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Grading care service quality in Scotland
At that time, a quality assessment and improvement approach was adopted after considerable consultation and preparation. The thinking was that providing a concrete yardstick of quality, a grade, from each inspection, would allow both the public and services themselves to pursue quality in the provision of care services.
The policy has been successful, and research has shown that quality of services, as measured by grades, is increasing steadily on average.
Quality standards are graded
Inspections in Scotland are based on the National Care Standards, and on relevant regulations. The new quality framework distilled these standards into quality statements which fell into four categories, Quality of Care, Quality of Environment, Quality of Staff and Quality of Management. Each quality statement inspected is graded as follows:
Grade 6 – Excellent
Grade 5 – Very good
Grade 4 – Good
Grade 3 – Adequate
Grade 2 – Weak
Grade 1 – Unsatisfactory
The grades are then aggregated for each of the four categories, so that published inspection reports give four grades for the service. Unsurprisingly, the lowest grades mean that the service may be subject to enforcement, and can lose funding or commissioning of places by the local authority.
At the other end of the scale, excellent services are celebrated: their good practice is noted and promoted as exemplary to other services.
One key theme of the quality assessment framework is participation. The Government wants people to be able to influence the quality of services they receive, and so care services are expected to involve their users in assessing and contributing to improvements in the quality of their service. This includes service users participating in the annual self-assessment which services submit as their judge of the grading which they have achieved.
The improvement of quality should be 'rigorously pursued'
Other key themes of grading are that the service must be able to demonstrate strong evidence of good outcomes for its service users. This has contributed in part to a welcome increase in evidence-based and outcome-based approaches to the provision and commissioning of care services.
The overall theme is the improvement of quality: the inspectors look for evidence that any previous requirements or recommendations have been met, and that opportunities to improve the quality are ‘rigorously pursued’.
Participation, strong evidence, good outcomes and an improvement agenda are features of services which are likely to achieve higher grading, as advised in the Care Inspectorate guidance on their website.
Duncan, B. (2007) Inspecting for Improvement in Scotland Journal of Care Services Management, vol. 2, No 1, pp 17 -27