The findings from the Equality and Human Rights Commission inquiry into home care for older people shone a welcome light on the quality of care provided and its impact on people’s autonomy and dignity.

As the commission notes, good home care is invaluable in enabling people to remain in their own homes and to continue to live independently and to exercise control over their lives.

However, despite the finding that around half of all the people who gave evidence to the inquiry “expressed real satisfaction with their home care”, there can be no grounds for complacency.

People are reluctant to express dissatisfaction or make complaints, and can be particularly concerned about repercussions. The concerns highlighted by the commission include: lack of care and neglect of needs; disregard for privacy and dignity; poor attitudes and patronising manner; rough handling; and financial abuse.

Many difficulties with rushed care visits are a result of the way they are commissioned (often in 15-minute time slots) and the low price paid by many local authority contracts. The logistics of delivering good quality home care are also inherently difficult – people typically all need help at the beginning and end of the day (when getting up and going to bed), and care assistants will frequently struggle to visit all their clients within a reasonable time. However, nothing excuses disrespect, abuse or lack of compassion.

The Care Quality Commission attempted to pre-empt the report the day before publication by announcing it will carry out “a themed inspection programme of home care services” (involving about 250 providers). This is important, but it isn’t enough. The care services minister, Paul Burstow, told Radio 4’s Today programme that the strategy would be one of “more snap inspections, backed up by tough enforcement”.

The obvious hole in this approach is the absence of adequate levers. Although care providers are registered with and inspected by CQC, the staff providing the care are not regulated. Burstow referred to an intention to introduce a ‘code of practice’, and claimed that when the coalition government came into office none existed. He is wrong.

The United Kingdom Home Care Association has long operated a code of practice which member organisations must sign up to. Equally, the social care workforce regulator the General Social Care Council introduced codes of practice in 2002 that were aimed at all “social care workers and employers of social care workers describing the standards of conduct and practice within which they should work”.

It was surprising that the minister made no mention of the role of workforce regulation, or offered any clarification about the future direction for social care. The General Social Care Council is to be abolished on 31 July 2012 and its functions transferred to the Health Professions Council (HPC).

However, the government indicated last year that it is committed to “reducing unnecessary costs of regulation” and in the current public spending environment it does “not believe that the statutory regulation of home care workers, or the wider adult social care workforce can be justified”. Instead, the HPC is to explore the scope for establishing a voluntary register of social care workers. What that might look like and how it would relate to improving public protection in home care is unknown.

Any voluntary registration system would need to be open not only to care staff working with providers already registered with CQC, but also to people working as personal assistants (PAs). The development of personal budgets means that increasingly people who use home care services will do so in a variety of ways. Contracting directly with providers or employing people as PAs will increase. The opportunity to choose to employ people who are on a register, who sign up to clear codes of practice and who take responsibility for the standard of their own practice should be available.

Most people who work in social care are committed to what they do and to providing good quality care, but the potential for poor care – and worse – to remain hidden from view is enormous. When care takes place in people’s own homes, behind closed doors and out of sight, those risks are magnified.

The report from the Equality and Human Rights Commission is a further reminder to both the CQC and HPC that the regulatory framework is incomplete, inconsistent and currently unable to offer the safeguards that are needed to protect the dignity and wellbeing of people who use home care services. More inspection and a further code of practice may be part of the solution, but it is not sufficient.

• Melanie Henwood is an independent social care consultant. She was a lay member and vice chair of the General Social Care Council

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