A High Quality Environment

October 24, 2017


I have been describing each week, one of the five headline outcomes which form the main structure of the new Scottish National Health and Social care standards. These will be fully introduced from April 2018. They can be consulted, and can be downloaded in their final form from the Scottish Government website. (https://beta.gov.scot/publications/health-social-care-standards-support-life/pages/2/)

The fifth and final headline outcome is the person’s experience of a high-quality environment:

5: I Experience a High-quality Environment if the Organisation Provides the Premises.

This, like the other four outcomes, gives expectations under the five main principles of care: dignity and respect; compassion; be included; responsive care and support, and wellbeing.

1 Dignity And Respect

The design and adaptations of the building should allow people privacy, security of their belongings, easy access to toilets, communal areas and to outdoor spaces.

A recent study of care home living by the University of Warwick found that the overall design of the building was less important than providing the ability to be outdoors and to freely interact with others. It is good to see these being recognised as important in the new standards.

2 Compassion

Under this principle, a person can expect a service that is the right size for them: that has comfortable, homely areas with soft furnishings where people can relax. In a care home, there should be opportunities for small group living, with access to a kitchen where possible.

My view is that this homeliness involves more than the traditional picture of each person in a lounge with their own upright armchair. That is all well and good, but should include a variety of seating options, areas, and layouts as in any of our homes.

3 Be Included

The person can expect to continue their involvement with people and with the community important to them, with the service being located as close as possible to these, and with personal TV, internet and telephone connections.

People can control access, decoration, lighting, ventilation, heating and security of their rooms. Private visiting and staying-over facilities should be available. People can bring their own furniture and fittings where this is possible. Staff facilities are not intrusive on the homeliness of the environment.

I was very impressed on one occasion, to find that a person who had recently come to the care home had been enabled to bring the plants from her garden and have them reset in full view from her bedroom window. That was in the spirit of this outcome.

4 Responsive Care And Support

The person can expect premises which have been adapted, furnished and equipped to meet their needs and wishes. This would include accessible means of calling for help and support from any area of the building.

5 Wellbeing

The person is secure and safe in a naturally lit, fresh environment with sufficient space for visitors in their own room. The person can share a room if they wish.  The environment is clean and well maintained.

The person will have access to a private garden and is supported, if possible, to keep a pet.

The person will usually have ensuite facilities, although care homes which are not purpose built may have shared bathrooms.


A surprising and pleasing aspect of this standard is that it does not mention any numbers. Previous standards often referred to specified areas and measurements, for example, the number of square feet for a bedroom, or to the width of a corridor. But here in these new standards, the measure is the person’s legitimate expectations, choices and wishes. While this might leave a standard open to personal interpretation, this is not a difficulty since the standards overall make clear that, within reason, it is the person who will themselves decide what is to be supplied. This is indeed a refreshing and original approach.

That covers the five main headline outcomes which can be expected by people receiving care. Next week I hope to summarise and give an overview of the standards as a whole.


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Tony Clarke

Scottish Care Inspectorate Specialist


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