National Care Standards Review

Introduction and background

Everyone in Scotland should receive high quality care no matter what service they use or where they live. The National Care Standards were created to help people understand what to expect from care services and help services understand the standards they should deliver.

There are many different types of care services in Scotland, ranging from nurseries and childminders to care homes for older people and independent hospitals. The National Care Standards help make sure the right quality of care is provided in every setting and provide information on how to raise concerns or complaints.

The standards were created in 2002 and it is now time to look at whether they meet current expectations and how they can be improved.

Currently, there are 23 different sets of standards each covering a different type of care service. You can find a full list of them at Annex A. They were developed from the point of view of people who use services and focus on the quality of life a person should experience. They are based on six principles; dignity, privacy, choice, safety, realising potential and equality and diversity. These should guide all care services.

The Care Inspectorate and Healthcare Improvement Scotland use the National Care Standards when they inspect the quality of care and particular healthcare services. The Standards also underpin the Scottish Social Services Council's Codes of Practice for Social Service Workers and for Social Service Employers.

Over the last few months, we have spoken with a range of people about the National Care Standards. These discussions have suggested that there are ways in which they can be updated and improved. Now we would like your views.

The context: public services are changing

The current standards have helped to make sure that the quality of care in Scotland continues to improve. But the way services are planned, delivered and experienced by people and communities is changing with a shift towards care that is centred on the person using the service.

The Christie Commission report on the future delivery of public services^[1] set the context for wide-ranging public sector reform. A wide programme of work is underway addressing many of the Commission's recommendations. This includes:

Integration of health and social care which brings the planning and delivery arrangements of Health Boards and the social care responsibilities of local authorities together - through new health and social care partnerships - to ensure that they are integrated around the service user.

The Public Bodies (Joint Working) (Scotland) Act 2014^[2] provides the legislative basis for integration. The Act establishes national outcomes for health and wellbeing. You can find the set of draft outcomes at Annex B. These are rights-based and stress the importance of improving health and wellbeing with services planned for the benefit of the individual. These draft outcomes are currently out for consultation.

The Act requires a strategic 'commissioning' plan for integrated adult services to begin with and arrangements to be put in place for clinical and professional leadership to ensure that planning is robust, effective and focuses on improving outcomes.

Self-directed support which is giving people real choice in the way they can access care and support. The Social Care (Self-directed Support) (Scotland) Act 2013^[3] ensures that people can design and arrange their own care, rather than just relying on what is offered to them.

Caring Together, the national carers strategy 2010-15, and Getting it Right for Young Carers, published in July 2010, which outline the key actions to help improve outcomes for carers and young carers.

The Scottish Government's 20:20 Vision which sets out that by 2020 everyone will be able to live longer healthier lives at home, or in a homely setting, and that we will have a healthcare system where:

• health and social care are integrated, meaning they work together seamlessly;
• poor health is prevented where possible, by people being more aware and able to manage their own health themselves;
• hospital treatment is normally provided without staying overnight, and should be provided in the community if possible;
• care meets the highest standards of quality and safety, with the person at the centre of all decisions;
• people go home or to the regular place they live after receiving care as soon as appropriate, without needing further treatment away from home.

The 20:20 vision provides the context for implementing the Quality Strategy for NHS Scotland, which sets out three quality ambitions to guide the delivery of all healthcare in Scotland - that care is safe, effective and person-centred.

Getting it right for every child (GIRFEC) which is the mechanism for ensuring that anyone providing care or support for a child or young person puts them and their family at the centre of decisions. GIRFEC identifies eight indicators of wellbeing to ensure that young people are safe, healthy, achieving, nurtured, active, responsible, respected and included (SHANARRI). The principles on which GIRFEC is based are set out at Annex C.

The Children and Young People (Scotland) Act 2014^[4] puts children and young people at the centre of planning and delivering services and strengthens their rights across public services. Amongst other things, every child up to the age of 18 will now have access to a named person, and those that require one will have a single child's plan.

Local authorities and Health Boards will have new responsibilities for planning the services that affect a child's and young person's wellbeing. The Act extends early learning and childcare for those aged from 2 to 4 and the right to aftercare for care-leavers and introduces a right to continuing care for those in care.

Access to quality childcare, support for looked after children and care leavers and children's rights are all contained within Scottish Government's vision to make Scotland the best place to grow up. Curriculum for Excellence in schools and colleges and schemes to tackle unemployment also seek to embed the same person-centred, rights-based ethos.

A rights-based approach to standards

In recent years there has been a move towards a rights-based approach to planning services and delivering care.

This approach is based on the basic human rights and freedoms to which everyone is entitled, regardless of nationality, sexuality, gender, race, religion, disability or age. It is a way of empowering people to know and claim their rights, and making people and organisations that are responsible for respecting, protecting and fulfilling rights more accountable.

It means giving people greater opportunities to shape the decisions that impact on their human rights. It also means improving the way in which people responsible for protecting other people's rights do that.

This approach is grounded in international human rights laws which the UK has voluntarily agreed to be legally bound by. The European Convention on Human Rights became part of Scots law in 1998. The Human Rights Act 1998 makes it unlawful for public authorities to act, or fail to act, in a way which is incompatible with the European Convention on Human Rights.

Other international human rights laws which are particularly relevant include the UN Convention on the Rights of the Child and the UN Convention on the Rights of Persons with Disabilities.

There are some underlying principles - known as the PANEL principles - which are fundamental in applying a human rights-based approach in practice. They are:

• Participation in decisions, autonomy and choice
• Accountability
• Non-discrimination, equality and diversity
• Empowerment to know and enjoy rights and realise potential
• Legality: all rights in the Human Rights Act and in other human rights laws shall be respected (including rights such as respect, dignity, privacy, safety, independent living, and the best interests of the child)

Approach to the review

All of these developments mean it is time to look at the National Care Standards in a different way. Care and health services are now working much more closely together to put individuals at the centre. Because of that, we want to identify the core elements of high-quality care that should be common across public services.

We are looking at something bolder than a simple review of the existing standards - and are proposing the development of quality standards for health and social care. High quality should be universal, no matter where health and care is being delivered, who is delivering it, or who is receiving care. People working in health and social care should have a common understanding of what quality means, and work to common core values which are rooted in human rights.

We think this approach will help people using services, their carers and families better understand what they can expect, and will help services better understand what people expect of them. We would like your views.

Why are the National Care Standards important and how are they used?

A standard is a level of quality against which performance can be measured to ensure safe and effective practice and support improvement. Everyone should receive the highest standards of care that reflects their needs and protects their rights. We think that having National Care Standards which promote high quality care is fundamental.

Care standards are important for people choosing and using services. People using a service for the first time may have nothing else to compare it to, so clear standards can help explain what to expect. Providers of care services need to know that they are doing the right thing and constantly improving. Regulators like the Care Inspectorate, Healthcare Improvement Scotland and Education Scotland need standards to identify areas to inspect and award quality grades.

Public expectations of care services are increasing with people rightly expecting high quality services for themselves and their loved ones. People who provide care services must protect people's human rights and increasingly want to deliver high quality.

The current care standards do not fully reflect this more ambitious aspiration and are sometimes seen as the minimum level of care that should be provided, rather than a baseline from which services should continually improve.

We believe that any new standards should reflect these changes and set out both the essential components of a service and the aspirational elements which support health and care services to improve.

What do people know about the current standards?

Knowledge about the current standards varies. Some people who use or work with care services know a lot about the current standards. Others know little.

The National Care Standards are used by staff in care services who are undertaking qualifications like SVQs. Some services discuss the standards with their staff when talking about performance management and service development.

Some people tell us that that even though they use care services, they were unaware of the National Care Standards and have never used them in any way.

We need standards that people using and working in services know about, understand, and use to make a positive difference to people's lives.

The bigger picture

While standards are important, they are only one of the ways we can improve the quality of care services and help protect vulnerable people.

A strategic approach to commissioning and planning and robust clinical and care governance are essential, as is a commitment to continuously improving quality.

The new integrated health and social care bodies will plan for services using a single budget and the Care Inspectorate and Healthcare Improvement Scotland will review joint strategic commissioning plans prepared by these partnerships to ensure they improve outcomes for people who use services.

Integrated health and social care teams are better able to provide care and support to people and communities. The Scottish Government and senior professionals are developing guidance on how clinical and care governance should operate to ensure that the quality of services is improved within the new health and social care partnerships.

Annual performance targets for Health Boards ensure that resources are directed to priority areas for improvement and to drive up quality. Patient Opinion, enabling people to comment on healthcare services, is an important source of information on the quality of NHS services and other similar sites exist to share social care experiences.

The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines for the NHS in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature and are designed as a vehicle for accelerating the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving outcomes for people.

Developing the skills and knowledge of staff working in services is also central to raising standards and protecting vulnerable people.

The Scottish Social Services Council (SSSC) registers and regulates staff working in social work and social care services and also regulates their education and training. Registered workers must hold or attain qualifications relevant to the role they undertake and continuously improve their skills and knowledge to maintain their registration. The SSSC takes action against workers who fail to adhere to the SSSC's Codes of Practice.

NHS Education for Scotland and the SSSC are working jointly on a project to support health and social care staff to meet the needs of carers and young carers and engage them as equal partners.

The Scottish Government has also appointed Professor Iram Siraj to chair an independent review of the early learning and childcare workforce and out of school care workforce. The review will look at a range of issues around workforce skills, qualifications and training, and is expected to report in spring 2015.

The new National Care Standards will complement these approaches.

Consultation questions

1. The foundations of new National Care Standards

We believe that new National Care Standards should take a human rights-based approach. This means putting people who use services at the centre of how they are planned and delivered. It also means increasing understanding and respect for human rights in those services.

We think the standards should make it easier for public services to work together, so must work in very different settings. People using and working in these services should understand them easily.

We believe that new standards should set out both the essential requirements of a service and the elements to which services should aspire to help them improve.

We would like your thoughts on this.

Question 1

Do you think that the new National Care Standards should be grounded in human rights?

Yes No Don't know

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