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Changes for care regulation in Scotland
How care services are inspected and regulated in Scotland is undergoing changes, some of which have happened and some are to be implemented in the near future. The following is a summary of what is happening.
New Care Standards
There has been extensive consultation across the country on the proposed new Health and Social Care Standards. This has covered the overarching principles and the specific rights which people using care services should have. This stage has already been completed and approved by Government ministers. The next stage will be to finalise general and some specific standards, which will be agreed and implemented from April 2018.
The new standards are rights-based and possibly simpler than the previous sets of standards. To be consistent with this the Care Inspectorate, and Health Care Improvement Scotland, will be revising their inspection methodology to be consistent with the promotion of the standards as they emerge.
Another interesting possibility is that current definitions of care services may be revised, ’to help remove barriers which providers of flexible, innovative services may be experiencing.’ At present, the older care standards were written as separate booklets for approximately 23 different types of care services. This made it difficult for providers who delivered flexible services, or several different types of service in one location. Any redefinition promises to make it easier to provide the type of support service a person needs, when and where they need it.
Recent changes in Inspection frequency and methodology
Over the past year, inspection methodology and frequency has already changed. The intention was to make inspection more streamlined and focussed on where services need more support, while high-performing services may have less inspection time, allowing inspectors more interaction with service users, families and other stakeholders.
The current situation is that inspections for most regulated services will be at least one annually and will be unannounced unless in very exceptional circumstances. There are now two main types of inspection: Graded inspections and follow-up inspections.
Graded inspections will look at a minimum of two themes, one of which must be care and support. Individual quality statements are no longer inspected. These inspections will be carried out for services grading at ‘good’ or better.
Follow-up inspections: A service may need a second inspection in the year if the grade is ‘adequate’ or lower. This inspection will concentrate on the action plan from the previous inspection, and on how the requirements and recommendations have been acted upon. Grades will not be made on the basis of the follow-up inspection.
The focus of inspections is now on how people experience the service, on how the service is aware of, and responds to people’s experiences. There is also increased focus on how personal outcomes and aspirations are worked towards. People’s rights are obviously now of increased importance, given the overall principles of the forthcoming finalised National Health and Social Care Standards.
These changes in methodology have already taken place, and the Care Inspectorate is currently consulting on how inspection might change as the new standards are finalised and implemented from next year. (The overarching principles and associated rights have already been approved, and are seen as already applicable).
Structure of the Care Inspectorate
There have been changes in the senior management and Board of the Care Inspectorate over the past year or so.
Like the services it inspects, the Care Inspectorate has had to cope with decreased funding. In the current year, it was expected to save over £1m. There may be reductions in manpower because of this, and some staff who leave may not be replaced. This may fit with a more proportionate, leaner, and more streamlined inspection process.
What do services need to do now?
Services, while pursuing their own aims and objectives, need to adapt to the changing focus and methods of inspection.
Since inspection frequency and intensity will increasingly depend on information held and received about the service, then submitting the self-assessment, annual returns, and notifications to the Care Inspectorate, need particular attention.
Care services need to develop their manager’s and staff’s knowledge and awareness of the experience of service users, focusing on their rights, the outcomes of care for individuals, and importantly working to support the aspirations of service users as well as their input on the quality of service provided.
For most services, this will require specific training at all levels, closer attention to involving the views of service users in improvement and being able to give strong evidence that the service is adhering to the new principles and specifics of the National Heath and Social Care Standards.
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