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Social care regulation rarely makes it onto the public or political radar. Interest, generally speaking, is usually confined to care professionals, service users and their families or the policy wonks in charge of regulatory issues.

But Winterbourne View has forced regulation up the national agenda. Suddenly, more people are aware that whether or not a care setting is registered and inspected, for example, has massive implications for the welfare of vulnerable people.

The Care Quality Commission (CQC, in the news today for its damning indictment of hospital care for the elderly) took responsibility for the regulation of health and adult social care providers in April 2009. Since the introduction of a new registration system for providers last year, as Community Care magazine has reported, there was a disastrous 70% drop in inspections by the CQC.

We have already questioned the long delays and administrative shortcomings of CQC along with the proposals for a replacement for the former star ratings system, so it was therefore imperative that the VODG submitted a detailed and robust response to the recent Department of Health consultation, Proposed changes to regulations for Care Quality Commission registration.

The 12-week DH consultation, which ended last week, included 19 proposals in three broad areas: changes to the extent of regulation, technical amendments to the regulations and minor clarifications to the regulations. Depending on how the consultation shapes the government's plans, the changes will come into force in 2012/13.

We agree broadly with the main proposals like CQC specifying a standard format for statutory notifications to ensure that providers are confident they properly informed CQC about a specific event or requiring providers to prove all reasonable steps were taken and all due diligence exercised to ensure compliance with registration requirements. However, we seized on the opportunity presented by the consultation to call for a focus on issues that we think are confusing or in fact add to the regulatory burden for providers. While amending the current regulations might not be the best way to solve some of the problems we highlighted, we felt it was an apt moment to raise our concerns.

One problem that we included in our response, which we know is of concern to our members, is the definition of a location; we need more clarity about what “a location” constitutes. While CQC has produced guidance (What is a location?), this fails to cover the diverse ways that providers deliver personal care.

We have examples of CQC accepting as a location situations where services are provided to people across one or several counties, across an entire region or indeed over the whole of England.

CQC guidance, for example, suggests that where a provider is an agency providing staff to people's homes (where the staff carry out regulated activities), then each office that manages those staff will be a location. This is not relevant to the examples I just mentioned  - services provided across one or several counties, across a region or the whole of England – because “a location” of that kind has had to introduce a structure beneath it to provide direct management of care more locally.

This is extremely confusing for providers. It makes it difficult to identify a registered manager in day-to-day charge of the regulated care activity. What happens when the registered manager role is taken by someone who is distant, in management terms, from the delivery of care? Our understanding, and indeed expectation, of the registered manager role is that the person in that role is in daily charge of the regulated activity from a location that allows them to be physically situated much closer to the delivery of the service.

There is another concern with the issue of registered managers. The wording of the relevant regulation needs clarification. The wording we are concerned about is this: “the registration of a service provider in respect of a regulated activity must be subject to a registered manager condition”. This seems to imply that a registered manager is required for the regulated activity overall, regardless of the locations where it is delivered. CQC have provided guidance (its Scope of Registration document states: “A manager is an individual who is in day to day charge of a service provider's regulated activity, or a service provider's regulated activity in a particular location.”) which is helpful but does not clarify how large a location can be and what management arrangements are needed for a registered manager to fully meet the requirements to be in “day to day charge”.

We agree with CQC's assertion that the manager role is such an important one, and this makes us even more concerned about the enormous geographical situations that CQC accepts as locations. We believe that a registered manager in those situations cannot truly be in day to day control of the location unless there are robust arrangements in place (for example if the registered manager has no other significant managerial responsibilities or if there are clear reporting and quality assurance systems that connect the registered manager with the front line workers).

When the regulations were originally being crafted we understood that the intention was that manager registration would be portable, allowing a manager to work for another registered provider without undergoing a full re-registration process.

We also have worries about what happens when a provider needs to make changes to their registration. An example of this is where a VODG member moved the office of a location overseeing their supported living services.  The personnel, equipment and facilities of the agency were to remain the same.  Under the Care Standards Act 2000 they would only have needed to tell the regulator of the move of address.  Under the Health and Social Care Act 2008 they must:

• complete and submit application to remove a location (provider)
• complete and submit application to add a location (provider)
• complete and submit application to remove a location (registered manager)
• complete and submit application to add a location (registered manager)

This confusing, time consuming and bureaucratic process adds to the regulatory burden for providers.

In a nutshell, as we have long stated, we want an inspection system that reduces regulatory burden (and therefore administrative costs), and ensures a transparent system with high quality consistent judgements.

In the consultation document, Simon Burns, Minister of State for Health Services, acknowledges CQC's teething problems, accepting that “the first year of the new registration system operated by CQC has highlighted a number of issues in the regulations that either do not function as initially intended, lack clarity or which impose an unjustified burden on providers.” He wants, he writes, the government to keep regulatory burdens to a minimum “while ensuring that the systems are effective at protecting service users.”

If the minister wants make his rhetoric on improving clarity and reducing burden a reality, then our suggestions must be taken on board and given serious thought.