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21st June 2017

Finalised Scottish National Health and Social Care standards

The Scottish Government has announced a new set of Health and Social care standards which will become fully applicable from April 2018. The standards are seen as innovative: They are more concise than the previous versions - applying across a wider range of services, and are human rights and person centred in their approach.

How the new standards were devised

The previous national care standards had been in use since 2002, from the establishment of the Care Commission, the forerunner of the Care Inspectorate. Practice and policy have changed since that time, and the old standards were seen as unwieldy and failing to capture all if the interim developments in care practice and provision. They were used by the Care Commission in its regulatory work (registration, inspection, complaint investigation and enforcement).

A drawback was that each type of service had its own standards which resulted in 23 sets of standards. On occasion, it was unclear which standards the service fell under, or indeed it might be covered by more that one set of standards.

It was determined to bring the standards up to date to remove this sort of ambiguity and to make them more relevant for modern and changing care service delivery. Increased expectations upon these services, the impact of human rights legislation, and the forthcoming integration of health and social care were further drivers of the need for change. The Government stated at the outset that:

'...the new standards will look and feel very different. They have moved away from particular settings or registration categories, are much more outcome-focused with less emphasis on provider inputs, and much more person-centred so that people’s care experiences are at the heart of a common understanding of quality.'

The standards, now finalised, certainly are different. It is immediately clear that there will be less focus on what the service provider does, or should do. The emphasis instead is on the views and experiences of the person who is receiving the service, and on how their expressed personal outcomes and aspirations are worked towards.

The new standards were drawn up in several rounds of extensive consultation. In 2014 the work began, and by 2015 five agreed principles had been agreed and approved. By October 2016 a more detailed set of standards had been reached, based on these principles. Further consultation took place through 2016/17, resulting in the present approved standards being recently accepted and published by the Scottish Government. They can be read and downloaded at here.

Structure of the new standards

The new standards are focussed on the outcomes, experiences and views of people using the services. This has helped to reduce the previous approximately 23 sets of booklets down to one 11 page document. The main structure of the standards is provided by five 'headline outcomes', stating what people can expect from quality services. These are:

  1. I experience high-quality care and support that is right for me.
  2. I am fully involved in all decisions about my care and support.
  3. I have confidence in the people who support and care for me.
  4. I have confidence in the organisation providing my care and support.
  5. I experience a high-quality environment if the organisation provides the premises.

Notice the first person language: this confirms the person-centred as well as outcome based nature of the standards. Under each of these headline outcomes are 20-30 descriptive statements which, if true, would signify that the standard is met. For clarity, these descriptive statements are grouped under the five main agreed principles, which are:

Dignity and respect,

Compassion,

Be included,

Responsive care, and

Support and wellbeing.

Although this may sound complex, it is simple when reading the whole document. It seems to me an effective way of cross-referencing the agreed principles of care with the expectations and outcomes which people using good quality care services will experience.

Some general features of the standards are that they are aspirational: they can be used by services to identify where they need to improve the quality they provide, rather than laying down a minimum standard which must be met. The Chief Executive of the Care Inspectorate stated:

“The new standards look very different to the ones from 2002. Where the old standards set out minimum things that care services had to do, the new standards raise the bar by setting out what people should actually experience."

Another important feature is that the standards now apply much more widely. They will apply to healthcare services as well as social care, and be overseen by not only the Care Inspectorate but also Health Improvement Scotland. The intention is that the standards are seen as relevant and applicable to all forms of personal care in the country to ensure a uniformity of what people can expect when they are cared for or supported in any service. This goes a long way to satisfy the important brief of the standards, to take a rights-based approach. Human rights should not vary according to location, and the wide applicability of these standards goes some way to support that.

What happens now?

The Government has stated that it intends to ensure that services are supported to know how to apply the standards in their practice.

Services should expect these standards to be fully applied by April 2018. In preparation for that, we are advising that a program of staff training should be undertaken to ensure that all staff are familiar with, and focussed on the expected outcomes of their work. In parallel with this, the service needs to amend their quality assurances systems, including questionnaires, surveys, and consultations with stakeholders. These all need to take into account more clearly the expectations, aspirations and outcomes for people using the service. This will be helped by reaching out to the support promised from the Government, which presumably will be offered through the appropriate regulatory body. It is important too for services to realise that quality of services is still dependent on meeting existing and continuing legislative requirements, as well as adherence to best practice as promulgated by the Care Inspectorate and other sources.

It is reasonable to expect the regulator, particularly the Care Inspectorate, to take changes on board in the light of the new standards. One example is the existing quality themes and statements used in inspection. These had been distilled from the previous sets of standards, and so we would hope that at least they be reviewed to reflect the new expectations on services. Another change may be that the Care Inspectorate may amend its inspection methodology, and it has already stated that it will be looking at this. Finally. there is the possibility that the new flexibility and extended applicability of the standards will prompt a redefinition of the type of service provision. This may provide greater flexibility of service providers, and stimulate innovation in how services are delivered. Regulated services are advised to keep up a liaison with their inspectorate, and to be alert to new information about developments as these are released.

Finally, Quality Compliance Systems needs to review the policies and procedures in line with the new expectations on services in Scotland. We will be keeping you up to date with this. Do be in touch if we can offer any further advice or information, or if you have anything else you think we should consider.

A lot of work has been done, and remains to be done, on implementation. However, the new approach has been welcomed in all quarters, and should in coming years lead to transformational improvement in how we can all reasonably expect to be cared for.

*All information is correct at the time of publishing

Tony Clarke

Scottish Care Inspectorate Specialist

Tony began care work as a care assistant in care of the elderly here in Scotland in the 1970s. He very much enjoyed promoting activities, interests and good basic care. After a gap to gain a social work qualification, he worked in management of care services, latterly as a peripatetic manager which gave him experience of a wide range of services.

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