Social care - Independent Review of Inspection, Scrutiny and Regulation: call for evidence analysis

Theme 3 – How should inspection, scrutiny, and regulation be carried out?

When referring to respondents who made particular comments, the terms 'a small number,' 'a few' and so on have been used. While the analysis was qualitative in nature, with the consultation containing only a limited number of quantifiable questions, as a very general rule it can be assumed that:

'a small number' indicates up to 5 respondents

'a few indicates around 6-9

'a small minority' indicates around more than 9 but less than 10%

'a significant minority' indicates between around 10%-24% of respondents

'a large minority' indicates more than a quarter of respondents but less than half

and 'a majority' indicates more than 50% of those who commented at any question.

It is important to understand views on how inspection, scrutiny, and regulation should be carried out. The call for evidence asked a series of questions in relation to this.

The first of these questions asked:

Q3: Would a system work where the same regulator inspected all services?

As the following table shows, opinions were very split: almost equal numbers of call for evidence respondents answered 'Yes' (29%) and 'No' (30%), although 41% did not express an opinion. However, a narrow majority of organisations (particularly HSCP / local authority consultees) thought a system would work with the same regulator, while a small majority of individuals did not.

Table 4: Would a system work where the same regulator inspected all services?

	Yes	No	Not sure	No response
	Number (%)	Number (%)	Number (%)	Number (%)
Advocacy (3)	1 (33%)	1 (33%)	- (0%)	1 (33%)
HSCP / Local authority (8)	5 (63%)	1 (13%)	2 (25%)	- (0%)
Regulator (5)	- (0%)	- (0%)	1 (20%)	4 (80%)
Representative body (28)	4 (14%)	7 (25%)	6 (21%)	11 (39%)
Service provider (10)	4 (40%)	3 (30%)	0 (0%)	3 (30%)
Other (6)	2 (33%)	2 (33%)	1 (17%)	1 (17%)
Total organisations (60)	16 (29%)	14 (23%)	10 (17%)	20 (33%)
Individuals (40)	13 (33%)	16 (40%)	9 (23%)	2 (5%)
Total respondents (100)	29 (29%)	30 (30%)	19 (19%)	22 (22%)

(Percentages might not add to 100% because of rounding)

All those who answered question 3 were then asked to give their reasons for their initial response. A total of 85 call for evidence respondents gave answers.

In favour of the same regulator

Among those who thought the same regulator could inspect all services, the main advantage (quoted by a large minority of call for evidence consultees across all sub-groups and a point made often at events) was that this would offer a consistent or streamlined approach to regulation (e.g. over how standards are applied).

Significant minorities of a broad mix of respondents felt there would be the benefit of a reduction in inter-agency tensions and conflicts in terms of policy and data sharing. Similar numbers thought a single regulator would help to avoid confusion over who is responsible for what andviewed the current system as overly complicated; this point was raised mainly by representative bodies and at events mostly attended by unpaid carers and representative bodies.

A significant minority saw benefits arising from a better or more efficient use of resources, citing fewer hierarchical structures, cost efficiencies, a perceived reduction in the regulatory burden and less duplication of effort (e.g. different regulators inspecting one service). A few social care providers and individuals identified advantages to do with continuity, including easier forming of relationships with a single regulator or inspector. A few respondents predicted a more equitable approach to inspections in term of equality of accountability, though a small number cautioned that standards should not be lowered.

Other reasons for having a single regulator were each given by small numbers of respondents as follows:

• More understanding of the (shared) challenges facing health and social care / more holistic approach to inspection (consideration of both social and clinical elements)
• Might be aligned with how the proposed National Care Service will operate (e.g. more joined up working, creates the conditions for greater integration of the inspection and scrutiny landscape)
• Helps to attain or set high standards (for support, care, assessment, protection, ensuring implementation of Health & Social Care Standards across services)
• Easier contact / more awareness of the relevant agencies and who to contact
• Easier to share best practice and learning

Among those in favour of a single regulator, a significant minority across all sub-groups noted the caveat that they would support this, assuming inspectors and regulators had a broad range of specialist knowledge across different services. A few respondents felt this would be dependent on human rights being embedded (e.g. prioritising personal outcomes), or as long as the principles of independent living are adopted (e.g. support for those choosing Self Directed Support Option 1).

In favour of more than one regulator

Among the number of respondents who were against the idea of a single regulator.

inspecting all services, the dominant theme (from a large minority of consultees across sub-groups and also frequently raised at events) was that each regulatory body has its own area of expertise and it will be therefore prove too much of a challenge to have only one regulator with the necessary spread and depth of knowledge, skills and expertise. They felt there would be compromise and expertise would be lost. A significant minority pointed out the many different organisations, services providing social care support and types of user (e.g. child and adult social care, social work services, health services) needing to be scrutinised by bodies familiar with each type of users' needs and priorities and there is therefore a risk of different outcomes if there is one regulatory body.

In particular, a significant minority pointed out that health, social work and social care are different things which could result in challenges to staff from different sectors understanding different roles.

A small number of respondents (two individuals and two representative bodies) reinforced this, saying that a regulatory system was needed that focuses on social care specifically, that was distinctive, and that it should be protected.

A significant minority across all sub-groups and at several events supported an improved partnership approach between regulators as opposed to having a single regulator. It was felt this would enhance the clarity of regulatory roles and would help promote consistency and avoid duplication and confusion. A small number of these commented that it was cultural change rather than structural change that was needed (e.g. shared use of language and clear communication with all stakeholders).

Small numbers of respondents felt there could be an umbrella body combining regulators if social care and social work maintained separate identities or different departments. A greater use of joint inspections by regulators was seen as preferable to the disruption caused by merging existing bodies, and this approach was seen to work well during the Covid pandemic. A small number stood by a need for an independent inspection, scrutiny, and regulation process, with a service providing social care support noting failures to deliver accountability.

Other remarks

Other remarks were received largely from respondents who did not respond 'yes' or 'no' at Q3. A few respondents considered the pros and cons of which regulators could or could not be merged, although there was no consensus on this. Small numbers said that the feasibility of having the same regulator would depend on the training, knowledgeability and expertise of inspectors regarding services. Very small numbers saw a need to focus on the improvement and development of the social care and support workforce.

The next question asked:

Q4: Should there be different regulators for inspection (the organisation that looks at how things are working) and improvement (the organisation that supports things getting better)?

As table 5 shows, a large majority of those who answered this question disagreed that there should be different regulators for inspection and improvement. This was particularly in the case of organisations.

Table 5: Should there be different regulators for inspection (the organisation that looks at how things are working) and improvement (the organisation that supports things getting better)?

	Yes	No	Not sure	No response
	Number (%)	Number (%)	Number (%)	Number (%)
Advocacy (3)	- (0%)	- (0%)	1 (33%)	2 (67%)
HSCP / Local authority (8)	1 (13%)	5 (63%)	1 (13%)	1 (13%)
Regulator (5)	1 (20%)	1 (20%)	0 (0%)	3 (60%)
Representative body (28)	2 (7%)	7 (25%)	6 (21%)	13 (46%)
Service provider (10)	0 (0%)	5 (50%)	1 (10%)	4 (40%)
Other (6)	0 (0%)	4 (67%)	1 (17%)	1 (17%)
Total organisations (60)	4 (7%)	22 (37%)	10 (17%)	24 (40%)
Individuals (40)	11 (28%)	19 (48%)	8 (20%)	2 (5%)
Total respondents (100)	15 (15%)	41 (40%)	18 (18%)	26 (26%)

(Percentages might not add to 100% because of rounding)

Respondents answering question 4 were then asked to give their reasons for their initial response to this question. A total of 73 call for evidence consultees chose to respond.

Those against having different regulators for inspection and improvement

Among the large majority not in favour of having different regulators, the main theme mentioned (by a large minority of respondents across all sub-groups and frequently at events) was that inspection and improvement are linked. It was also suggested that it would be difficult to separate the two areas, and that having the same regulator would support a consistent approach.

A large minority (including the majority of HSCP / local authority respondents) thought inspectors should be able to or were best placed to offer improvement support for social care services. Inspections could therefore be a stimulus for quality improvement. A significant minority from across all sub-groups supported closeness of dialogue, depth of understanding and a relationship building approach between an inspector and the service inspected. A social care provider noted this had been a success during the Covid pandemic.

A significant number of responses echoed those given at the previous question, in that having more than one regulator could lead to differing development and improvement plan ideas, confusion, inconsistency, ineffective sharing of information and other tensions. A very small number identified savings in terms of time, effort and resources (e.g. fewer visits required to the same site).

A few respondents across all sub-groups cited easier sharing of good practice, such as shared learning and training and national arrangements for benchmarking. Two providers of social care support thought it would be easier to meet the required improvements to achieve the necessary standards (e.g. keeping to timescales for monitoring improvements).

A few mentions noted a need for some autonomy (e.g. separate departments or specialisms) within the same regulator. Some scenarios where this would be useful were elements for enhanced inspection (e.g. for children or in the justice area), differing skills requirements for assessing the meeting of prescribed standards of care, and improvement methodology specialisms (e.g. an independent improvement professional getting involved where the relationship between an inspector and the service providing social care support is problematic). Small numbers at events urged clarity of roles within regulators.

Those in favour of having different regulators for inspection and improvement

Most of those in favour of different regulators (a small minority overall) thought this would help to ensure improvement. Reasons given included that improvement was happening not only as result of inspections, that this supports a development approach, and inspections and scrutiny should not be a tick box exercise. A representative body and an individual thought there would be better quality outcomes.

A few respondents thought having different regulators would provide greater focus on specific areas, noting that each social care area provides differing levels of service to those who use social care support. Very small numbers each noted better governance, accountability or transparency (without going into details), or ensuring that regulatory expertise, experience and knowledge is not diluted.

Other remarks

A few respondents (particularly regulators and representative bodies) thought the current regulators needed to work together more closely, especially in the areas of data, information and documentation sharing.

Other comments made (each by small numbers of respondents) included:

There are too many quangos, inspectors and regulators

The grading system is not fit for purpose (comments included that it could feel subjective and that it might encourage playing the system)

There is a need for those with lived and living experience to take a leading role

Concerns about the implications of perceived funding cuts and costs difficulties

Suggested other focuses for future development (e.g. more local engagement in frontline service delivery, more flexibility within the system, a focus on what works rather than what is administratively convenient, instigating a National Improvement Plan)

The next question went onto ask:

Q5: How can we ensure that regulation and inspection processes are underpinned by a commitment to improving services?

A total of 86 call for evidence consultees responded to this question.

Collaborative working

The largest number of respondents – a large minority and particularly across most events – supported regulators and inspectors working collaboratively with the social care and support workforce, people receiving social care support, services providing social care support and other regulatory bodies. This could take the form of partnership working, relationship building, and knowledge and good practice sharing (e.g., celebrating success). Stakeholder engagement was focused on by a few respondents, in particular engaging with people receiving social care support and unpaid carers.

Supportive approach

A large minority across all sub-groups recommended that inspections and improvements should be approached in a supportive manner, advocating a flexible system and provision of person-centred support. At events there were mentions that regulators should take the role of a 'critical friend' to services being inspected or regulated. A representative body stated that regulators and inspection services should focus on:

"…outcomes for people rather than provider compliance with policy and process."

Similar numbers across all sub-groups wanted a focus on removing stigma or anxiety from the process. It was recommended that an inspection should be regarded as a learning opportunity to strive to be better. To achieve this, a culture was advocated that enables stakeholders to voice concerns and suggestions for improvements to social care support services without fear of repercussions, aided by a change in the language used and improved complaints procedures.

Focus on ongoing and continuous improvement

A large minority overall across all sub-groups and at events thought there should be a focus on continuous improvement. The advantages of this included an improvement-focused culture in regulatory organisations, support for self-evaluation for improvement, improvement planning, facilitation and maintenance. A large minority also discussed following through in terms of regular feedback, reviews and monitoring. Examples were given such as ensuring all directives for improvement are actioned adequately, having an overview of performance outcomes and regular data collection and analysis. A small number mentioned independent reviews (e.g. from the Scottish Government).

Standards and codes of practice

A large minority across all types of organisation (though only a few individuals amongst consultees or at events) wanted to implement or create a code of practice for social care support services to uphold, or decide what is and is not good practice for improvements or professional governance standards. There were a very small number of suggestions to either refresh or adhere to the Health and Social Care Standards. A few respondents cited a need for minimum inspection standards and statutory standards for regulators and inspectors (e.g. regarding reporting requirements). Similar numbers requested a consistent approach by regulators, in terms of regularity of inspections and transferable benchmarks in order to gain a more realistic view of services.

Resourcing the commitment to improve

A significant minority across all groups and at events cited a need for sufficient funding and resources for the regulatory, inspection, and improvement systems. Slightly smaller numbers were concerned to ensure that inspectors have the necessary skills, tools, training, qualifications and expertise to be supportive in improvements / improvement methodology. A small number requested improved training opportunities for the social care and support workforce.

Small numbers expressed concerns about adequate social care and support workforce availability to help deliver improvements, given the current recruitment issues in the social care sector. A significant minority (almost all of them organisations rather than individuals) thought people with lived or living experience should be employed as part of the regulatory and inspection services.

Reducing bureaucracy and administration was the focus of a few respondents and at events. Too much unnecessary scrutiny of top performing services was mentioned in this context as well as removing pressures from regulatory staff and leadership, and pressure from inspections draining resources from the improvement function. At one event, a point was made about extra measures put in place during the Covid pandemic still being in place with many services struggling to adjust. Services felt they could not improve due to the restrictions placed on them.

Other points

Small numbers of respondents each wanted to see:

Additional enforcement powers for improvement (e.g. ensuring the regulator has the ability to intervene where excellence is not being achieved)

Regulator(s) and inspectors held to account (e.g. by having an organisation that regulates the regulator or having inspectors inspected in order to ensure protocols are followed)

Q6: Should regulation, inspection, and scrutiny have an emphasis on services continually improving? What might that look like?

A total of 77 consultees responded to this question. Nearly half of these agreed that regulation, inspection, and scrutiny should have an emphasis on services continually improving. Only a very small number disagreed.

Suggested focuses for improving

A significant minority (mainly individuals and representative bodies) asked for clarity of expectations for improvement. It was suggested this might involve standard setting, having realistic or flexible expectations of standard achievement, robust or realistic improvement plans for meeting new or updated guidance, benchmarking guidance, and time-frames for improvements. A few respondents also felt that attention needs to be paid to the complexities of service delivery (e.g. flexibly adapting services to the needs of those using social care support or having realistic expectations given facility layout or size constraints and consideration of contexts).

Similar numbers (almost all of these being individuals, representative bodies and HSCP / local authorities) highlighted sharing best practice, for example establishing what is or is not working, and showcasing services which provide social care support where improvements have been made.

Smaller but still significant numbers wanted to see consistent monitoring and requirements for feedback to demonstrate improvements (e.g. using databases, digital means or progress reports). Similar numbers would like to see more focus on improvements during inspections themselves to demonstrate a more fundamental role for improvements in regulation. There were a couple of suggestions that more inspections or more consistent inspection visits should be made. This was also suggested during events.

A few respondents were in favour of greater use of self-evaluation or self-identification of areas for improvement by providers of social care support.

Support measures for improvement

A large minority wanted closer collaboration with social care providers including building relationships; this could include regular interaction with a named inspector or closer involvement at a local level. A few respondents argued for supportive methods of inspection and regulation, for example acting in an encouraging way and enabling safe and open conversations.

A focus on people-centred outcomes and meeting the needs of people receiving social care support was advocated by a significant minority across all groups.

As at the previous question, there was a small minority of calls for those with lived and living experience to be involved with improvements on the regulatory side.

Support needs

A significant minority (from across sub-groups) saw a need for resource provisioning to help regulators and inspectors focus on service improvements. Social care and support workforce recruitment was specified as well as more general building of capacity, while these respondents also warned of resourcing challenges. A small number of respondents suggested not focusing resources on services which were already very good, as it would be difficult to demonstrate improvements with these.

A small minority saw a need for more or better training and development opportunities for the workforce (e.g., development and delivery of the National Training Framework for PAs and PA Employers, mentoring programmes).

A few respondents wanted to ensure processes are not too bureaucratic or cumbersome (e.g., in terms of too much paperwork or perceived duplication of effort between regulators).

Disagreement that regulation, inspection and scrutiny should have an emphasis on services continually improving

Only a very small number of respondents (two representative bodies and an individual) disagreed with the first part of the question, citing issues around a lack of resources to enable extra reviews and meetings.

Q7: What should happen if something goes wrong in a service?

A total of 83 call for evidence respondents commented at this question. Responses at events were similar.

Process for reporting and rectifying problems

A large minority of consultees thought there should be a procedure for reporting incidents and problems. Clear pathways of communication for people receiving social care support and others to engage should be provided. An event respondent raised concerns that there can be difficulties in communication and that inspectors need communication training. They also wanted to see more time for inspectors to engage and build trust with certain people with communication difficulties. A significant minority wanted to enable trustworthy and safe reporting of issues by the person or provider of social care support concerned (i.e., confidential, open, honest reporting of what went wrong).

A significant minority recommended having a clear process for rectifying problems such as national care guidelines, Charter of Rights and Responsibilities for a National Care Service. Clarity of guidance for approach and understanding of procedures for both inspectorate and service were requested. A small number of representative bodies and HSCP / local authorities thought current processes are already adequate to deal with problems.

Solutions to problems

The highest number of responses (almost half of the repondents at this question) focused on the necessity of implementation and provision of solutions and actions to solve problems. This could be by sharing good practice, finding solutions from among social care staff or from the inspecting body / regulator, or by instigating an improvement plan.

A large minority from across all sub-groups recommended investigation of problems at an appropriate or proportionate level, with a few respondents commenting that this will depend on the gravity of the problem. Suggestions ranged from regulatory investigation leading to interventionist or enforcement action if there is an imminent safety issue, to disciplinary action if an individual rather than the process is at the root of the problem, to more supportive action in minor cases. It was suggested facilities should be closed if they were seen as unfit to deliver the service, with alternatives made available as soon as possible. There were a couple of mentions of escalation to the Scottish Public Services Ombudsman, for instance where there is dissatisfaction with a response to a complaint.

A significant minority thought it important to analyse what went wrong or having a clear investigation, for instance by seeking a full understanding of the situation or by validating concerns which have been raised.

A significant minority across most sub-groups thought it best to work with services by offering collaborative support to solve problems and that it was best if the methodology of solutions was non-threatening. This would result in a better understanding of the service.

Finally, timely action by agreeing timescales for rectification of problems or improvements, was considered important by a significant minority of respondents.

Accountability

A significant minority (almost all of them individuals and representative bodies) wanted accountability for things going wrong. A very small number mentioned redress, but similar numbers simply thought there should be an apology issued.

A few respondents were in favour of independent arbitration between regulators and those providing social care support to ensure the regulator does not end up "marking their own homework", as one individual put it. It was also regarded as important to take the views of other expertise outwith the regulator in cases where people were unhappy with the assessment of the service.

Additionally, there should not be a "blame" culture with regards to individuals, the social care and support workforce, services and providers of social care, according to a significant minority of mainly individuals and providers of social care (and also at events attended by providers of social care).

Reflection

Reflection by way of learning reviews (e.g. as to how the situation arose) was suggested by a large minority consisting mainly of individuals and most of the HSCP / local authorities. A significant minority cited the importance of preventative measures to prevent reoccurrences of incidents. These could take the forms of holding enquiries, putting remedial plans in place, retraining of staff, reviewing adequacy of controls or holding commissioners to account. Finally, an individual and a representative body suggested informing anyone who raised a complaint about improvements made and actions taken to rectify the situation.

Q8: Who should be responsible for making improvements to services?

A total of 78 call for evidence consultees responded to this question. Among relatively few mentions at events, the same pattern of answering emerged.

Services

Providers of social care services were the most frequently mentioned as having responsibility for making improvements to services, according to a large minority of respondents across all sub-groups. These respondents felt they should have accountability and primary responsibility for their services. A few respondents however said they should have support for identifying and sustaining improvements. Managers within organisations providing social care support were mentioned by fewer but still significant numbers of respondents, again with a few of these mentioning they should have guidance and support. Similar numbers stated "the service" or "services" without specifying managers or providers.

A large minority also suggested regulators, as these should provide support to the service providing social care support, ensure improvements are made, provide leadership and guidance and work collaboratively, sharing best practice. The Care Inspectorate was mentioned by small numbers, while Healthcare Improvement Scotland and the Scottish Social Services Council were each mentioned by very small numbers. Inspectors or inspection teams received a few mentions.

Other stakeholders

A large minority (mostly individuals and HSCP / local authorities) simply stated that everyone or all those involved in the service providing social care support should take responsibility for making improvements.

Frontline social care staff were mentioned by a significant minority, assuming they have adequate training and individual responsibility; these were also mentioned as being a good source of knowledge. Similar numbers of mentions were made of those with lived or living experience, who were also recommended as a source of knowledge.

A significant minority cited local authorities, particularly where they are the owner of a service offering social care support or the commissioner of the social care services. A representative body said that the Quality Improvement Officer's role was valued.

A few mentions were made of the Scottish Government or Scottish ministers, for example where regulators or agencies are failing they could provide leadership, share best practice, or have public accountability.

Very small numbers of mentions were made of the following:

• Improvement services / teams (e.g. from a future national improvement body)
• Support agencies (with relevant experience)
• Care Boards
• Health and Social Care Partnerships (e.g. for support)

Q9: How do we make sure regulatory bodies are doing a good job?

A total of 80 call for evidence respondents answered this question.

Information provision and communication

The largest numbers of respondents (a large minority across all sub-groups) cited feedback from services and providers of social care support as a means of making sure regulatory bodies are doing a good job. It was suggested this should consist not just of the complaints themselves but also their context, and feedback about the inspection process. A significant minority cited feedback from people receiving social care support or people with lived or living experience. A few wanted to see feedback from the social care and support workforce.

A large minority of mainly HSCP / local authorities, representative bodies and individuals saw a need for openness, transparency and communication about regulators' activities and roles. This included guidance about inspection processes, information about the complaints process, and sharing of knowledge. A significant minority suggested this should at least partly take the form of performance reviews and reports, mostly in a context of self-reporting and self-assessment. It was mentioned at an event that regulators use the Professional Standards Authority (PSA) Certified Framework to assess themselves, which was claimed to be open and transparent.

Small numbers cited a need for more dialogue, communication and collaboration with other regulators, for instance to ensure learning is maximised.

Scrutiny

A large minority from across all sub-groups thought regulators should be subject to independent scrutiny, with suggestions for an independent board of scrutiny from across social care, which would help to ensure accountability. A small number of respondents suggested scrutiny should come from government oversight and similar numbers simply cited that more monitoring of regulators was needed in general.

External auditing was advocated by a few respondents; an HSCP / local authority suggested a role for Audit Scotland in this, without providing any more detail. Small numbers of organisations cited the importance of the regulator's own quality assurance processes. A regulator stated:

"We undertake an annual self-assessment of our progress using an adapted version of the PSA's Standards of Good Regulation. We also maintain regular dialogue with many of the regulators the PSA oversees such as Social Work England and the Nursing and Midwifery Council. We would welcome the opportunity to have a further discussion about the case for and role of an independent scrutiny body."

Analysis

A large minority (many of whom were representative bodies) cited a need for better or more evidence and data for analysis to help ensure regulators are doing a good job. Performance measures were mentioned, particularly in relation to improving the quality of services and outcomes for people receiving social care support. A significant minority across all sub-groups focused on analysis and comparison of inspection reports, suggesting these should be scrutinised for consistency of approach, consistency among inspectors, benchmarking purposes and whether or not they meet standards.

Other ways

A few respondents again raised funding and resourcing issues for regulators, in particular the need for experienced, qualified and trained people.

Very small numbers of respondents thought regulators must:

Have a better complaints system or make better use of the complaints system (e.g. handling concerns and feedback)

Ensure failures and inadequacies are properly dealt with (e.g. with punishments such as fines)

Have greater knowledge of the services being inspected (e.g. via relationship building)

Be independent

In summary: Theme 3 – How should inspection, scrutiny, and regulation be carried out?

Opinions were very split on whether the same regulator should inspect all services (Q3); almost equal numbers of respondents answered 'Yes' and 'No'. The key benefit identified by those in favour was that this would offer a consistent or streamlined approach to regulation. Other benefits included a reduction in confusion over specific responsibilities. This would lead to more efficient usage of resources. A significant minority would only support one regulator if their workforce maintained a broad range of specialist knowledge across different services.

Among those against having the same regulator, the main reason given was that it would prove too much of a challenge to have one regulator with the necessary spread and depth of knowledge, skills and expertise. Health, social work and social care were also regarded as being distinct. However, an improved partnership approach between regulators was proposed as an alternative.

A large majority disagreed that there should be different regulators for inspection and improvement (Q4). Among respondents not in favour, the main reason was that inspection and improvement are linked. It was also felt that inspectors are best placed to offer improvement support for services providing social care support if inspections are carried out in a supportive manner. Having more than one regulator could lead to differing priorities for development and improvement plans.

Among those in favour of having different regulators, this was seen as helping ensure improvement. It was perceived that improvements happen due to a variety of factors and not only as a result of inspections.

To ensure that regulation and inspection processes are underpinned by a commitment to improving services (Q5), respondents said that regulators and inspectors should work collaboratively with the social care and support workforce, people receiving social care support, services providing social care support and other regulatory bodies. They also said that inspections and improvements should be approached in a supportive manner to relieve anxiety. A focus on continuous improvement was supported, for example, by following through in terms of regular feedback, reviews and monitoring. The implementation of good practice was recommended as well as funding and resourcing.

Respondents reinforced their agreement that regulation, inspection, and scrutiny should have an emphasis on services continually improving (Q6). There were calls for clarity of expectations and sharing of good practice, along with closer collaboration with providers of social care support. There were also calls for a focus on meeting the needs of people receiving social care support. Issues with the provision of resources for improvement actions were again raised.

If something goes wrong in a service (Q7), respondents want to see a clear procedure for reporting the problems, particularly for people receiving social care support.

There were recommendations for providing and implementing solutions, along with appropriate actions and changes to solve problems. That said, respondents felt that investigations should be at an appropriate or proportionate level depending on the issue raised. Accountability was seen to be important, although there should not be a "blame" culture. A collaborative approach to problem solving with services which provide social care support was thought best where possible, along with timely remedial action. After resolution, learning reviews were strongly advocated as well as introducing preventative measures to reduce the reoccurrence of problems.

Providers of social care support were most commonly seen as being responsible for making improvements (Q8), as they are seen to have responsibility for arrangements and delivery of their services. The managers of providers of social care support were mentioned less often. Regulators were mentioned in the context of providing support and guidance. Significant minorities suggested that front line staff offering social care support, those with lived and living experience (as a source of knowledge for making improvements) and local authorities also had a role.

There were also calls for all people involved with providing social care support to have a role in improvements.

In order to ensure regulatory bodies are effective (Q9), feedback from services and social care providers offering social care support was most frequently mentioned, with fewer mentions of feedback from those with lived and living experience.

A need for openness, transparency and communication about regulators' activities was supported, such as production of reviews and reports. Independent scrutiny of regulators was also supported, along with a need for evidence and data (e.g. analysis of inspection reports).