The Quality Of Care Services

Care Appointments reports on the Care Commission’s recent review of care services in Scotland…

The Care Commission, has released the findings of its Annual Quality Review, which for the first time presents a comprehensive national picture of the quality of care in Scotland. The landmark review, titled The Quality of Care Services in Scotland, considers evidence from the Care Commission’s first four years in existence to assess the quality of care provided across all sectors.

This review marks the first time this information has been easily available and allows the Care Commission to use evidence to accurately pinpoint which service types are performing well and, equally, where there is greatest room for improvement. The report concludes that there are thousands of innovative services providing a high quality of care across Scotland – this is particularly true in the case of Childminders and Daycare of Children.

And the publication also highlights areas where the Care Commission has the most cause for concern and where it needs to see most improvement – such as in Care Homes for Older People and services providing residential care for children. Jacquie Roberts, chief executive of the Care Commission, said:

“This publication gives us a unique insight into the quality of care services in Scotland. It is the first comprehensive, credible, accurate and evidence-based picture of all care services in Scotland in terms of both quality and availability. For the most part the findings are positive and we have discovered there are thousands of services offering a very high quality of care for service users.

“However, we make no secret of the fact that while there are excellent services out there, there are still many who give us cause for concern. This publication gives us the evidence to highlight these areas and specifically target the service sectors where there is greatest need for improvement.

“We have already made a big difference in improving the quality of care in Scotland and we are committed to maintaining this improvement in all service sectors. We realise that the review won’t make pleasant reading for all care service sectors but it does make it clear to providers that there is no hiding place and those that have not done so must adapt and improve to offer a service befitting of 21st century national care standards.”

The review uses evidence from more than 55,000 inspections and almost 5000 complaint investigations from April 2002 to April 2006, with particular emphasis on the findings from the inspection year 2005-06. It sets out findings and commentary by specific service sector.  

In each section it details the number of complaints, requirements and enforcements made against each service type within adult services, children’s services and independent healthcare services. The report also show the breakdown of types of care services by who provides them – local authority, voluntary and not-for-profit, NHS or privately run. In addition it details the availability of services by local authority area – which should be of particular interest to those responsible for planning and commissioning care services.

The main general findings of the review include (please see review for full findings by specific service type):

During the regulatory year 2005/2006, of the 15,179 services registered:

• 4.2 per cent had a complaint upheld against them during 2005/2006
• 0.7 per cent had an enforcement action taken against them
• 25.8 per cent had a requirement made against them
• 16 services were issued with cancellation notices  

Providers:

• The majority of registered services (57 per cent) are run by the private sector – although this figure includes all childminders who make up 40 per cent of all registered services – When childminders are taken out of the equation, the majority of registered services in Scotland are run by the voluntary sector (38 per cent) followed by local authorities (33 per cent) and then the private sector (29 per cent)

Jacquie added: “There is no question that there have always been some poor services in Scotland. However, we are now in a position to be able to identify these more clearly and specify where there is greatest room for improvement. Many services are good, but we want to see an increased capacity for improvement.

“At the same time, people’s understanding of the Scottish National Care Standards has increased and as a result their expectation level of the quality of care has also risen. The fact that more people are aware of what they are entitled to expect is undoubtedly a positive and can only serve to increase standards of care. We are also constantly evolving our regulatory process to improve and maintain standards of care as well as praising and promoting good practice where it exists in many services.”

Carole Wilkinson, chief executive of the Scottish Social Services Council said: “We know that competent and confident workers are key to providing better quality services for the most vulnerable people in our communities. With many social service workers now required to gain qualifications to be able to register with the Scottish Social Services Council, people are increasingly having access to a professional workforce and more effective services.

“Those services with trained staff consistently perform better and I welcome this review which is a helpful contribution towards building a picture of what regulation is achieving, identifying the excellent practice across the sector as well as areas for improvement including developing a motivated, professional workforce.”{mospagebreak}

Delivering Improvements

As the Care Commission publishes the Quality of Care Services in Scotland, one care service highlights the benefits of embracing the National Care Standards to improve the quality of care offered to residents. Wheatlands Care Home in Bonnybridge, Stirlingshire, is a shining example of how strong organisational leadership and a skilled workforce can work together to improve a service which had previously raised some concerns.

Prior to a change of ownership at the home in November 2006, the Care Commission had previously taken action against the home about some aspects of the National Care Standards not being met. Areas where improvement was required included maintaining standards in the accommodation and improving the records about the likes, dislikes and needs of residents in the personal care plans.

But since the change of ownership at the home, management and staff have worked extremely hard to address requirements made by the Care Commission and significantly improve the service for their residents. Liz Norton, director of adult services regulation at the Care Commission, said:

“Wheatlands Care Home is a prime example of how a service can constructively act on requirements made by the Care Commission to improve the service for residents. While the standard of care at the service was good, we did have concerns that the accommodation was not maintained in terms of decor and environment and that the paperwork for personal care plans did not reflect the detail needed to ensure consistent, quality care for each resident.

“These may seem like more trivial aspects of improving care but the providers were fully committed to acting on these requirements and worked very closely with the Care Commission to enhance the service they were able to offer to residents. Every care service has ways in which they can develop and improve and Wheatlands is a tremendous example of how services can embrace this improvement. After all, the common goal of the Care Commission and care services is to ensure users receive the best care possible.”

Helen McIntyre, manager of Wheatlands Care Home, said: “We have always prided ourselves on providing an extremely high standard of care for our residents and we therefore take on board the Care Commission’s comments about our service. While the standard of care for our residents never dropped we recognised that more attention could have been paid to maintaining the environment in the home and recording paperwork with regards to care plans.

“Through strong leadership and investment responded to the Care Commission’s requirements and ultimately improved the overall service our residents enjoy. Wheatlands welcome any constructive input from the Care Commission, and we are fortunate in having Pauline Kyle as a person committed to working with us in a team effort. We all feel the level of care is now exceptionally good as well as the accommodation decor and so forth.”

Case Study: Marion Neil, Care Commission Officer

Marion Neil joined the Care Commission hoping she could make a difference. Five years on she’s confident that, even in her small way, she’s helping to improve standards of care that are changing people’s lives.

Marion is one of the 338 Care Commission Officers (CCO), whose job it is to regulate the 15,000+ care services used by almost 320,000 people across Scotland. Marion’s job involves visiting care services in Fife to carry out annual inspections or to conduct investigations into complaints. Her caseload focuses primarily on care services for children such as nurseries, childminders, pre-school groups and school care accommodation services.

Her career in education – she was a guidance teacher for 25 years before becoming a manager of a multi-discipline community school project – provides a solid, credible background to her work with service providers.  

In their inspections, CCOs use the Scottish Executive’s National Care Standards to monitor the quality of care provided to people who use care services, ensuring a uniform level of expected standards regardless of where someone lives.  Each CCO, like everyone in the Care Commission, is dedicated to raising standards of care by involving people who are cared for, their families and carers and those who provide care. The primary purpose is to regulate for the improvement, by identifying examples of poor practice and asking for action to taken where appropriate.

As well as her educational career, Marion’s job skills are greatly enhanced by her Regulation of Care Award (Scotland) RoCA qualification. Marion was one of the first people in the Care Commission to graduate with the RoCA Post Graduate Diploma, which provides CCOs with a professional qualification in regulation for the first time.

She said: “Our aim is to work with care providers to assist them to improve and develop their practice in order to always keep aiming for a better service. It’s important that Care Commission Officers are highly skilled, professionally competent and confident in their ability to influence practice. This can only ultimately improve the quality of care and the support that care users receive.

“The RoCA qualification – with my background in working with children and their families-means I have a wider knowledge of good practice and can work to promote this with providers. Regulation should be robust – and that can only be of benefit to the people who use care services now, and in the future. I’m pleased to think that I’m playing my part to ensure we provide the highest levels of service for some of the most vulnerable people in society.”

Ultimately, all CCOs will have the RoCA qualification, ensuring the Care Commission remains totally committed to have a workforce that not only strives to improve the quality of care but is equipped to deal with the ever changing face of the care sector in Scotland.

Visit www.carecommission.com for further information.