New National Health and Social Care Standards

1. Background

What are National Health and Social Care Standards and how will they be used?

The purpose of the new National Health and Social Care Standards (the Standards) is to set out what we can expect when we use health and social services in Scotland. This includes a diverse range of services from childminding and daycare for children in their early years, housing support and care at home for adults, to hospitals, clinics and care homes.

From Spring 2018, the new Standards will provide a framework for registration and inspection of individually registered care and health services, but they will also be relevant to all care and health services including those not inspected by the Care Inspectorate or Healthcare Improvement Scotland. Services which are not currently required to register with or be inspected by these regulators will be encouraged to adopt and apply the Standards as a framework for high quality care.

The new Standards show what our rights to dignity, respect, compassion, being included, responsive care and support and wellbeing should actually look like across health and social care services.

They replace the 23 sets of standards produced for different types of registered care settings introduced in 2002.

Why review the Standards?

The original 2002 Standards mainly looked at technical requirements, such as written policies and health and safety procedures. The new Standards need to reflect recent changes in policy and practice and also be fit for the future. For example:

• more of us are supported and cared for in our own home and as part of the local community than ever before;
• we consider the quality of care experience to be as important as other aspects of care like safety ^[1] ; and
• the establishment of Health and Social Care Partnerships ^[2] means that when people use health or care services they should get the right care and support whatever their needs, at any point in their care journey.

How we inspect health and social care services has also changed. The Care Inspectorate and Healthcare Improvement Scotland continue to regulate each individually registered health and social care service, they also now work with other regulators and scrutiny bodies to carry out strategic inspections. These inspections look at how the wider health, social work and social care system is working for children or adults in a local authority and health board area. 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.

To support these changes, we need a single set of Health and Social Care Standards that apply across all care services we may use in our lifetime. These must promote flexible services and innovation.

Development of the Standards

In 2015 a public consultation confirmed widespread support for the new Standards being based on human rights and the wellbeing of people using services. The following Principles were approved by Scottish Ministers in February 2016:

• Dignity and respect
• Compassion
• Be included
• Responsive care and support
• Wellbeing

Since then draft new Standards have been developed by a Development Group made up of organisations representing people using services, unpaid carers, social care providers and commissioners of care. At an early stage there were focus groups with individuals who use care services and their carers to understand what matters most to people about their care.

Throughout the project the Scottish Government has chaired a Project Board of representatives from across the public, private and voluntary sectors. The next phase of the project is to develop an implementation plan for the final Standards.

Why are the Standards based on human rights?

Human rights are the rights and freedoms that belong to every person, at every age. These rights are set out in laws which help raise everyone's awareness of the need to uphold individual rights and protect people with protected characteristics from discrimination. Looking at standards of care from a human rights perspective helps us identify what individuals using care services should be entitled to, as well as ensuring providers comply with legislation when providing care.

More information on Scotland's National Action Plan for Human Rights ( SNAP) is available at http://www.gov.scot/Topics/Justice/policies/human-rights/scotlandsnationalactionplanforhumanrights

The new Standards

We propose the following new Standards apply across health, care and social work services:

1. I experience high quality care and support that is right for me

2. I am at the heart of decisions about my care and support

3. I am confident in the people who support and care for me

4. I am confident in the organisation providing my care and support

5. And if the organisation also provides the premises I use

6. And if my liberty is restricted by law

7. And if I am a child or young person needing social work care and support.

The first four headings set out Standards for everyone. These are complemented by three additional headings with Standards that only apply in specific circumstances.

For example, if a young person is looked after by the local authority and living in a residential unit, then Standards 1-4 will be complemented by Standards 5 and 7. Or, if an adult is accommodated and receiving compulsory treatment under the Mental Health (Care and Treatment) (Scotland) Act 2003, then Standards 5 and 6 apply as well as Standards 1-4.

Additional Standards for people experiencing restricted liberty and for children and young people who need social work support?

People experiencing restricted liberty and some children and young people who have particular needs sometimes require specialist care and support. Standards 6 and 7 reflect these particular care and support needs, and are different from, and additional to, those covered by the other Standards that are applicable to everyone.

For example, Standard 6 ('And where my liberty is restricted by law') states: "I can be with my peers, including other people who use the service, except where this has been properly assessed as unsafe" (6.7). This reflects the expectation that, for people experiencing restricted liberty, the question of whether it is safe to have contact with peers is routinely assessed. For most care and support however, this question is not routinely applicable as people have control over their own contact with peers.

Standard 6 is very specific to the relatively unusual situations where someone is subject to a formal restriction on their liberty. Standard 7, on the other hand, covers many of the same issues as in Standards 1-4, but goes into more detail of what is expected in order to meet the particular needs of children and young people who are in need of social work care and support.

How do the Standards fit with other Scottish Government priorities?

The Standards have been prepared to deliver the collective ambitions of a range of legislation and Scottish Government policy that relates to health and social care, for example:

• Scotland Performs: National Performance Framework
• Getting it Right for Every Child and the wellbeing indicators
• The Public Bodies (Joint Working) (Scotland) Act 2014 and the National Health and Wellbeing Outcomes prescribed under that Act
• The Social Care (Self-directed Support) Act 2013
• The Carers (Scotland) Act 2016
• Social Services in Scotland: a shared vision and strategy 2015-2020
• A National Clinical Strategy for Scotland
• Standards of Care for Dementia in Scotland
• My Home Life
• Expansion of funded childcare
• National Common Outcomes for Community Justice

What will happen next?

• The public consultation on the draft new Standards will run from October 2016 until January 2017
• During the consultation, we will make available personal stories to illustrate the range of people who will be impacted by the new Standards
• After the consultation, Scottish Government will review and analyse responses. The Project Board and Development Group will consider the findings and a consultation report will be published in Spring 2017
• The final Standards will be published in Spring 2017
• The new Standards will be implemented from Spring 2018
• The Scottish Government will set up a short term group to identify and advise on the detail of full implementation of the Standards
• Current inspection methodologies will be updated to ensure they align with the new Standards
• The final Standards document will explain the complementary relationship between the Standards and existing legislation, standards, guidelines and professional codes, including for example:

• the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011;
• the Healthcare Improvement Scotland (Requirements as to Independent Health Care Services) Regulations 2011;
• the Dementia Standards; and
• the Scottish Social Services Council's Codes of Practice for Social Service Workers and Employers.

• The Standards will be taken into account in inspections and registration decisions in relation to health and social care services from April 2018.