National health and care standards: consultation analysis

3. Views on the Relevance of the Standards

Background

The new Standards need to be fit for purpose for assessing how well people's care needs are met on both a strategic and an individual service level. The Scottish Government proposes that a single set of Health and Social Care Standards should apply across all care services which may be used in a lifetime.

Question 1: To what extent do you think the Standards will be relevant and can be applied across all health, care and social work settings?

3.1 427 (97%) respondents to the full consultation and 57 (97%) respondents to the easy-read consultation answered this question.

3.2 Table 1 in Annex 1 shows views by category of respondent to the full consultation. Table 3.1 below summarises these views.

Table 3.1: Views on the extent to which the Standards will be relevant and can be applied across all health and social work settings

View	No. of respondents	% of all respondents
Strongly agree	131	31
Agree	207	48
Neither agree nor disagree	50	12
Disagree	39	9
Total respondents	427	100

3.3 79% of those who provided a view strongly agreed or agreed that the Standards will be relevant and can be applied across all health, care and social work settings. Individual respondents expressed stronger support than organisations with 36% of the former, compared with 25% of the latter, strongly agreeing with the statement. A significant minority (9%) respondents disagreed.

3.4 Views of those responding to the easy-read version of the consultation are summarised in Table 3.2 overleaf.

Table 3.2: Views on the extent to which the Standards will be relevant and can be applied across all health and social work settings

View	No. of respondents	% of all respondents*
Yes, agree relevant across all health and social work settings	49	86
Mixed - some agree and some agree a bit (reflecting group views)	1	2
Agree a bit	6	11
No - disagree that the Standards will be relevant across all health and social work settings	1	2
Total respondents	57	100

*Percentages may not total 100% exactly due to rounding.

3.5 All but one respondent who answered this question in the easy-read version of the consultation agreed a bit or agreed fully that the Standards will be relevant and can be applied across all health and social care settings.

General supportive views

3.6 Many respondents outlined broad features of the Standards which they particularly welcomed, the most common being:

• Human-rights focus
• Person-centred focus
• Outcome focus
• Easy to read
• Up-to-date in terms of reflecting current landscape
• Based on five principles
• Promoting consistency in provision and expectation

3.7 Other attributes of the Standards which received specific support included: their perceived flexibility across different settings/not overly prescriptive; adaptability and applicability for different settings; usefulness for those working across agencies, to have one set of Standards to adhere to; and usefulness to commissioners of services to have a common set of Standards across the board.

3.8 Many of those who were generally supportive of the Standards suggested that they fitted more with social care contexts than with health care environments.

General concerns about the relevance of the Standards

3.9 A repeated view, across a wide range of sectors, was that by attempting to apply to all settings, the Standards were too general to be useful or practical. It was considered that they presented clear principles and values, but lacked the specifics on how to apply these in some circumstances. Several respondents called for the Standards to be supported with tailored and specific guidance to enhance their relevance in different settings. Some felt that at present the Standards provided more detail relating to some contexts than others.

3.10 A few respondents perceived the Standards to be too general in places and too specific in others to be meaningful across all health, care and social work settings.

3.11 Many respondents identified contexts which they considered were not adequately covered by the Standards, including:

• End of life care
• School care accommodation
• Care within prison
• Foster care
• Care of older people
• Homecare

3.12 Other perceived omissions included mention of "empathy" (perhaps instead of "compassion"); recognition of the role of representatives/advocates in helping service users with choices and decisions; giving prominence to "inclusive communication", with one voluntary organisation suggesting this might merit another principle; and introducing another Standard on the assessment process for care packages.

3.13 Two voluntary organisations considered that the Standards would benefit from being organised into overarching, generally applicable statements, followed by a menu of "pick and mix" statements, or more setting-specific statements.

3.14 Whilst appreciating the human-rights focus of the Standards, several respondents, including two of the statutory bodies, suggested that relevance could be enhanced by being more explicit about how human rights can be exercised through the Standards, what this means in practice. One respondent considered that some minor editing, with a few words and phrases added, would make this important aspect of the Standards much clearer.

Specific concerns about inspection

3.15 A common concern was that the generalisable nature of the Standards could present challenges for inspection regimes. The language of the Standards was considered by some to be subjective in places, with terms such as "where possible" highlighted as too open to interpretation to form a robust basis for benchmarking. Questions were raised over how adherence to the Standards could be evidenced, with requests for case studies/examples of evidence provision in practice.

3.16 Several respondents suggested that greater clarity on terminology and definition of phrases and words (perhaps in the glossary) is needed in order to support a credible inspection regime. One regulatory body requested definition of: "care"; "health"; "social work"; and "social services". A representative body questioned whether the word "Standards" was appropriate, considering their view that what was proposed was more akin to a set of guidelines, underpinned by expectations and principles. A few respondents requested that "early years" be defined and be consistent in meaning to wider frameworks (for example, up to 18 years).

3.17 A recurring view was that the Standards, whilst worthy, were reflective of aspirations rather than practical application. As such, providers may be open to complaints of failing to meet expectations. It was considered that inspections should take account of the reality of planning and delivering in health, care and social care settings, perhaps providing information on how they will use specific Standards in their inspections.

Specific concerns about understanding the Standards

3.18 Many respondents commented that for the Standards to be relevant they need to be readily comprehensible to the users of services and the workers providing services. Whilst the Standards were welcomed as easy to read, some thought that there were too many statements within the Standards, and this detracted from clarity. A few considered aspects of the Standards to be repetitive and suggested that some editing may be required.

3.19 An emerging theme was that awareness-raising and educating on the Standards will be required to ensure that they are relevant to service users and staff providing care.

3.20 A few respondents expressed concern over the place of the Standards within commissioning frameworks, providing the view that common understanding of the requirements of commissioners and consistency across commissioning, will be crucial.

Specific concerns about applying the Standards

3.21 Several respondents remarked that application of the Standards should be a key focus, alongside ensuring relevance. A common view was that applying the Standards could be challenging and will require increased awareness of the Standards; shared understanding of their meaning; and additional resourcing, for example, for training of staff.

3.22 A few respondents commented that effective application of the Standards will need effective communication between agencies to track people using different parts of the system, and between inspectors across different agency contexts.

3.23 A small number of voluntary organisations, individual workers and service users emphasised their view that strong leadership, along with commitment and motivation will be necessary to implement and apply the Standards consistently and effectively.

Question 2: To what extent do these Standards reflect the experience of people experiencing care and support?

3.24 402 (91%) respondents to the full consultation and 57 (97%) respondents to the easy-read consultation answered this question. ^[1]

3.25 Table 2 in Annex 1 shows views by category of respondent to the full consultation. Table 3.3 below summarises these views.

Table 3.3: Views on the extent to which the Standards reflect the experience of people experiencing care and support

View	No. of respondents	% of all respondents
Strongly agree	109	27
Agree	187	47
Neither agree nor disagree	77	19
Disagree	29	7
Total respondents	402	100

3.26 74% of those who provided a view strongly agreed or agreed that the Standards reflect the experience of people experiencing care and support. Individual respondents expressed stronger support than organisations with 32% of the former, compared with 22% of the latter, strongly agreeing with the statement.

3.27 Voluntary sector respondents appeared to be more ambivalent in opinion, with almost one-third (32%) neither agreeing nor disagreeing that the Standards reflect the experience of people experiencing care and support; likewise, half of the 18 professional representative bodies who provided a response neither agreed nor disagreed.

3.28 Views of those responding to the easy-read version of the consultation are summarised in Table 3.4 overleaf. All but one respondent who answered this question in the easy-read version of the consultation agreed a bit or agreed fully that the Standards reflect the experience of people experiencing care and support.

Table 3.4: Views on the extent to which the Standards reflect the experience of people experiencing care and support

View	No. of respondents	% of all respondents*
Yes, agree relevant across all health and social work settings	49	86
Mixed - some agree and some agree a bit (reflecting group views)	2	4
Agree a bit	5	9
No - disagree that the Standards will be relevant across all health and social work settings	1	2
Total respondents	57	100

*Percentages may not total 100% exactly due to rounding.

Interpretation of the question

3.29 Question 2 was interpreted differently by different respondents, with some stating that they were unclear as to its meaning. In particular, respondents queried whether the question referred to current or past experience, future experience, aspirations and expectations or what has been experienced on the ground. Responses reflected this mix of interpretations of the question.

Commonly held views

3.30 Common views across a wide range of sectors were that the Standards reflect the ideal experiences of people who are receiving care and support, but in reality these will vary between people and contexts. Many respondents commented that providers have to work within their means and that level of provider resources and organisational structures will impact on individual experiences of service users. Some expressed concern that the Standards raised expectations which cannot be fully met.

3.31 A recurring theme was that the experience of people receiving care and support will be influenced to some extent by the way in which the new Standards are implemented and enforced. A few respondents questioned how providers will evidence their adherence to the Standards, with suggestions made that greater emphasis should be placed on evaluation of performance.

3.32 Many respondents outlined aspects of the Standards which they welcomed as setting the context for positive outcomes for service users. These included:

• Person-centred approach.
• Written in the first person - meaningful and easy to understand.
• Holistic, comprehensive, inclusive approach, covering issues of importance to service users across all life stages.
• Clear and well-structured presentation of Standards.

3.33 In contrast, some respondents, across a wide range of sectors, held the view that the Standards were ambiguous, subjective and repetitive in places, risking different interpretations which undermined their usefulness. A few respondents, including some service users, considered that the language used in the Standards was that of professionals rather than the service user.

Views on groups not covered by the Standards

3.34 A few respondents identified service user sectors which they considered did not have their experiences adequately reflected by the Standards. The most commonly identified are below:

• Those receiving care and support at home, perhaps through self-directed support.
• People with dementia.
• Children and young people (it was felt that the Standards referred generally to the experiences of adults).
• Very young children.
• People in secure care settings.

Views of experiences not covered by the Standards

3.35 Some respondents identified experiences which they considered the Standards did not encompass sufficiently. The most commonly identified are below:

• Use of advocates.
• Safety of service user and service provider.
• Transitions and interfaces between care and support contexts.