The journey from first inspection to quality standards (1857-2016): are we there yet?

Abstract

This paper is a qualitative analysis of areas of the inspection and regulation of care for people with learning disabilities and mental health problems in Scotland, in two time periods. The paper uses comparative historical research, drawing on primary sources from 1857 to 1862 in the form of Annual Reports of the General Board of Commissioners in Lunacy for Scotland and associated papers, to compare inspection methods, quality standards, and to identify persistent challenges to effective inspection. Political, clinical and public awareness led initially to criticisms of existing care and eventually to the development of the "The Lunacy Act" of 1857. This Act resulted in the first attempts to set minimum standards of care for individuals at risk, with enforceable regulation. Some factors recur as challenges to effective practice in the inspection and regulation of care today. There are problems of definition, reliable monitoring of quality standards and adequate, independent inspection of services that respond to unacceptable standards of care. There is a growing evidence base about best methods of inspection of services for people in care who are most at risk. These methods attempt to strike a balance between evidence-based and valuebased judgements. Perspectives from history may help focus resources most effectively. This paper identifies common themes and common challenges in two time periods to investigate what can be learned about the development of policy and practice in inspection and regulation of care.