An Exploratory Study of the Views of Stakeholders About the Role of Regulation in Social Care Service Provision in Scotland
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PRITCHARD, G.B. 2020. An exploratory study of the views of stakeholders about the role of regulation in social care service provision in Scotland. Robert Gordon University, DPP thesis. Hosted on OpenAIR [online]. Available from: https://openair.rgu.ac.uk An exploratory study of the views of stakeholders about the role of regulation in social care service provision in Scotland. PRITCHARD, G.B. 2020 Copyright: the author and Robert Gordon University This document was downloaded from https://openair.rgu.ac.uk An exploratory study of the views of stakeholders about the role of regulation in social care service provision in Scotland Gillian Borthwick Pritchard DPP 2020 An exploratory study of the views of stakeholders about the role of regulation in social care service provision in Scotland Gillian Borthwick Pritchard A thesis submitted in partial fulfilment of the requirements of the Robert Gordon University for the degree of Doctor of Professional Practice This research was carried out in collaboration with the Care Inspectorate July 2020 1 Abstract Performance management of social work and social care services, complemented by effective regulation, is viewed as key to improving delivery and providing public assurance about care quality, and the value of listening to stakeholders as contributors to the knowledge base has long been recognised. The evidence base as it relates to stakeholders’ experiences of regulation, however, has not been comprehensively explored. Many studies seek the views of stakeholders in the development of individual services, yet fewer studies seek their views in shaping regulatory methodology. The rationale for this research was to contribute to a knowledge base from evidence using an empirical approach and to contribute to better understanding of regulation from the perspectives of stakeholders. The research was undertaken using an explanatory sequential mixed methods design. For the quantitative phase, a descriptive analysis of data held by the regulator in relation to the evaluations of care services, improvement in evaluations over a specified period of time and the impact of complaints, requirements or enforcements on this performance was undertaken. Data in relation to inspection satisfaction questionnaires was also descriptively analysed. Findings from the quantitative phase informed the qualitative phase. The qualitative phase began with a co-productive approach involving ten individuals: both regulatory staff and inspection volunteers. Themes arising from their responses, complemented by the findings from previous research phases, then informed the design of individual interviews with six service providers. A thematic analysis was undertaken for both parts of the qualitative phase. The research demonstrated some contradictory views between regulators and those being regulated. Regulators described building positive relationships with services within a model of responsive regulation. Service providers experienced a bureaucratic process with a compliance focus and relationships in which the power imbalance and a lack of knowledge often led to feelings of anxiety and fear. In the current environment in which high quality care is expected by both public and government alike, despite the impact of austerity measures, this research recommends that further dialogue needs to take place to ensure the impact and outcomes from regulation are better understood and explicitly articulated. 2 Identifying key words for indexing and information retrieval: • Regulation • Social care • Social work • Inspection • Stakeholder / stakeholder views • Mixed methods research • Co-production 3 Acknowledgements I would, firstly, like to thank everyone who participated in and supported my research through the co-productive phase and the individual interviews. Without them, this research would not have had the benefit of expert knowledge and experience in enabling me to understand their perspectives and I am very grateful for their time, insight and involvement. I would also like to thank my tutors at Robert Gordon University – Dr Linda H. Smith, Janine L. Bolger and Professor Lesley Diack. The help, support, challenge and encouragement they provided to me consistently over the last five years have been invaluable and inspiring. I would like to acknowledge the support of the Care Inspectorate in enabling me to pursue this research. In particular, I very much appreciate the support from colleagues in the Intelligence Team and Business Support. For not questioning our loss of evenings and weekends while I squirreled myself away in our study writing furiously for the last five years, a huge thanks go to my beloved husband. I have always had the support of my parents in everything I do and this Doctorate is no exception, so my enduring thanks go to them both for their constant encouragement. This thesis is dedicated to the memory of my dad who is always with me. 4 Contents Page Chapter 1: Introduction 19 1.1 The provision of social care services in Scotland 19 1.2 The regulation of social care in Scotland 20 1.2.1 Early years inspections 20 1.2.2 Residential care 20 1.2.3 Nursing homes 20 1.2.4 Care at home services 20 1.3 Variation in the regulation of care services 21 1.4 Regulation of care (Scotland) Act 2001 21 1.5 Public Services Reform (Scotland) Act 2010 22 1.6 Problem statement and rationale 22 1.6.1 Research in the field of social work 22 1.6.2 The importance of an evidence base 23 1.6.3 The evidence for involving those using services in research 23 1.6.4 Research about regulation with those using services 24 1.6.5 The significance of this study 25 1.7 Research question, aims and objectives 25 1.7.1 Research question 25 1.7.2 Research aim 25 1.7.3 Research objectives 25 1.8 Overview of the research 26 1.8.1 Research approach 26 1.8.2 Mixed methods 26 1.8.3 Quantitative phase 26 1.8.4 Qualitative phase: co-productive approach 28 1.8.5 Qualitative phase: interviews 28 1.9 Ethical and other considerations 28 1.9.1 Value relevant research 29 1.9.2 Anonymity, confidentiality and consent 29 1.9.3 The role of the ‘self’ as researcher and employee 29 1.9.4 The balance of power 29 1.9.5 Trustworthiness 29 5 1.10 Limitations of the study 29 1.11 The researcher 29 1.12 Chapter summary 30 1.13 Thesis structure 30 Chapter 2: Social care regulation in Scotland 32 Introduction 32 2.1 The Care Inspectorate 32 2.2 Registration of care services 32 2.3 The regulator’s duties 33 2.4 National Care Standards 33 2.5 The Care Inspectorate approach to the regulation of care services 34 2.6 Evaluation of registered care services 34 2.7 Using the evaluations 34 2.8 Joint strategic inspections 35 2.9 Supporting improvement 35 2.9.1 Signposting 35 2.9.2 Recommendations 35 2.9.3 Requirements 36 2.9.4 Enforcements 36 2.10 The involvement of stakeholders in inspection 36 2.10.1 The regulator’s approach to involvement 37 2.10.2 How the regulator involves people 37 2.11 How the regulator seeks the views of those using services 38 2.11.1 Care standards questionnaires (CSQs) 38 2.11.2 Inspection satisfaction questionnaires (ISQs) 38 2.11.3 The voices of those using services during inspection 38 2.12 Following inspection 39 2.13 Chapter summary 39 Chapter 3: Literature review 40 Introduction 40 3.1 Regulation in history 42 3.2 Defining regulation 45 3.3 The language of regulation 45 3.4 Findings from the literature review 46 6 3.4.1 Assurance and accountability 46 3.4.2 Public safety and protection 46 3.4.3 Value 47 3.4.4 Compliance 47 3.4.5 Identifying, addressing and learning from failures 48 3.4.6 Regulating risk 48 3.4.7 Supporting change or improvement 48 3.5 Complexities of regulation in the care sector 50 3.5.1 Regulation of the workforce 50 3.5.2 Complexities of the care sector 50 3.5.3 The complex role of the regulator 51 3.5.4 Regulation and performance management 51 3.5.5 The evidence base of care regulation 52 3.6 Models of regulation 52 3.6.1 Compliance 53 3.6.2 Responsive regulation 53 3.6.3 Smart regulation 57 3.6.4 Self-regulation 57 3.6.5 Voluntarism 58 3.6.6 Right touch regulation 58 3.6.7 Anticipatory regulation 60 3.6.8 Regulatory sandboxes 60 3.6.9 The integrated model of regulation 62 3.7 Critiques of regulation 63 3.7.1 The process of regulation 64 3.7.2 Regulatory practice 66 3.7.3 The impact and outcomes from regulation 68 3.8 Involving stakeholders in regulation 70 3.8.1 The stakeholders of regulation 70 3.8.2 Engagement with stakeholders 71 3.9 Learning from regulation 72 3.10 Themes arising from the literature 75 3.11 Chapter summary 76 7 Chapter 4: Methodology 77 Introduction 77 4.1 Methodology overview 77 4.2 Research approach 77 4.2.1 The researcher’s world view 78 4.3 Research design: mixed methods research 80 4.3.1 Explanatory sequential mixed methods 83 4.3.2 Within subject design 86 4.3.3 Between subject design 86 4.3.4 Mixed methods research using a co-productive approach 86 4.4 Phase 1: approaches to the quantitative phase 87 4.4.1 Quantitative data 90 4.4.2 How the regulator uses data 91 4.4.3 External statistics to which the regulator contributes 92 4.4.4 How the regulator’s data can be accessed 92 4.5 Sampling 93 4.6 Methods 93 4.7 Analysis of the quantitative data 94 4.8 Limitations 94 4.9 Linking the quantitative phase to the qualitative phase: the Co-productive approach 94 4.10 Phase 2: approaches to the qualitative phase: the co-productive approach 95 4.10.1 Defining co-production 95 4.10.2 A co-productive approach in this research 98 4.10.3 Consideration of a Delphi study 99 4.11 Sampling 100 4.11.1 Numbers