Wales

Registration of providers is subject to the acceptance by Welsh Ministers of a statement of purpose from the service provider about their service. This statement relates to staffing level decisions because schedule 2 of the registration regulations requires that the statement specify how the service will meet the needs of individuals and support them to achieve their personal outcomes. It is also a requirement that the statement specify details of management and staffing structure.

Statutory registration as a homecare provider depends upon satisfying Welsh Ministers that domiciliary care visits will not be of less than 30 minutes duration, unless those visits meet statutory conditions for permissibly shorter visits.

Regulations 6-13 of the service providers regulation set out requirements for registered providers that pre-empt the actual provision of any service.

Regulation 6 requires that service providers must ensure that their service is provided with ‘sufficient care, competence and skill, having regard to the statement of purpose’.

This puts staffing issues at the heart of service standard regulations and statutory guidance on regulation 6 makes clear that Welsh Government expects ‘safe staffing arrangements, underpinned by professional development, to meet the care and support needs of individuals’.

Welsh Government Statutory Guidance on Parts 3 to 20 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

Issues of staff workload are pertinent to care quality.  Regulation 8 requires that service providers ensure that there are effective arrangements in place for monitoring, reviewing, and improving the quality of care provided. These arrangements must include seeking the views of ‘staff’ on the quality of care provided and how it could be improved. When making decisions about plans for quality improvement, service providers must take those staff views into account. Statutory guidance on regulation 8 expects service providers to encourage feedback and to regularly seek staff views about quality of care. Service providers are expected to be able to demonstrate they have done this and provide analysis of feedback received. The meaning of ‘staff’ for the purposes of the regulations includes employees, workers, self-employed individuals and agency workers.

Welsh Government Statutory Guidance on Parts 3 to 20 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

Regulations 14-20 of the service providers regulation set out the standards that must be met by service providers in the provision of services.

Staffing level and workload issues are pertinent to regulation 14 (suitability of service) because it requires that service providers do not provide care and support for an individual unless the service provider has made a determination that the service is suitable to meet the individual’s care and support needs and to support the individual to achieve their personal outcomes. That determination must include consideration of any risks to individuals’ well-being or to other clients.

Statutory guidance about regulation 14 (suitability of service) states that registered providers ‘must not’ take on new domiciliary care clients unless they are ‘sure’ that existing clients will not be impacted, and gives the example of changing their preferred/required call times. This implies that regulatory requirements about suitability of service may be complied with in domiciliary care only if staffing levels are sufficient as to ensure that taking on new clients does not change arrangements already in place with existing clients. This suggests Welsh Government expects a degree of certainty and security to be in place in the relationship between service users and staff, although it does not go so far as to explicitly state that staff should not be placed with other service users due to the taking on of new clients.

Regulations 21-32 of the service providers regulation set out the standards of care and safeguarding that must be met by service providers.

There are staffing level and workload implications arising from Regulation 22 (continuity) because this requires service providers to put in place arrangements to ensure that individuals receive such continuity of care as is reasonable to meet their needs for care and support.

Regulations 34-42 of the service providers regulation set out the staffing standards that must be met by service providers.

Regulation 34 (staffing) requires that service providers ‘must ensure that at all times a sufficient number of suitably qualified, trained, skilled, competent and experienced staff are deployed to work at the service’.

Service providers are required by regulation 34 (staffing) to calculate their ‘sufficient number’ of staff with regard to ‘the statement of purpose’ of their care service, the ‘needs of the persons to whom care is provided’, the need to support individuals ‘to achieve personal outcomes’ and the meeting of regulatory requirements.

Statutory guidance enhances the specificity of regulation 34 (staffing) with an expectation that service providers have a ‘demonstrable, measurable and systematic’ approach to determining staff numbers.

This must include consideration of skills needed and care workers qualifications required for reliable provision.

This must also include consideration of, at minimum, the organisations’ statement of purpose, the assessed needs and dependency levels of individuals, the environment facilities and equipment provided, the location of homecare service delivery including travel time requirements, the mix of knowledge, skills and competence required to meet the specific needs of individuals on a collective and individual basis.

Regulation 34 (staffing) requires service providers to be able to demonstrate how they have determined the type of staff deployed and the numbers of each type.

Because service providers must ensure arrangements are made for the support and development of staff, staffing level implications arise from this aspect of Regulation 34 (staffing).

Service providers must ensure that individuals are not prevented from receiving reasonable continuity of care to meet their needs due to the employment or engagement of any persons on a temporary basis or on a non-guaranteed hours contract.

According to statutory guidance about regulation 34 (staffing), service providers are expected to keep staffing levels and skill mix under continuous review in order to respond to changing needs and circumstances.

Service providers must ‘prepare a schedule of visits in respect of each domiciliary care worker working at the service’ and ‘provide a copy of the relevant schedule of visits to the domiciliary care worker to whom that schedule relates’.

‘The schedule of visits must delineate the time allocated for travel time, the time allocated for each visit and (if applicable) the time allocated for rest breaks’

‘(3) The time allocated for travel time must be sufficient having regard to—

(a) the distance between the location of one scheduled visit and the next scheduled visit; and

(b)any other factors which might reasonably be expected to affect travel time, such as traffic congestion and the availability of parking at the location of the scheduled visits.

(4) The time allocated for each visit—

(a) must be sufficient to enable care and support to be provided to the individual in accordance with their personal plan; and

(b) must not be less than 30 minutes unless either condition A, B or C, as described in section 8 of the Act, is met.’