National care standards: short breaks and respite care services for adults

Introduction

Short breaks and respite care - a developing range of services ¹

Short breaks and respite care cover a range of services and situations. Different ideas are emerging about the purpose of the break. Evidence of the need for breaks is also moving from a general awareness of their value to much more detailed information that people need breaks in different ways at different times and for different periods. As the carer's voice has become stronger through carers' organisations and centres, attention has been focused on short breaks and respite care. Now, as people who use services are being consulted, a greater emphasis is being placed on the quality of services and the standards that you and your family can expect to receive.

The distinctive feature of respite care is that the break should be a positive experience for you and your carer (if you have one) in order to improve the quality of your life and to support your relationship. It can be provided in your home or elsewhere and may extend from a few hours to a few weeks.

The quality of 'spare bed' respite care currently provided in long-stay care homes has been heavily criticised. The Guidance for the UK Carers Strategy recommends that 'good quality short-term breaks will ensure separate provision is made in units which provide both long-term care and short-term breaks'.

Other short break services depend on how willing people are to open their doors to others. These are services that have to be carefully developed and supported. As new ways and best practice for short breaks are developed, so standards will also change and develop.

Most short break services involve you being temporarily separated from your carer (if you have one). However, support at home and holiday escorts may also allow family members to enjoy the break with you. Breaks may be close to home or farther away. Breaks may be provided by services or through individual arrangements paid for by direct payments.

The particular needs of rural communities where residential facilities tend to be small, few in number and scattered about should also be recognised.

Short breaks and respite care - a range of settings

Short breaks and respite care can be offered in a wide variety of settings including:

• breaks in respite-only units (specialist guest houses, community flats, purpose-built or adapted houses);
• breaks in care homes;
• breaks in the home of another individual or family who have been specially recruited;
• breaks in your own home through a care attendant or sitting service;
• holiday breaks;
• supported breaks for you and your carer together;
• befriending schemes where volunteers provide short breaks;
• breaks in supported accommodation; and
• flexible breaks through direct payment arrangements.

Also some forms of day care should be seen as falling within the definition of short breaks and respite care. These were covered by the 1996 Guidance on Respite Care. Although it is clearly seen as a service for you, the user, befriending is also included to cover breaks using local leisure resources with a befriending escort.

Short breaks and respite care and the national care standards

All providers must provide a statement of function and purpose when they are applying to register their service. On the basis of this statement, the Scottish Commission for the Regulation of Care ('the Care Commission') will determine which standards will apply to the service that the provider is offering.

The standards for short breaks and respite care will apply to all services where short breaks and respite care are offered. They cover your needs and the needs of your carer or family (or both). They cover some services that rely on volunteers.

Some services to you, the user, may incidentally provide your carer with a break. These indirect sources of support are not included within the scope of these standards.

This means that the standards for short breaks and respite care should:

• be applied with reference to other care standards that relate to specific services;
• be applied with due regard to the differences between services;
• help to achieve a balance in which service quality is guaranteed and a range of service models can develop; and
• be read as referring to all services.

The national care standards

Scottish Ministers set up the National Care Standards Committee ( NCSC) to develop national standards. The NCSC carried out this work with the help of a number of working groups. These groups included people who use services, and their families and carers, along with staff, professional associations, regulators from health and social care, local authorities, health boards and independent providers. Many others were also involved in the consultation process.

As a result, the standards have been developed from the point of view of people who use the services. They describe what each individual person can expect from the service provider. They focus on the quality of life that the person using the service actually experiences.

The standards are grouped under headings which follow the person's journey through the service. These are as follows:

Before using the service (standards 1 to 6)
1 Informing and deciding
2 First meetings
3 Your legal rights
4 Positive experiences
5 Management and staffing arrangements
6 Individual agreement

Using the service (standards 7 to 18)
7 Starting to use the service
8 Making choices
9 Feeling safe and secure
10 Exercising your rights
11 Expressing your views
12 Lifestyle
13 Eating well
14 Keeping well - healthcare
15 Keeping well - medication
16 Private life
17 Daily life
18 Supporting communication

Going home or moving on (standard 19)
19 Ending the short break or respite care

Using the national care standards

As a user of the service, you may want to refer to the standards when you, your family, carer or representative are considering a short break or respite care. While on a short break or in respite care, you may use the standards when discussing the service you receive with those providing your care and support, care staff or befriending volunteer or with the service provider.

If things go wrong, you can refer to the standards to help you raise concerns or make a complaint. ( See 'Expressing your views', standard 11.)

If you have a carer, she or he can refer to the standards to know what support the service provider will give her or him. Providers will use standards to find out what is expected of them in offering support and care services.

The principles behind the standards

The standards are based on a set of principles. The principles themselves are not standards but reflect the recognised rights people enjoy as citizens. These principles are the result of all the contributions made by the NCSC, its working groups and everyone else who responded to the consultations on the standards as they were being written. They recognise that services must be accessible and suitable for everyone who needs them, including people from black and ethnic minority communities. They reflect the strong agreement that your experience of receiving services is very important and should be positive, and that you have rights.

The main principles

The principles are dignity, privacy, choice, safety, realising potential and equality and diversity.

Dignity

Your right to:

• be treated with dignity and respect at all times; and
• enjoy a full range of social relationships.

Privacy

Your right to:

• have your privacy and property respected; and
• be free from unnecessary intrusion.

Choice

Your right to:

• make informed choices, while recognising the rights of other people to do the same; and
• know about the range of choices.

Safety

Your right to:

• feel safe and secure in all aspects of life, including health and wellbeing;
• enjoy safety but not be over-protected; and
• be free from exploitation and abuse.

Realising potential

Your right to have the opportunity to:

• achieve all you can;
• make full use of the resources that are available to you; and
• make the most of your life.

Equality and diversity

Your right to:

• live an independent life, rich in purpose, meaning and personal fulfilment;
• be valued for your ethnic background, language, culture, and faith;
• be treated equally and to be cared for in an environment which is free from bullying, harassment and discrimination; and
• be able to complain effectively without fear of victimisation.

The Scottish Commission for the Regulation of Care

The Regulation of Care (Scotland) Act 2001 ('the Act') set up the Care Commission, which registers and inspects all the services regulated under the Act, taking account of the national care standards issued by Scottish Ministers. The Care Commission has its headquarters in Dundee, with regional offices across the country. It will assess applications from people who want to provide short breaks and respite care services for adults. It will inspect the services to make sure that they are meeting the regulations and in doing so will take account of the national care standards. You can find out more about the Care Commission and what it does from its website ( www.carecommission.com).

The Scottish Social Services Council

The Act created the Scottish Social Services Council ('the Council') which was established on 1 October 2001. It also has its headquarters in Dundee. The Council has the duty of promoting high standards of conduct and practice among social services workers, and in their education and training. To deliver its overall aims of protecting service users and carers and securing the confidence of the public in social services, the Council has been given five main tasks. These are: to establish registers of key groups of social services staff; to publish codes of practice for all social services staff and their employers; to regulate the conduct of registered workers; to regulate the training and education of the workforce; to undertake the functions of the National Training Organisation for the Personal Social Services. The Council has issued codes of practice for social service workers and employers of social service workers. These describe the standards of conduct and practice within which they should work. The codes are available from the Council website ( www.sssc.uk.com).

How standards and regulations work together

The Act gives Scottish Ministers the power to publish standards which the Care Commission must take into account when making its decisions. It also gives Scottish Ministers the power to make regulations imposing requirements in relation to care services.

The standards will be taken into account by the Care Commission in making any decision about applications for registration (including varying or removing a condition that may have been imposed on the registration of the service). All providers must provide a statement of function and purpose when they are applying to register their service. On the basis of that statement, the Care Commission will determine which standards will apply to the service that the provider is offering.

The standards will be used to monitor the quality of services and their compliance with the Act and the regulations. If, at inspection, or at other times, for example, as a result of the Care Commission looking into a complaint, there are concerns about the service, the Care Commission will take the standards into account in any decision on whether to take enforcement action and what action to take.

If the standards were not being fully met, the Care Commission would note this in the inspection report and require the service manager to address this. The Care Commission could impose an additional condition on the service's registration if the provider persistently, substantially or seriously failed to meet the standards or breached a regulation. If the provider does not then meet the condition, the Care Commission could issue an improvement notice detailing the required improvement to be made and the timescale for this. Alternatively, the Care Commission could move straight to an improvement notice. The Care Commission would move to cancel the registration of any service if the improvement notice does not achieve the desired result. In extreme cases ( i.e. where there is serious risk to a person's life, health or wellbeing) the Care Commission could take immediate steps to cancel the registration of any service without issuing an improvement notice.

Regulations are mandatory. In some cases not meeting a regulation will be an offence. This means a provider may be subject to prosecution. Not meeting or breaching any regulation is a serious matter.

Decisions by the Care Commission on what to do when standards or regulations are not met will take into account all the relevant circumstances and be proportionate.

You can get information on these regulations from the Regulation of Care (Scotland) Act 2001, which is available from the Stationery Office Bookshop. You can also see the Act on-line ( see Annex B for the address).

You can also see the Scottish Statutory Instruments for the Regulation of Care Regulations 2002 on-line ( see Annex B for the address).

Comments

If you would like to comment on these standards you can visit our website and send a message through our mailbox: http://www.scotland.gov.uk/health/standardsandsponsorship

You can also contact us at:

Tel: 0131 244 5387
Fax: 0131 244 4005

1 There is a growing debate about the term 'respite care'. Some feel it describes the importance of the break for the carer, and others feel that it is a negative term. For the purpose of these standards, 'short breaks' and 'respite care' have been adopted and used at different points to reflect the terms that are currently used and understood. In both cases, they cover a service that may be provided in the person's own home, in a family home or in a care home.