National Care Standards Review: Consultation Analysis

5 Views On How The National Care Standards Should Be Written

Background

5.1 The Scottish Government believes that new National Care Standards should have a clear, overall statement of standards which includes both appropriately worded explanations of the rights of people using services and the responsibilities of service providers to deliver high quality care. The consultation document (full version but not the easy-read version) provided an example of how this could be set out with two columns: one headed, "As a person who uses services I have the following rights...", and the other headed, "As a service provider we have the following responsibilities...."

Question 3a) What are your views on how standards should be written?

Question 3b) (full version only) What are your views on the example of how the rights and entitlements of people using services and the responsibilities of service providers could be set out?

5.2 The responses to question 3a) and 3b) from the main version of the consultation paper were analysed together as there was considerable overlap in the content of these, indeed, some respondents simply providing the same comments in response to both. Furthermore, the easy-read version of the consultation paper asked only one generic question: "What are your thoughts about how the standards should be written?", and the responses to this have been amalgamated with the others for the purposes of analysis below.

5.3 426 respondents (90% of all those who responded to the consultation) addressed the broad topic of how the standards should be written. There was variety in how respondents interpreted the various questions posed in the full and easy-read versions of the consultation. A few respondents stated that they were unclear about what was being asked. Many respondents focused entirely on the language and presentational features of the proposed standards. Others referred to the particular example of how overarching standards could be set out (although those responding to the easy-read version did not have sight of this); or provided their views on detailed points of difference between, for example, rights and entitlements. This resulted in a complex array of views with some clear messages, but also some ambiguity over what a few respondents were referring to and where their preferences lay.

Comments regarding clarity of language and accessibility of standards

5.4 There was a general agreement with the statement in the consultation document that the National Care Standards should be written in a manner which strikes a balance between the need to use language that is simple and easy to understand, whilst also needing to express standards in a way that makes it clear when they have been breached by a provider. One respondent concurred:

"These need to strike a balance between being meaningful for service providers but still understandable to service users and their families" (Renfrewshire Council).

5.5 Over one-third (36%) of those who addressed these questions recommended that the standards be written in unambiguous, lay terminology, in plain English, avoiding jargon. 49 respondents (12% of those who provided a response) specifically advocated publishing the standards in an easy-read version with symbols and pictorial representation to promote understanding. Nine respondents called for a large print version.

5.6 37 respondents urged that the standards should be presented concisely, nine respondents suggesting a bulleted format and three suggesting the use of colour-coding.

5.7 Recurring themes included ensuring that the standards were presented in an accessible manner (22 respondents); and in a range of formats including BSL (21 respondents). Six respondents explicitly requested a Braille version of the standards; 13 recommended publishing the standards in different community languages; a further 13 advocated audio versions of the standards on CDs or DVDs. One voluntary organisation suggested a "talking tablet" could be used to communicate the National Care Standards.

5.8 31 respondents considered that the accessibility of the standards would increase if they were developed in conjunction with service users, carers and providers. One respondent commented:

"We understand that there is a balance to ensuring the standards are both easy to understand and yet comprehensive and believe that the best way to achieve this balance is to ensure people who use services and their carers are at the heart of developing the Care Standards. They should be involved in large numbers, across a broad spectrum of illnesses (including neurological) and there should be a wide geographical spread" (The Neurological Alliance of Scotland).

5.9 Two voluntary sector respondents, however, argued that an independent person with no affiliation to any particular group or body would be best placed to draft the standards, as this would ensure impartiality.

Comments on dissemination of and access to the standards

5.10 Many respondents recommended that a robust public awareness campaign should accompany the development and publication of the standards and suggested ways to publicise them:

• internet
• hard copy
• on Facebook and other social media
• using Apps
• posters
• leaflets
• on view at GP surgeries
• by post directly to service users
• face-to-face (e.g. in the case of people with learning disabilities).

5.11 Two voluntary organisations suggested that a distinctive logo would also help to make the standards memorable.

5.12 12 organisations from a range of sectors referred explicitly to the Standards of Care for Dementia in Scotland as a useful model of how principles can be written in a way that applies across a wide range of service settings; others (12 respondents including 11 organisations and one individual) felt that GIRFEC principles and indicators could be adapted and written in a way that applies across all age groups. Other respondents identified potentially useful examples of frameworks as the Patient Rights Charter (two voluntary organisations) and Developing a Quality Framework for General Practice in Scotland (Rep).

5.13 Whilst respondents appreciated the need for clarity and simplicity in presentation of the National Care Standards, many acknowledged the need to accommodate supporting detail also. Various suggestions were made for documenting this in appendices, a glossary, or an accompanying document.

Views on the proposal for overall statement of standards

5.14 The main consultation document proposed a clear, overall statement of standards which includes both appropriately worded explanations of the rights of people using services and the responsibilities of service providers to deliver high quality care (see boxed background paragraph at the start of this chapter). The main consultation document asked for views on the example provided.

Views in favour of the example provided

5.15 Amongst those who provided views on how the standards should be written, 135 respondents were explicit in stating that they were in favour of the layout provided in the example. It was perceived to be a clear and user-friendly way of presenting rights and responsibilities for both users and providers of services. Some identified it as transparent, streamlined and helpful in enabling users and providers to know what to expect, contributing to ensuring compliance with the standards. A few respondents remarked that the visual appearance of the two columns, side-by-side, created the impression of partnership working between user and provider. A repeated view was that the layout was in keeping with a rights-based approach, with a few respondents commenting that they particularly supported the use of the first person, "I have the right..." and "We will ensure...." in the example provided. A typical remark was:

"The example given, using both "I" and "We" as terminology, is, in our view, a good one making it clear who the standards are written for. It indicates to the individual what they can expect and also the provider's responsibilities" (Social Work Scotland).

5.16 50 respondents (including 23 individual respondents) commented that they preferred more of a focus on the users' rights, amongst them being some respondents who felt that there was perhaps no need for the second column of service providers' responsibilities. For example, one individual respondent commented that there would be an implicit expectation that users' rights will be met, thus no need for articulating providers' responsibilities. Another individual remarked:

"A clear statement of rights and entitlements is required by the service user. This way there is no muddying of the waters and it is clear what can be expected from service providers. Please do not mix the two, it just creates a watered down set of standards."

5.17 In contrast, one local authority expressed their preference for setting out the standards from the service providers' perspective.

Views against the example provided

5.18 The most common criticism of the example (23 mentions) was over some of the language used, which was described variously as vague, jargonistic and far too complex for some service users. Terms like "take steps to" or "adequate" were perceived to be open to interpretation. A few respondents criticised what they felt were long-winded sentences used in the example.

5.19 Another common criticism (14 mentions) was that the example does not recognise that service users also have responsibilities and service providers also have rights.

5.20 A few respondents felt that the columnar presentation created an artificial, combative, "them and us" impression which they considered was unhelpful.

5.21 Three voluntary organisations all proposed a similar alternative format: a flow/driver diagram or "journey narrative". One described their vision thus:

"...the rights and entitlements should be set out for each stage of interacting with (the) service, even if this necessarily produces repetition, it would make the document more clear for a vulnerable individual who would see their interaction with the service as a series of stages and be able to check on their rights and entitlements accordingly" (Befriending Networks).

5.22 One local authority advocated an "audit format" for setting out the care standards in which service providers could self-evaluate their performance against the standards.

5.23 Seven respondents across four sectors recommended maintaining the format of the current care standards and simply updating this. They argued that this would enable a smoother transition to the new standards, with less need for education on how to work with the new ones.

Views on additions to the proposed example

5.24 A common view was that the inclusion of specific examples and case studies would provide a useful supplement to what was proposed in the consultation document, making the standards more meaningful and applied. One suggestion was for the addition of a third column to accommodate this. Some respondents called for greater specificity over service provision and support, whilst others expressed their view that greater detail is required in order for service provision to be readily measured.

5.25 A recurring theme was that the standards should refer to related policy documents and standards such as the Dementia Standards, clinical standards, government policies, public sector equality duty and UNCRC.

5.26 13 respondents called for the standards to provide clear information on how users can speak up, have their say, and claim rights they feel are not being met. Other additions suggested by only a few respondents were:

• reference to self-directed support
• reference to the safety agenda
• reference to quality of service
• access to independent advocacy

Summary of main findings

• It was generally agreed that the National Care Standards should be written simply, in a jargon-free manner, which enables identification of any breach of standards by service providers.
• Respondents requested that the standards be published in a variety of accessible formats.
• Many respondents praised the presentation of the standards which was proposed in the consultation document in which the rights of service users were set against the responsibilities of service providers.