Scottish People At The Centre New Care Standards

From next month (April), a new grading system for every care service in Scotland is to be introduced by the care regulator, the Care Commission.

Care homes, child care services and those offering services to people with mental health problems will be amongst the 15,000 providers to be covered by the new system.

The aim of the new system is to make it easier for members of the public to ascertain the quality and performance of a care service so they can make a more informed choice about whether or not to use it.

Jacquie Roberts, chief executive of the Care Commission, describes it as a ‘hugely significant move for everyone in Scotland who has – or will have – contact with a care service’. 

The grading system has been designed around the needs of care users and their families who wanted a simple, quick and effective way to rate services in their area.

The new system gives them that, says Ms Roberts:  ‘We are putting people at the heart of regulation.’

One of the reasons it is so needed is the level of confusion the public has with regard to the standards expected of care providers.

This was evident in the last Awareness of the National Care Standards survey in 2005. 

It showed a lack of understanding of the standards, which ensure that service users receive the same standard of care wherever they live in Scotland, among service users.

It revealed that, while 100 per cent of providers knew about the National Care Standards, only 41 per cent of users said the same.

Just 44 per cent of carers were aware of the standards and only nine per cent of older people in care homes had heard of them.

So there seems to be a need for providers to work at ensuring service users know about the standards to be met.

That is partly why communication is an essential component in achieving a good grade in the new system.

The new grading system will work by assessing each care provider against quality statements within the four main areas or themes of importance to service users and their carers. 

The themes are:  quality of care and support; quality of the environment; quality of staff; and quality of management and leadership.

Before inspection, providers will be asked to complete a self-assessment of their service using a framework of the quality statements and themes which are linked to the National Care Standards. 

Providers will have to award themselves a grade between one and six – with one being unsatisfactory and six being excellent – for each theme.

At inspection, the Care Commission officer will verify the evidence and amend the grades if necessary.  The officer will award the provider the final grade, which will appear in the service’s inspection report and on the Commission website.

A service cannot receive a high grade for any of the quality themes without providing evidence of consultation with people who use the service.  

This will vary according to the service and client group, but may include questionnaires, focus groups or one-to-one interviews. 

The Care Commission will assess the quality of consultation to ensure that service users’ views are truly being gathered and acted upon so as to avoid a tick-box approach.

The grading system has been in development since 2004 and more than 150 services have taken part in pilot projects to test and refine the system via 177 inspections.

Renfrewshire childminder Denise McGinlay was one of them.

She took part in the pilots twice last year.  Ms McGinlay says she is pleased that providers’ views were taken into consideration in its development,

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‘The process was much simpler the second time, which I found reassuring.  The Care Commission had changed the paperwork slightly to make it easier which was a big help,’ she says.

Bill Duncan, manager of the regulating for improvement project at the Care Commission, says that this was not the only change that the Care Commission made as a result of providers’ feedback.

For example, one of the four themes had been amended after pilot participants challenged it.

He says: ‘We started by having  ‘quality of life’ as the first one but, after a lot of dialogue with providers, we accepted that quality of life is not something wholly within the power of providers so we changed it.’

English providers are also to see a new system of assessing their services which shares the aim of making it easier for the public to choose services. 

But the Care Commission has opted for a different rating system from its English equivalent, the Commission for Social Care Inspection (CSCI).

While both are based on self-assessment, the similarities end there.

In England, quality ratings will use stars and words to describe the CSCI judgement on services.

Three stars will mean excellent, two stars will be good, one star for adequate and no stars signals a poor service.

But the Care Commission has opted to avoid a star-rating system like the one in England, which gives an overall assessment of the service.

For example, a CSCI inspector may feel some evidence falls in the ‘adequate’ category while other parts of the service are ‘poor’.  If providers can show the type of improvements that are to be implemented then a home may still be judged ‘adequate’.

In Scotland, the Care Commission will publish information on each of the four themes being assessed.

Mr Duncan says this ensures a fair and comprehensive grade for each aspect of a service.

‘We decided that it was not appropriate to simplify what we are saying about quality.  This way, we don’t allow poor performance in some area to become masked by good areas.’

However, if a service receives a weak or unsatisfactory mark on any quality statement within a theme, then the whole theme will be graded at that level regardless of other others.

Many providers are likely to feel worried about a new grading system, especially the prospect of receiving a low mark.

After all, the nature of inspection means that disagreement sometimes occurred between the Care Commission and the provider.

While there is to be no formal appeal system, disputes can be flagged up at the feedback session at the end of the inspection. 

Challenges that are not resolved at that stage will be handled through the Commission’s error response system. 

But Liz Norton, director of adult services regulation at the Care Commission, says that fears about overly-stringent grading are unfounded.

She points out that seventy per cent of providers who took part in the pilots agreed with the mark given to them by the Care Commission.

And, of the three out of ten that disagreed, some felt they had been graded too high by inspectors.

‘So it shows the challenges are not always about the Care Commission awarding lower grades but sometimes giving higher grades,’ says Ms Norton.

The experience of the pilot site participants should reassure other care providers that the new system is fair, she adds.