National minimum standards
National minimum standards
The national minimum standards constitute the minimum expectations the state sets for English and Welsh care providers in the services they deliver. The existing standards have been brought in progressively since the passage of the Care Standards Act 2000, which totally overhauled the system of regulating and assessing the quality of social care services in the two countries.
The national minimum standards are the product of the 1998 modernising social services white paper issued by the Department of Health, which said there were "huge differences in standards and levels of service" across England and Wales. It called for national standards and this was one of the many themes that informed the groundbreaking Care Standards Act 2000. Under this legislation, the secretary of state for health and Welsh assembly were empowered to set national minimum standards for all organisations providing registered services under the act.
The National Care Standards Commission was set up to monitor compliance with the national minimum standards in England, and in Wales this became the responsibility of the Care Standards Inspectorate for Wales. In April 2004, the NCSC was abolished and its functions passed to the Commission for Social Care Inspection. In April 2007, the CSIW was merged into the Care and Social Services Inspectorate Wales, while Ofsted took over CSCI's children's services functions.
Under the Health and Social Care Bill, a new regulator, the Care Quality Commission, will be set up in 2009 and it will take over all of CSCI's functions, as well as those of the Healthcare Commission and Mental Health Act Commission. The government will also introduce a new system of registration for all social care and health providers, replacing that laid down under the Care Standards Act 2000.
The NMS are distinct from the regulations governing social care services. The latter are legal requirements services must meet if they want to be registered providers, and breaches are punishable, including by being barred from providing care. The national minimum standards are not legally enforceable but are guidelines for providers, commissioners and users to judge the quality of a service. Inspectors must take them into account when judging whether providers are compliant with regulations.
What services are covered?
The following sets of national minimum standards apply to adult services in England and providers' performance against them is assessed by CSCI.
- Care homes for people aged 65 or over
- Care homes for people aged 18-64
- Domiciliary care
- Adult placement schemes
- Nurses agencies
Ofsted inspects performance against the following sets of national minimum standards for children's services in England:
- Residential special schools
- Children's homes
- Boarding schools
- Adoption support agencies
- Voluntary adoption agencies and local authority adoption services
- Fostering services
- Private fostering
What do the standards say?
These were last revised in 2003. There are 38 standards covering choice of home, health and personal care, daily life and social activities, complaints and protection, environment, staffing and management and administration.
- A minimum of 50% of care staff (excluding the manager) to be trained to NVQ level 2 or equivalent by 2005.
- Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users’ preferences.
There are also standards specifying the minimum sizes of rooms in homes.
These date from 2002. There are 32 standards covering fitness to provide a service, management, welfare, recruitment of staff and foster carers, record keeping, financial requirements, providing suitable premises, short-term breaks and kinship care.
- The fostering service has an adequate number of sufficiently experienced and qualified staff and recruits a range of carers to meet the needs of children and young people for whom it aims to provide a service.
- Each foster carer receives an allowance and agreed expenses, which cover the full cost of caring for each child or young person placed with him or her. Payments are made promptly and at the agreed time. Allowances and fees are reviewed
What have the standards achieved?
In its 2008 report, the State of social care in England - 2007-8, CSCI reported on providers' progress against the NMS.
It found that in 2007:
- Care homes for older people met 80% of the standards on average, up from 59% in 2003.
- Care homes for younger adults met 83% of standards, up from 63% in 2003.
- Home care agencies met 78% of standards, up from 65% in 2005.
- Children's homes met 83% of standards, up from 58% in 2003.
- Fostering services met 82% of standards, up from 57% in 2003.
- Adoption services met 61% of standards, up from 56% in 2004.
- Adoption support agencies met 87% of standards in their first year of inspection.
- Residential special schools met 89% of standards, up from 61% in 2003.
However, it found progress in certain sectors had stalled, with increases of just 1% in the average number of standards met in all care homes from 2006-7, while performance against particular standards was highly variable.
For instance, fostering services met 94% of standards in relation to promoting contact but 66% in relation to supervising carers; and care homes for older people met 88% of standards relating to personal dignity and respect, but just 61% of standards covering safe working practices.
How useful are the standards?
However, in that same report, CSCI said: "It is important to highlight that the NMS were put in place five years ago and whilst some look at outcomes, there is a disproportionate emphasis on inputs and processes in others. Thus some standards may be met, but may simply indicate that there are policies and processes in place, and not whether these are actually applied in practice."
This reflected a longstanding CSCI critique of the standards, which dates back to its 2004 report, Inspecting for Better Lives. Another criticism of the standards were that they could not distinguish between average, good or excellent services that met minimum requirements.
At the time of Inspecting for Better Lives, the Department of Health was reviewing the NMS for adults' services and the then Department for Education and Skills was reviewing those for children's services.
However, these changes have subsequently been put on hold, with the DH promising to review the standards in the wake of the passage of the Health and Social Care Bill and creation of the new Care Quality Commission. The Care Matters white paper on services for children in care includes a pledge to review the NMS for children's social care, which will be taken forward by the Department for Children, Schools and Families.
In the meantime, CSCI has reviewed the way it inspects and regulates providers to place a greater emphasis on quality and outcomes, within the context of the NMS.
In Inspecting for Better Lives, CSCI proposed to group the children's social care standards under the five Every Child Matters outcomes: being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being.
This came into force. Children's services providers were assessed on how well they did in relation to the NMS, but also on their performance against the ECM outcomes on a four-point scale, enabling families to distinguish between good and better performers.
This has since been taken further. Ofsted now gives each social care provider an overall quality rating on a four-point scale - inadequate, satisfactory, good and outstanding - as well as assessing them against each of the five ECM outcomes.
CSCI has now introduced quality ratings for adult social care, which have been given to providers after every key inspection from January 2008 onwards and published on CSCI's website since May 2008. Services are judged as excellent (three stars), good (two stars), adequate (one star) or poor (zero stars).
The first published ratings showed that 13% of providers were given three stars, 57% two stars, 24% one star and 3% zero stars.