Sir: The tragic death of Jonathan Newby focuses thinking about issues of regulation and the enforcement of standards that have concerned local- authority inspection units since their inception under the terms of the NHS and Community Care Act in April 1991.
Local authorities in London work to agreed standards that are defined in shared guidelines, but which allow some flexibility for specific local policy agreements within each borough. These guidelines state the expectation of 24-hour staff cover in any registered care home, although this is not required by any relevant legislation. Inspectors, who must make at least one announced and one unannounced inspection each year, check on staffing rotas, ratios and experience in line with these London standards.
Although imperfect in many ways, the present system for the registration and inspection of homes remains the most effective means of identifying and pursuing those deficits in provision that endanger the health and welfare of residents and staff. Local authorities with knowledge of local needs and circumstances are well placed to retain responsibility for registering and inspecting care homes, collaborating with professional colleagues (health and safety officials, planning officers and health agency staff) in a formal framework.
The serious issues highlighted by the killing of this young volunteer must also be seen within the wider context of the general debate on regulation. Methods of enforcing standards must be strengthened. Contracting officers are not in a position to fulfil a regulatory function, nor are those workers with the task of making individual placements for vulnerable people, as they each have different priorities and constraints. A full review of the Registered Homes Act (1984) and the tribunal process linked with it is required. It is hoped that the forthcoming Department of Health review of the inspection function in local and health authorities and agencies will address this comprehensively.
The strident voice of those providers who demand self-regulation and complain about the demands of external inspection should be muted by this sad example of its necessity.
Chair, London Heads
27 JulyReuse content