At the Care Roadshow in Glasgow on 19th of April, we heard about and had some discussion of the current changes which the Care Inspectorate is beginning to introduce in its inspection and regulatory work. The following is how the future plans seem to me at present based on limited information currently available.
External influences are the Government initiative to emphasise human rights, and to introduce this approach in the current review of the National Care Standards. There is also, this month, the introduction of integrated Health and Social Care Boards in Scotland to oversee commissioning and provision.
Internally the Care Inspectorate is to increasingly take a proportionate and partnership approach to improve quality through improving outcomes, rather than the main focus always being on enforcing compliance with regulatory inputs and requirements. Innovation is also to be further encouraged.
The current picture for Care Homes
There are approximately 1500 registered care homes across Scotland, of which 879 are care homes for older people. The majority, approximately 75%, have overall grades of good or very good. Care homes for (non-elderly) adults have a 90% rate of achieving good or very good grades from their inspections.
The overall picture then is of good services, and the Care Inspectorate aims to continue to actively support services in implementing their own improvement strategies.
Rights based standards and inspections
A current review of the National Care Standards is under way. The emphasis of the new standards, under which services will operate and by which they will be inspected, is on Human Rights. A website is available documenting the progress of consultation and the introduction of these new standards, (http://www.newcarestandards.scot/)
The present situation is that overarching principles for the standards have been agreed after consultation, and approved by the Scottish ministers. They are:
- Dignity and respect;
- Compassion;
- Being included;
- Responsive care and support;
- Wellbeing.
The more detailed and specific standards will be consulted on later this year, with a phased introduction from 2017. This should enable services to prepare staff for the changed emphasis, and introduce training and other necessary procedures.
Compliance v Partnership for good outcomes
A new approach to inspection is already being tested out by the Care Inspectorate, as it moves to more targeted, proportionate and outcome-focused working.
Being targeted means that services which have demonstrated they are performing well will receive a lighter touch, possibly less frequent and/or less intense inspection. Inspections will monitor the improvement in quality and follow up on points raised in previous inspections. Services which need greater support will therefore be able to have more resources and time allocated to them.
Proportionate inspection will focus on the service’s own responsibility to provide good outcomes, and a positive approach will encourage and highlight the good outcomes achieved for people using the service. Where at present requirements may be made when there are gaps in procedures, in the new approach the outcomes will be considered and discussed, and noted in the inspection report for follow up at the next inspection.
The overall aim will be for services and inspectors to understand what it is like to live in the service, and to ensure that people’s rights are fully observed. Innovation is to be encouraged, with services responsible for implementing and sustaining their own improvement.
New inspection methodology
Currently inspections sample quality statements from four quality themes, but the Inspectorate is moving to a looser approach which will focus on the quality themes only. It is thought this will allow a more flexible approach to support services in a partnership approach to improving quality, rather than compliance on enforcement. However, services which support people with dementia may not follow these changes in inspection at present.
Commissioning of services has often been based on people’s comments on the service, rather than on the grades, so the inspection reports are planned to be shorter, with more emphasis on the views and influence people have on the service they receive. The report will show what services do well, and will emphasise and look for innovation in how quality is achieved.
People based
There has been a relatively new senior management team, promoted from within, at the Care Inspectorate. This is seen as supporting continuity in progress which has already been made, and strength to introduce further innovations in inspection.
It is encouraging that the people-centred basis of inspection will be sustained. At the roadshow we heard that the approach of inspectors will be understand and take into account what it is like to receive, and in care homes to live in, the service. It is also encouraging that the Inspectorate aims to have confident, specialist inspectors working together in collaboration with services.
We hope that this vision becomes a reality involving as it does considerable cultural changes for all, not least for services. It is promising that the roots of this approach are already established: participation by service users in how the service is delivered has always been a key feature of inspection criteria; and inspection reports have always aimed to be balanced between strengths and areas of improvement.
Challenges?
A risk based approach requires very good intelligence and information gathering, and possibly on the integrity of each service providing accurate information to ensure that inspections are properly targeted and carried out. But clearly poorly performing services may not assess their performance accurately and this could influence inspection decisions adversely.
A rights’ based scrutiny is welcome, but has subtle differences: it has been suggested that rights can sometimes be qualified, yet this does not sit easily with fixed regulations, or with common standards for all. This may or may not be an issue to be ironed out, as changes are introduced.
It will clearly take considerable time to establish the new ethos, and to motivate staff and services in changes when they are used to the more traditional approaches. But change is inevitable, and necessary in pursuit of continued improvement in how our services are delivered: this goal should be welcomed by us all.
