National health and care standards: consultation analysis

11. General views on the new Standards

Question 10: To what extent do you agree these new Standards will help support improvement in care services?

11.1 395 (90%) respondents to the full consultation and 56 (95%) respondents to the easy-read consultation answered this question.

11.2 Table 10 in Annex 1 shows views by category of respondent to the full consultation. Table 11.1 below summarises these views.

Table 11.1: Views on the extent to which respondents agreed that the new Standards will help support improvement in care services

View	No. of respondents	% of all respondents
Strongly agree	126	32
Agree	169	43
Neither agree nor disagree	73	18
Disagree	27	7
Total respondents	395	100

11.3 75% of those who provided a view strongly agreed or agreed that the new Standards will help to support improvement in care services. Individual respondents expressed stronger support than organisations with 40% of the former, compared with 26% of the latter, strongly agreeing. Relatively few (7%) respondents disagreed.

11.4 Amongst those individuals working/volunteering in the health or social care sectors 85% of those providing a view strongly agreed or agreed that the new Standards will help to support improvement in care services.

11.5 Views of those responding to the easy-read version of the consultation are summarised in Table 11.2 below.

Table 11.2: Views on whether the new Standards will help support improvement in care services

View	No. of respondents	% of all respondents
Yes, agree that the Standards will help to make care services better	44	79
Mixed - some agree and some agree a bit (reflecting group views)	1	2
Agree a bit	8	14
No - disagree that the Standards will help to make care services better	3	5
Total respondents	56	100

11.6 All but three of the respondents who answered this question in the easy-read version of the consultation agreed a bit or agreed fully that the Standards will help support improvement in care services.

Views on why the Standards will help to support improvement

11.7 Many respondents were specific about why they considered that the Standards will help to support improvement in care services. The three most common reasons given were:

• The Standards are easy to understand; user-friendly; accessible; self-explanatory; clear and concise.
• They provide a common understanding and framework which ensures shared expectations and will promote consistency of provision.
• The rights-based approach helps providers and service users to understand what is required.

11.8 Other reasons were given less frequently:

• Person-centred.
• Comprehensive/holistic.
• The Standards link with wider Codes of Practice and guidance.
• They provide a robust benchmark across settings.
• The Standards promote empowerment and independence amongst the workforce and service users.
• They provide a clear vision, particularly important for non-regulated services.
• Outcome-focused.
• Up-to-date and relevant.

11.9 Many respondents remarked that although they considered that the Standards will help to support improvement, the wider context in which they operate will impact on their effectiveness. Limited resourcing was identified as a key contextual factor in this regard.

Views on how the effectiveness of the Standards can be enhanced

11.10 Several respondents proposed ways in which the Standards could be supported to enhance their effectiveness. The most common proposal was for practice-based guidance to help providers implement the Standards within their own setting. Some respondents suggested that examples of good practice be given, demonstrating how they could be applied in practice. It was considered that these would be particularly helpful for non-regulated services:

"We found the previous guidance on how we can evidence meeting the standards and the good examples of evidence on the self-evaluation - "how you can do this" examples very helpful and wondered if there were any plans to develop anything like this to accompany the new standards. We also think this would help with consistency and standardisation regarding individual inspectors and their expectations." (Health and Care Partnership)

11.11 Another common suggestion was for a clear inspection framework to be developed to ensure providers and inspectors have a common understanding of expected competencies and delivery outcomes.

11.12 Other proposals were made by a few respondents:

• The Standards should be supported with a robust feedback system for service users and workforce, with staff empowered to challenge provision not meeting the Standards.
• Should be supported with an appeals process.
• Needs an extended glossary.
• Needs to be supported with a communication policy for people with communication barriers.

Views on risks to the success of the Standards

11.13 Whilst there was much support for the Standards, many respondents highlighted what they considered were threats to their successful operation. Most frequently mentioned was that the view that the Standards may be too broad, creating ambiguity and resulting in different interpretations by service providers and service users.

11.14 Another commonly mentioned risk, again associated with the broad scope of the Standards, was that applying all aspects of the Standards, in all settings, will be challenging.

11.15 The Standards were viewed by some as overly aspirational in nature, which they considered could undermine and weaken their potential, whilst also raising expectations which cannot be fulfilled.

11.16 A few respondents felt that the Standards risked becoming overwhelming and confusing, and suggested that there could be scope for rationalising.

11.17 A few respondents considered that achievement of the Standards may prove difficult to measure, and raised as a risk a lack of consistency in inspection.

Views on why the Standards will not support improvement

11.18 A few respondents specified why they considered that the Standards, as drafted, will not help to support improvement in care services. The key reasons given were:

• The Standards are too vague to be measurable or enforceable and will most likely be side-lined.
• One size does not fit all and will result in a "poor fit" for some settings and circumstances.
• There is too much scope for different interpretations which will lead to inconsistencies.
• There is no review framework, no provision for reflecting, feeding back and revising the Standards.

Views on factors which may influence the degree of success of the Standards

11.19 Many respondents considered that the success of the Standards depended on many factors, with the most frequently mentioned being:

• Adequate resourcing by Scottish Government.
• Effective launch and implementation strategy which is structured and co-ordinated.
• Robust inspectorate and enforcement regimes which are sensitive to different provider settings and take account of the commissioning and procurement activities and the role these play in service delivery and service user experience.

11.20 Less frequently mentioned factors were:

• Accessible and appropriate training opportunities for the workforce on the new Standards.
• Awareness-raising activities for workforce, particularly front-line staff, and service users.
• Proportionate approaches to evaluation which take cognisance of the setting and are not overly bureaucratic.
• Universal commitment to embracing the Standards and embedding them within different settings.
• Culture change in which priority is given to the business of caring within society, from policy-makers to the general public.
• Transparent and honest review mechanisms with a timescale for review and updating.