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Leadership and management failures are most common reason for regulatory action

Failures in leadership and management are the most common reason for a Priority Action Notice (PAN), the Welsh care regulator has concluded.

In its Annual report 2021-2022 , the Care Inspectorate reported that in affected homes, providers and responsible individuals had not put in place robust governance arrangements. Where staffing levels were a concern, affected homes often had no contingency planning in place, and there was a lack of training and support for staff. “These shortfalls had a significant impact on outcomes for people,” the regulator concludes.

Concerns raised about staffing levels in services significantly rose (128 per cent increase from the previous year, 174 rising to 396 in 2021–22). Concerns raised by staff working at services also increased, with almost half (47 per cent) of all concerns being raised by staff working at services compared with 39 per cent in the previous year.

In addition, there was a 45 per cent increase in changes of managers. Along with a 25 per cent increase in changes to responsible individuals, this presented instability in leadership and management with implications for continuity of care and impact on people’s wellbeing.

The report also notes a very small reduction in the number of adult care homes and places being registered, compared with the previous year (a decrease from 1,049 care homes providing 25,466 places on 31 March 2021 to 1,033 care homes providing 25,332 places on 31 March 2022). However, there has been an increase in nursing care places at the expense of residential care places.  

The most common reasons given for services permanently leaving the market is the service no longer being financially viable, or providers no longer wishing to operate a care home service. Of the new care home services entering the market, all were owned by private providers.

In total, the regulator issued 693 PANs in respect of 189 services, in comparison to 300 PANs to 109 services in 2019–20. This illustrates the increased level of serious concerns found when inspecting services. In total 23 per cent of inspections in 2021–22 resulted in PANs being issued compared with 24 per cent in 2020–21. However, both years show a marked increase from 11 per cent in 2019–20.  

The period 2021–22 saw a decline of 10 services that operate in Welsh, or Welsh and English, which includes a reduction of 83 places in care home services. Only 23 per cent of services (461 services) stated they are currently providing the active Welsh language offer.

Chief Inspector Gillian Baranski said: “System improvements are needed to ensure sustainable outcomes for people. We should not accept the experiences of conflict between health and social care about funding arrangements as the norm.” On workforce, she added: “COVID-19 has created a perfect storm, drastically altering the stability of the social care workforce.”


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