed by existing arrangements such as the Wales Programme for Improvement.

Recommendation 2 (paragraph 4.11).  The Committee recommends that:
The Welsh Assembly Government issues guidance to local authorities on how resources can be made available to ensure that the recommendations from inspections are able to be carried out.

8. Reject. We agree that it is essential for well-founded inspection recommendations to be appropriately and promptly implemented.   That in turn requires that implementation is fully accepted, owned and taken forward by all interested parties within a local authority, including in particular scrutiny committees, and we strongly welcome the Committee’s later recommendations in that regard.

9. However, not all action required to make improvements to services necessarily requires extra human or financial resource; improvements can be made, for instance, by adjustments to working practices or by following examples of good practice, which in some cases may even result reductions in resource requirements in the short or long term.  Indeed, reducing resource requirements while maintaining service standards is of itself an important form of improvement.

10. The means by which local authorities allocate their resources to achieve improvements are not driven solely by individual inspection findings – and the decisions that they make in doing so are properly for them in light of their wider pressures and priorities.  The Welsh Assembly Government, in partnership with the Welsh Local Government Association (WLGA) and others, will issue guidance on the role of regulatory and inspection bodies and how their work should inform improvement, as part of the Wales Programme for Improvement.

11. Financial Implications.  None, beyond the funding of actions already provided for within the context of the Wales Programme for Improvement.

Recommendation 3 (paragraph 4.13).  The Committee recommends that:
The Welsh Assembly Government should ensure that the measures that can be taken against failing organisations should be made clearer to all involved in the process and strong lines of responsibility identified.

Recommendation 4 (paragraph 4.14).  The Committee recommends that:
The Welsh Assembly Government should investigate any anomalies that exist between the measures that can be taken against failing organisations by the different inspection regimes.  If necessary, legislation should be amended to ensure the same level of measure apply in all regimes.

Recommendation 5 (paragraph 4.15).  The Committee recommends that:
The Welsh Assembly Government should ensure that measures currently in place for failing organisations are applied consistently and that their effects are regularly monitored and publicised.

12.     Accept the spirit. Intervention, while necessarily a course of last resort, remains an essential element and possible consequence of any regulatory and inspection regime.  We thus agree that the measures available should be fit for purpose and clear to all concerned.  However, the proper purpose of any intervention is to protect the interests and needs of service-users, and to restore acceptable service standards promptly: it should thus focus primarily on remedial action, rather than taking punitive steps against “failing” service-providers.

13. So far as local authorities are concerned, the circumstances in which intervention powers would be used are clearly and fully set out in a protocol agreed between the Welsh Assembly Government, the WAO and the WLGA. In addition the individual and collective action of those organisations is set out clearly in a published Improvement Protocol that shows how Local Authorities will be supported in their improvement requirements. We do not believe there is a significant lack of clarity here, though there is always scope to improve in this area in the light of experience.

14.      The existence of the protocol should help to reduce the danger of inappropriate anomalies, but it needs to be borne in mind that inspection regimes cover a wide variety of very different settings and inspect across the public, voluntary and private sectors.  While the basic principles underpinning the regimes are essentially the same, the detailed inspection regime may differ in different fields.  For instance, local authorities are democratically accountable whereas other bodies are not; some services are provided under a statutory duty (and must thus continue) and some at the commissioner’s or provider's discretion; and there are multiple local providers of some services and single providers of others.

15.       The level and nature of intervention must properly reflect the circumstances of each case. In that spirit, we do not agree that publicity is necessarily helpful in all cases; it can too easily become a case of “naming and shaming”, which can hinder the practical process  of taking remedial measures and longer-term improvement.  

16.         Financial Implications.  None. This work is already under way.

Recommendation 6 (paragraph 4.20).  The Committee recommends that:
Inspection agencies should draw up proposals of how they can offer appropriate support to those they inspect to achieve the improvements necessary.

17. Accept.  To the extent that it is appropriate for the Welsh Assembly Government to guide Inspection Agencies to do so, the Welsh Assembly Government will seek to do so. This is already in hand under the draft revised WPI guidance, and through the work of the Improvement Board’s Inspection Sub Group. It needs to be recognised, however, that there are limits to which inspection agencies can offer direct support to those they inspect given that they will be returning to inspect at a future date, and there may even be potential conflicts of interest where inspection agencies charge for additional help.

18.          Financial Implications.  None.

The burden of inspection versus risk

Recommendation 7 (paragraph 5.7).  The Committee recommends that:
Those organisations that carry out inspections should start to move towards a more risk based assessment system.

19            Accept.  Most Inspectorates already adopt this approach, and the Welsh Assembly Government will further encourage moves in this direction. WPI inspections have been based on, and proportionate to, risk for a number of years and we will continue to develop this approach. It helps to focus inspectorate resources on those that most need to improve. A lighter touch for those services which are assessed as low risk is one reward for better performers.

20.          However, some inspection of good performers will always be necessary: first, to validate that the high opinions of good performers are justified; second, to ensure inspectorates have experience of inspecting services and authorities judged as low risk as well as higher risk ones; third, to recognise that the impact of some services (eg cared for children) being below acceptable standards is so great that a certain level of inspection is appropriate even in areas where there is agreement on an assessment of low risk and, finally; to identify examples of effective practice which could be adopted by those who are performing less well.

21.        The Concordat highlights the need for external reviews to be targeted and proportionate and for external review bodies to develop a review framework to plan activities relative to risk and to consider reducing, proportionately, review activity in areas that carry an assessed lower risk. The Concordat also highlights the need for external review bodies, in making recommendations, to consult “with providers and/or commissioners of health and social care, and consider, where practicable, the balance/proportionality of the costs and benefits of implementation.”

22.     Financial Implications.  No additional costs as this movement is already in train. In due course, services and authorities judged as low risk will gain from a reduced burden of inspection activity.

Recommendation 8 (paragraph 5.11).  The Committee recommends that:
Local authority overview and scrutiny committees should have a role in assessing the risk of services within local authorities.

23.     Accept. In the case of local authorities, this is in line with the draft revised WPI guidance. The move to increasing levels of self assessment within inspection regimes relating to services and organisations will inevitably give increasing weight to the risk assessments made within local authorities and other bodies (eg NHS , educational and social care bodies), which in turn requires that assessment to be internally validated and/or challenged by any appropriate means. Precisely who within the body being inspected makes a contribution to an inspectorate’s risk assessment will vary depending on the precise type of service or body.

24.          Financial Implications : None

Recommendation 9 (paragraph 5.13).  The Committee recommends that:
Policy agreements be used by local authorities to help assess risk within their areas of service provision.

25. Reject. We agree that all local authorities should have robust means for identifying, assessing, prioritising and mitigating risk, supported by reliable performance management systems. The revised guidance on the Wales Programme for Improvement will stress and expand on this.  

26. However, policy agreements specify service outcomes and objectives that the authority is committed to meet; they do not contain assessments of risk or commitments to its reduction. While authorities will wish to accord a relatively high priority to addressing risks to their policy agreement targets, this would flow naturally from any reasonable process of risk assessment, just as it would for other high-impact risks.

27.      Financial Implications.  None.

Recommendation 10 (paragraph 5.18).  The Committee recommends that:
The Welsh Assembly Government should undertake research to establish a method for producing a cost benefit analysis of the regulation and inspection regime in Wales based on the costs and benefits of each inspection body/sector being inspected.

28.     Accept the spirit. With other members of the Wales Programme for Improvement (including the WLGA and inspection bodies), the Welsh Assembly Government pursues increasing the value added by the inspection process in terms of service improvements, while reducing the level of unnecessary costs, both in terms of the direct costs of the inspectorates themselves and in particular unneccessary burdens which may be placed on those they inspect.  The level of Wales Audit Office inspection is thus broadly decreasing over time as the assessed level of risk decreases.

29.      Objective Four of the Concordat concerns the need for external review bodies to evaluate the long term impact of their reviews, to assess the impact of significant changes to review processes and methodologies, and (at Objective Six) to assess the impact of external review bodies’ policies.

30.           Financial Implications.  No additional ones. This is an important part of the ongoing work of the Wales Programme for Improvement, and of the work of signatories to the Concordat.

Methods of Inspection

Recommendation 11 (paragraph 6.4).  The Committee recommends that:
The Welsh Assembly Government should undertake further research to identify best practice in self assessment for inspections.

31.     Accept.  The Welsh Assembly Government accepts the spirit of this recommendation and will work within its existing relationships with inspectorates and others to ensure that the methods relating to external review continuously improve. This is probably better done by means of peer support than centrally-commissioned research.

32.    Self-assessment is the established first stage of the annual improvement cycle under the Wales Programme for Improvement, subject to subsequent validation by regulators, and our revised guidance will build on and enhance that. Estyn uses the most recent self evaluation and development plan as the starting point for its inspections since last year.

33. Estyn issued guidance on the issues those should being inspected should address and the underpinning process to be followed. Each report then includes a section on the quality of the self evaluation process and the extent to which its findings match those of inspectors. In addition, the Inspection Sub Group has as part of its remit the requirement to identify, share and disseminate good practice in all aspects of the inspection process, including the potential benefits of self-assessment as part of the overall inspection process.

34. The Concordat refers to the need for external review bodies to provide support and guidance to health and social care bodies to develop tools for self-assessment that can contribute to the continuous measurement and improvement of services. The Concordat also expresses the need for the signatories to spread good practice, encourage innovation and learning from experience, together with seeking the views, opinions and advice of those receiving and providing care, and supporting worthwhile innovation and the development of research strategies and projects in relevant areas.

35.       Financial Implications. No additional costs.

Recommendation 12 (paragraph 6.7).  The Committee recommends that:
Inspection bodies should seek ways of moving towards less frequent planned inspections (in conjunction with self assessment) and should carry out more unplanned unannounced inspections.

36.         Accept in part. Unannounced  inspections have to be seen as part of a total planned programme. They may be particularly worthwhile when they address services at the point of delivery, but of much less value when they do not, or are concerned with the corporate whole.  Here, if regulation and inspection is to be a source of support for improvement, then planning by the body concerned is essential to identify areas, processes and services that would be likely to benefit.

37.         Financial Implications. None additional to current activities. Where less frequent inspections take place there will be a reduction in the cost (particularly in terms of staff time) to bodies being inspected.  

Recommendation 13 (paragraph 6.12).  The Committee recommends that:
There should be a clearly defined role for service users in the inspection process and that role should be communicated to them by the most effective means possible.

Recommendation 14 (paragraph 6.13).  The Committee recommends that:
Service users should be involved in the report back process, especially if they have been involved at the inspection stage.

38.    Accept the spirit.  Service users should be part of the planning of services. In terms of an increased focus on the service user as indicated in “Making the Connections”, the Welsh Assembly Government wholeheartedly commends both these recommendations to all inspection bodies.
 
39. We note with approval that the recently launched Concordat says that “External reviews of health and social care focus on the experience of patients, other service users and carers.”, and that it  commits its signatories to “Involve those who use services” and take account of their views in “the planning , delivery and evaluation of external reviews..”.

40. The roles of citizens as service users, carers etc will vary in detail from service to service and organisation to organisation.  The revised Wales Programme for Improvement will require local authorities to assess annually how far their service planning processes engage with service users and respond to their, and involve them in periodic service reviews. Inspectors already take on a service-user perspective when undertaking inspections in a number of cases.

41. Financial Implications.  None beyond planned activity.

“Joined up thinking” in regulation and inspection
Recommendation 15 (paragraph 7.10).  The Committee recommends that:
Inspection bodies should seek ways in which inspections can be rationalised to reduce the burden on those being inspected through the Inspection sub group of the Wales Programme for Improvement and the Wales Inspectorate and Regulators
Fora.

Recommendation 16 (paragraph 7.11).  The Committee recommends that:
Inspection bodies should liaise over their inspection programmes to ensure that the burden of inspection is not increased by several different inspections within a short timeframe.

Recommendation 17 (paragraph 7.12).  The Committee recommends that:
The Welsh Assembly Government should ensure that the remits of those regulation and inspection organisations established by them include and encourage co-operative working between them.

Recommendation 18 (paragraph 7.15).  The Committee recommends that:
Good practice in sharing information amongst regulating and inspecting bodies should be identified and used as models for co-operative working.

42.   Accept.  These four recommendations all need to pursued (in many cases continue to be pursued) if the Welsh Assembly Government’s objectives in “Making the Connections” are to be realised,.  As Recommendation 15 implies, this is already a key issue for the Inspection sub committee of the WPI. All local authorities have a Relationship Manager, appointed by the WAO, among whose tasks is to co-ordinate  each local authority’s regulatory plan with other regulators and periodically to review the regulatory calendar.

43.    The Concordat highlights the need for external reviews to be “ co-ordinated with other reviews and collections of data.” This includes defining and explaining their remits to ensure clarity and effective co-ordination, the use of existing data sets, sharing information with other bodies and the planning of external reviews.

44.          Financial Implications. None beyond current plans

Recommendation 19 (paragraph 7.16).  The Committee recommends that:
The Welsh Assembly Government and inspection bodies consider initiatives such as the Joint Scrutiny Forum Website and Scottish Executive Charter for Inspectorates in Scotland in order to facilitate greater transparency and co-ordination in terms of timing of inspections and methodological approaches.

45.           Accept.  The Welsh Assembly Government will consider with inspectorates and other partners the scope to make increased use of websites to achieve greater transparency and better functioning of inspection regimes.  The Concordat signatories are currently considering the possibility of a Concordat web-site being developed and hosted by a signatory or another appropriate body.
 
46.        Financial Implications.  None in addition to current overall plans

Recommendation 20 (paragraph 7.21).  The Committee recommends that:
Models of inspection regimes requires covering cross cutting issues should be identified by the Welsh Assembly Government and assessed for suitability in Wales.



Recommendation 21 (paragraph 7.24).  The Committee recommends that:
The Welsh Assembly Government carries out research on the regulation regime for each sector with a view to potentially rationalising regimes and decreasing the regulation burden.

47.           Accept.   These recommendations relate to the need for inspection regimes, as with all parts of public sector services in Wales, to work together with two main aims – first, to add maximum value in terms of the improvement of delivery of services to citizens (and citizens as service users are interested in the quality of overall services delivered and the outcomes for them that  they achieve irrespective of how many different public services are involved), and second to ensure that whatever the structural landscape of inspection and regulatory regimes at any point, they operate in a coordinated way to expose and reduce unnecessary burdens on those they inspect and regulate.  This is linked intimately to the need for regulation and inspection to be proportionate to risk.

48. Developing a new approach to regulation and inspection among all stakeholders is an important part of the Welsh Public Service Ideal set out in “Making the Connections” – an approach which is more closely linked to our agenda for improving services, which are better coordinated and more citizen centred.

49. Financial Implications. There may be some minor and short term additional costs, particularly for the Welsh Assembly Government and Inspectorates and Regulators in further developing improvements in these areas, but they will quickly be more than compensated for by reduced burdens on those being inspected (eg by releasing staff time).