NATIONAL CARE STANDARDS REVIEW
Thank you for giving Quarriers the opportunity to respond to this consultation. Quarriers is a major Scottish charity providing practical care and support every day to thousands of people. Through more than 100 services for Adult Disability, Children and Families, Epilepsy and Young Adults in Scotland and a growing number of services in parts of England, we challenge inequality of opportunity and choice, to bring about positive change in people’s lives.
Question 1
Do you think that the new National Care Standards should be grounded in human rights?
Quarriers welcomes a review grounded in human rights. Social Care Services provide the most intimate and personal care for some of the most vulnerable people in Society and in the light of changes in Society, social progress and technological developments it is always beneficial to take every opportunity to strengthening and ensure protection of these rights. We must ensure we pay attention to how people are treated and listened to and would welcome an approach where people supported are afforded greater participation in their support. Such an approach should also be based on principles of equality of access and may present challenges in terms of a variety of concepts eg eligibility criteria, capacity of an individual.
Question 2
a. Do you agree that overarching quality standards should be developed for all health and social care in Scotland?
It is Quarriers view that service specific inspections don’t take cognisance of some of the bigger issue and that a whole systems approach to inspection from commissioning down to specific services. The final report of the Christie Commission emphasised putting individuals and communities at the heart of public service design and delivery. Its priorities for reform included ‘recognising that effective services must be designed with and for people and communities – not delivered ‘top down’. However there is a desire on the part of both politicians and the public, to ensure that taxpayers money is spent efficiently and effectively – a concern that will only increase at a time of constrained public spending. The inevitable focus on deliverable outcomes raises policy dilemmas for both universal services and m and more targeted interventions. A Demos Report “The Ties That Bind” 2014 stated that there will always be a tension between ‘what works’ and what families really want. A whole systems approach would take that into account as well as the following example. Often commissioned services have eligibility criteria which is not within their control. Quarriers accepted a person with a learning disability into a care home with some pressure from their funding authority and subsequently found the information given did not match that person’s needs. The Care Inspectorate subsequently took a view on the situation which resulted in the service being downgraded. A whole systems approach would provide a route for the CI to comment on commissioning of services. Some services feel accountable for commissioners mistakes.
b. Do you agree that the overarching quality standards should set out essential requirements based on human rights?
Yes.
Quarriers would recommend that there is a clear interface between the care standards and human rights, which would result in how the standards are informed by a rights approach
That public bodies and third sector organisations are required to take steps to ensure they comply with the following:
- Right to the integrity of the person
- Right to liberty and security
- Respect for private and family life
- Protection of personal data
- Right to marry and right to found a family
- Freedom of expression and information
- Right to education
- Freedom to choose an occupation and right to engage in work
- Freedom to conduct a business
- Rights of the child
- Rights of the elderly
- Equality between women and men
- Integration of persons with disabilities
- Right of access to preventative health care
We would also suggest consideration be given to how breaches of these requirements can be challenged, particularly by children and vulnerable adults.
Proposals should have the level of detail required for a comprehensive analysis of impact.
c. Do you agree that the current National Care Standards should be streamlined and a set of general standards developed that would sit below the overarching standards and apply to all services?
Whilst the National Care Standards should ensure safe and effective practice and support improvement, there are significant developments which raise the bar in relation to the Scottish Government’s aspirations. Eg Curriculum for Excellence, GIRFEC, The Children and Young People (Scotland) Act 2014 and the Integration of Health and Social Care. These not only take a human rights approach but place significant emphasis on public sector reform, national outcomes and the importance of improving health and wellbeing with services planned for the benefit of the individual. A set of overarching standardswould capture these aspirational elements.
d. Do you think general standards should set out essential requirements and aspirational elements?
Yes. This is likely to place more emphasis on outcomes whilst continuing to look at processes. Quarriers consider the following would contribute to a more collaborative approach.
- Quarriers are customers of the CI and a co-productive/partnership approach should be taken
- CI methodology should be more transparent. Feedback from Quarriers staff suggests there is some inconsistency in the approach of individual inspectors.
- It is right that there should be a focus on service users but the inspection methodology should take account of this adopting more creative approaches. EgThere are issues around engagement. Young people for example use social media
e. Do you agree that a suite of specific standards are developed for particular aspects of care, circumstances or need?
Whilst the current standards are over 10 years old and set out the minimum standard of care, there is no doubt that there is a need for specific standards which people who use care understand.
Quarriers are a diverse organisation delivering services in early years through to older people. We would suggest consideration be given to increasing the pool of lay assessors which might help build the capacity of services providers.
Quarriers support the idea of shared standards across health and social care which will support closer working between sectors and improve integration as well as outcomes.
Question 3
a. What are your views on how standards should be written?
Quarriers believe it is important that a balance is achieved between rights and responsibilities and using simple language with enough detail to ensure people know when their rights have been breached.
Standards should be written with clarity and in a way which enables people who use services to understand them. If the CI move to more streamlined approaches with overarching, general and specific standards, it should be easy for a person using services to understand what to expect. The SHANARRI outcomes are a good example of of a consistent approach in terms of reporting on outcomes for children and young people. Quarriers welcome clear quality thresholds below which standards of care should not fall. Easy read versions of the national care standards should also be available.
We agree that the principles in the current care standards – dignity, privacy, choice, safety, realising potential and equality and diversity should be included in the new overarching quality standards.
b. 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?
The example of how the overarching standards could be written is good. Easy read versions should be available for people who find some of the concepts difficult to understand.
There are several publications which HMIe have used in their child protection inspections which set out expectations and provide quality indicators to assist services on their improvement journeyfor service providers. For example ‘How well do we protect children and meet their needs’ This is a guide to self evaluation but provides a framework with a focus on delivering positive outcomes for service users and reinforces the partnership between external and internal evaluation of services.
This document provides links to high level social policies and also reflects human rights themes such as equality and fairness.
Question 4
a. Accountability and enforcement – how will National Care Standards be used.
We agree that overarching quality standards should be promoted and upheld and could be used as a test of compliance when new services are being registered
We believe that strategic inspections such as those carried out in Child Protection would be more likely to pick up themes in local areas and would provide a more in depth understanding of what services are commissioned and why, avoid categorising and replication and move towards commissioning for outcomes. Many third sector providers in times of austerity and with the onset of Self Directed Support have had to change their approaches in practice and ensure their support systems can adapt to a more personalised approach. Picking up themes in a culture of such transformational change and accountability is more likely to be levelled in the right direction, if a strategic approach is taken. If Commissioners of services were held accountable for holding the service to account, this would be more transparent if wider inspections of health and local authority services were carried out.
b. How should we ensure that services not regulated by the Care Inspectorate and Health Improvement Scotland comply with the new standards?
This is a difficult area particularly with the implementation of the Self Directed Support (Scotland) Act. The Public Sector havea duty to protect vulnerable people, and have a duty to get best value for the public pound. Services which they commission which are not registered, including those commissioned by Community Planning Partners and should be accountable to them. Should strategic inspections be implemented there is a route there, plus the Audit Commission to ensure they regulate and monitor these services appropriately. In the case of SDS this should be through a robust care management system.
c. We suggest that the Care Inspectorate and Healthcare Improvement Scotland, consulting with others, should develop the suite of specific standards. Do you agree with this?
Yes. This should also include Education. Children’s services is a crucial part of Quarriers delivery of care. Quarriers are somewhat concerned that in joint planning processes may be more difficult with the introduction of the integration of health and social care when education sits outside this umbrella body. Wider inspections in local authority areas may ensure that planning process are integrated and partners widely consulted.
Question 5
a. Please tell us about any potential impacts, either positive or negative, you feel any of the proposals set out in this consultation paper may have on particular groups of people, with reference to the ‘protected characteristics’ listed above.
b. Please tell us about any potential costs or savings that may occur as a result of the proposals set out in this consultation paper and any increase or reduction in the buden of regulation for any sector. Please be as specific as possible.
Should Strategic Inspections be implemented across Health and Social Care, intelligence should be gathered across a local network which would highlight themes and unearth issues for more intense scrutiny. Quarriers would recommend that there is a clear interface between the care standards and human rights, which would result in how the standards are informed by a rights approach
That public bodies and third sector organisations are required to take steps to ensure they comply with the following:
•Right to the integrity of the person
•Right to liberty and security
•Respect for private and family life
•Protection of personal data
•Right to marry and right to found a family
•Freedom of expression and information
•Right to education
•Freedom to choose an occupation and right to engage in work
•Freedom to conduct a business
•Rights of the child
•Rights of the elderly
•Equality between women and men
•Integration of persons with disabilities
•Right of access to preventative health care
We would also suggest consideration be given to how breaches of these requirements can be challenged, particularly by children and vulnerable adults.
These legislative proposals lack the detail required for a comprehensive analysis of impact. scrutiny. Local services should still be inspected but the frequency might reduce.
Question 6
Please tell us if there is anything else you wish us to consider in the review of the National Care Standards that is not covered elsewhere in the consultation paper.
- Staff state that they would appreciate training from the inspectorate; would like to see more examples of good practice linked to evidence
- Improved engagement with people using services – samples can be very small and in some cases result in a requirement based on limited evidence.
- Service users who have no speech need a specific approach to engagement.
- If a service is high risk the volume of work required to reduce the risk is unlikely to be achieved in less than 6 months, therefore inspections should take account of this.
- Quarriers would like to see an appeal process in place for complaints