National health and care standards: consultation analysis

5. Views on proposed Standard 2: I am at the heart of decisions about my care and support

Question 4: To what extent do you think this Standard describes what people should expect to experience from health, care and social work services?

5.1 398 (90%) respondents to the full consultation and 56 (95%) respondents to the easy-read consultation answered this question.

5.2 Table 4 in Annex 1 shows views by category of respondent to the full consultation. Table 5.1 below summarises these views.

Table 5.1: Views on the extent to which Standard 2 describes what people should expect to experience from health, care and social work services: full consultation

View	No. of respondents	% of all respondents
Strongly agree	188	47
Agree	159	40
Neither agree nor disagree	34	9
Disagree	17	4
Total respondents	398	100

5.3 87% of those who provided a view strongly agreed or agreed that Standard 2 describes what people should expect to experience from health, care and social work services. Individual respondents expressed stronger support than organisations with 57% of the former, compared with 39% of the latter, strongly agreeing with the statement. Relatively few (4%) respondents disagreed.

5.4 Amongst the individual respondents, those working and volunteering in healthcare/social care supported the Standard most strongly, with 61% strongly agreeing that it describes what people should expect to experience. This compares with 42% of individual service users who strongly agreed.

5.5 Views of those responding to the easy-read version of the consultation are summarised in Table 5.2 overleaf.

Table 5.2: Views on the extent to which Standard 2 describes what people should expect to experience from health, care and social work services: easy-read consultation

View	No. of respondents	% of all respondents*
Yes, agree with this standard	50	89
Agree a bit with this standard	2	4
Mixed - some agree and some agree a bit (reflecting group views)	2	4
No - disagree with this standard	2	4
Total respondents	56	100

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

5.6 All but 2 of the respondents who answered this question in the easy-read version of the consultation agreed a bit or agreed fully with Standard 2.

General views in favour of Standard 2

5.7 A few respondents expressed general views in support of Standard 2 in its entirety, or aspects of it. Healthcare and Health and Social Care Partnerships, in particular, considered the Standard to be comprehensive, written clearly, and fitting with the wider policy context, such as self-directed support, and outcome-focused models of commissioned care and support.

5.8 Aspects of the Standard which were especially welcomed by respondents included the focus on positive risk-taking; emphasis on play; involvement of family and friends; focus on communication; significance of service users' choice and control; and implied emphasis on empowerment.

5.9 A few respondents felt reassured that various communication needs had been encompassed by the Standard, in particular those of people who are deaf or have hearing loss.

Broad concerns about Standard 2

5.10 The title of the Standard attracted criticism from a few respondents across several different organisational sectors. They drew the distinction between "person- centred" and "person-led" decisions, with a shared view being that being "at the heart of decisions" does not necessarily mean being involved and participating in such decisions.

5.11 A repeated view across organisations and individuals was that contextual factors such as resources, physical structures of care settings, staffing ratios, and so on, will impact on the degree to which Standard 2 can be implemented and achieved.

5.12 Some respondents expressed concern that all of the statements will not apply to all settings. Prison and acute health care settings were mentioned in this context.

5.13 Various potential tensions were identified as arising from Standard 2, in particular balancing the needs of the individual against the needs of a wider group/community; balancing budgets with service provision; and balancing a person's wishes and their best interests if these are deemed to be different.

5.14 A few respondents commented that the detail contained in this Standard appeared to be overwhelming; one voluntary organisation suggested combining several of the statements to make the Standard more concise and easier to read ( e.g. 2.10 and 2.11; 2.19 - 2.21).

5.15 A recurring view was that the language of the Standard was appropriate for professionals but not for some service users such as young people or people with dementia.

5.16 A few respondents expressed concern that issues of safeguarding were not clear in the Standard.

Summary of comments relating to each descriptive statement

5.17 More detailed comments were made relating to individual descriptive statements and are summarised in Annex 2, Table 2.

Views on omissions from the Standard

5.18 The main omissions suggested were:

• Reference to support plans.
• Mention of Attorney or Guardians.
• Mention of rights and responsibilities.
• Needs more emphasis on rights of adults with incapacity and the role of others where capacity varies over time ( e.g. delirium).
• Mention of who the other significant people may be in a person's life and reassurance that their views will be sought and taken into account.
• More on healthcare settings. The Standard was perceived as more relevant to social care.
• Being realistic - for example, if the person's choice is novel, untested and is an alternative treatment, then other considerations may come into play.