Chief Executive Karen Reid welcomes the new Health and Social Care Standards

Karen Reid, Chief Executive, Care Inspectorate

I believe Scotland’s new Health and Social Care Standards will be amongst the most progressive and radical anywhere in the world and I look forward to their implementation over the coming months. Almost everyone in Scotland will use a care service at some point in their lives, whether that is a nursery or a childminder, a care at home service or a care home. More people of all ages and experience are coming into contact with care.

The new standards have been produced together by a broad range of people from the public, private, voluntary and third sector, through partnership and collaboration, and with input from people who experience care, providers and other professionals. 

When you read the new standards, they will look very different to the ones from 2002. They are relevant across all health and social care provision, rather than just in regulated settings, including across early learning childcare and children’s social work services, and they are significantly more rights-based and outcome-focused than those developed over 15 years ago.

Scotland is leading the way in developing standards which have such a strong focus on human rights and wellbeing, making them unique and innovative. As the Care Inspectorate develops world-class approaches to scrutiny and improvement, the standards will play an important role in our work too.

The findings of the National Care Standards Review showed that the vast majority of people surveyed feel the new standards will help to support improvement in care services and it is encouraging to note that so many of us view the new standards as a potential tool for more partnership working in future.

So, what do these new standards mean for scrutiny and improvement in care services? We have started to consider what changes we will need to make to our inspection methodology, in light of the new standards, and how we will need to change the way we inspect services in the future. For example, at the Care Inspectorate, it is our intention to start using the standards to inspect care homes for older people from April 2018 and to undertake significant work before then in partnership with care home providers and residents. We will begin to roll these out in inspections of other types of care thereafter.

There will be no ‘big bang’ for service providers. However, providers do need to start examining the new standards now and think about what they mean for them. We will work with providers and commissioners during a phased implementation to make sure that we continue to build on the overall good quality of care and support the committed and skilled social care workforce.

The new standards will form the basis of future inspections but they are not just designed for scrutiny. They are explicitly designed to support strategic inspection and the way services are planned, commissioned and delivered, and to be used in supporting improvement too.

So, what are the big changes? First, they are much more person-led than before. Virtually all the statements start with “I experience…” or “I am…”. This locates quality firmly through the lens of the person experiencing care, rather than by describing specifically what care professionals should do. This is empowering for people who may be in unfamiliar or distressing environments and is designed to ensure care professionals reflect on their practice from the perspective of the person. This person-led approach is designed to help people and organisations to work together to support people to direct their own care.

Second, they are outcome-focused, describing what the consequence of good care should be, not how it should be delivered. Detailed and technical inputs about staff ratios and nutritional intake are replaced by outcome indicators. For example, a previous descriptor about the minimum size of a care home room or early learning premises is replaced by a new descriptor which states “I have enough physical space to meet my needs and wishes”. This allows care providers, along with the people experiencing care, to decide what the right size is – and on inspection, explain how and why they came to that decision. We understand that the care sector will still need guidance on these areas, so you are clear about our expectations of you. Over the coming year, we will be publishing our expectations and guidance and the new standards will allow this guidance to be updated reviewed over time.

Third, the outcomes are decoupled from settings. Instead of separate standards for care homes, hospitals, children’s services, there is a common set of outcomes across all care. The standards are relevant for planning, commissioning, assessment and care delivery. This is to allow coherence and improvement activity at every level, but also reflects the fact that many people use different types of care at the same time – why should the quality of experience be different? It is also important that commissioners understand and reflect on how the standards can support them to ensure that high-quality care is commissioned from the outset. Our expectation is that commissioners and care providers work in partnership to design and deliver care that meets people’s needs.

These three changes are designed to ensure that the assessment of quality is not whether a minimum standard is met but whether the experience and outcomes for people are positive. We want service providers to creatively solve problems and innovate to improve. The new standards are designed to help managers and care staff to plan, do, study and act. Increasingly our inspection has moved from seeing whether something is done ‘correctly’, to asking ‘how successful is this in improving experiences and outcomes for people?’. The new standards reinforce the new approach completely.

The Care Inspectorate’s role is to inspect care and report on the quality of experience. We champion good care wherever we find it, working closely with providers to support them to improve where needed.

The new standards will be very different to those previously set out and, in respect of the needs, choices and rights of the individual experiencing care they will be much more outcome-focused and will help everyone focus on what really matters – the experience of the person who uses care. The development of the new standards has required new ways of thinking and they provide a tremendous opportunity to shape the way we all would like care to be designed and delivered in the future.

I have often said that the Care Inspectorate is on a journey from compliance to collaboration, and these standards help that. I am committed to the Care Inspectorate working in collaboration with care providers and care staff to do the thing we all want –deliver excellent care for people who experience care. Together and over time, we can make sure the new standards become a reality for everyone.

Karen Reid
Chief Executive
Care Inspectorate