Headline Outcome – Involving People in Decisions About Care

September 28, 2017


It will be useful for services to become familiar with the layout and content of the new Health and Social Care standards in Scotland before they are fully introduced in April 2018. This will help services to review their operations, such as training, recruitment, and policies on rights and personal outcomes. It will also enable the quality of support to be provided in accordance with these increasing expectations.

Headline Outcomes

The standards are simply laid out according to five ‘headline outcomes’. Each has descriptions of what can be expected, based on the five agreed principles of the new standards as follows:

  • Dignity
  • Compassion
  • Be included
  • Responsive care and support
  • Wellbeing

(The complete standards can be downloaded at: the Scottish Government website.)

Each week I will cover one of the five headline outcomes, with the standards descriptions under these principles, of what people choosing the service should expect, and what the service should do to meet these expectations.

‘I Am Fully Involved in Decisions About My Care And Support

This week I will discuss the outcome ‘I am fully involved in decisions about my care and support’.

Dignity and respect

Under the principle of dignity and respect, people’s expectations of the service include being supported to be in control of their care and to make relevant choices in how it is provided. Understanding their rights, and access to advocacy is important here. Where support is needed in managing finances, the person should have this provided. There should b effective safeguards, and they should be in control as much as possible. Any decisions on restrictions or personal monitoring which may be necessary should be made with the person’s involvement and agreement where possible.

Advocacy is a very import part of meeting these expectations. It is very helpful to have details of an independent person, advocate, relative or friend, who can be involved, where necessary, in an informed way to ensure that expectations are clear, and are met.


Compassion is expected of people who provide support, in being sensitive to the person concerned and their needs, particularly in how these are communicated. This highlights the need in recruitment to give high priority to selecting people who can demonstrate sensitivity and compassion. In turn this will demand of managers good interviewing skills and procedures. A review of how compassion and sensitivity is handled in the induction procedure, as well as in staff appraisal procedures will be valuable.

Be Included

This expectation begins from the very beginning of support. Has the person been included in the decision about which service to accept, and which type of service? Self-directed support, as it becomes more widely available should ensure that this expectation is met. Information about the services should be easily accessible, and understood, with translation and other procedures where necessary. Services might consider video presentations, or other media.

Where the person has reduced capacity, or a decision must be made with which they may disagree, then an independent person should be involved who knows the person’s wishes, and can help with communication about the reasons involved. Each person is enabled to build positive relationships and to manage any conflict, as well as to understand when and why information about them may need to be shared with others. Again, staff skills will be crucial in meeting this expectation, particularly the need to be able to communicate and to listen effectively,

Responsive Care and Support

The personal or care plan, and other records must be regularly reviewed and assessed as to whether it is responsive to, and clear about the person’s needs and choices. Friendships and relationships are encouraged, with support where necessary.

If the person wishes another type of care and support the service must accept this. They must support the person in making the decision and carrying it through.

Meeting these expectations needs consistent personal communication and monitoring of records.


The person’s hobbies, interests and things that are important to them are vital to quality of life. Therefore these things should have a high priority in planning support and care. Arranging activities and mealtimes, maintaining independence in taking medication, and being in touch with relevant outside organisations are all important to this outcome. Members of staff who are good at organisation and activity planning, and who involve people in decisions, will be invaluable in meeting the outcome. Recruitment criteria and skill balance among the staff will be crucial also.


This headline outcome is important in putting the person at the centre of their care. Reviewing recruitment and induction procedures will assist in any changes needed to meet the expectation. Minor changes in documentation may assist in reorienting the service towards putting people’s expectations at the centre of the work to be done.

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Tony Clarke

Scottish Care Inspectorate Specialist


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