Care Standards: They Are There For A Reason!

Care Appointments catches up with Care Commission Chief Executive Jacquie Roberts…

The Care Commission recently hosted a series of public forums in order to measure and raise awareness of the National Care Standards and to establish people’s opinions on a proposed ‘grading’ system for care services. These forums followed the publication of the report The Quality of Care Services in Scotland. Promoting awareness of the care standards is something that the regulator takes very seriously.

“Everything we do is based on the National Care Standards – they are the underpinning to what we look for. They are very different to any other UK standards as they are written from the point of view of the service user – ‘You should expect this, you should have that, when you first enter the service this is what you can expect the management to give you, you can expect the right the staffing levels according to your service and according to your needs’,” explains Care Commission chief executive Jacquie Roberts.

“The standards are actually quite revolutionary and we promote them wherever we go.” To that end, significant steps have been taken to promote the message, as Roberts explains: “The Minister’s action plan from the last government in response to the Age and Experience strategy was to devote £200,000 towards an awareness raising campaign of the National Care Standards for older people – ministers are accepting of the fact that people need to know what they are entitled to expect.

“On our website we have a section where visitors can instantly access the standards and a previous minister took the step of making copies of the standards document available free of charge to service users, their families and carers. Whenever we release a bulletin we talk about the National Care Standards in one form or another, but it requires more than just us (to be promoting the standards) as there are 15,000 services and some quarter of a million people using services.”

An earlier stakeholder survey showed that there was 100% awareness of the standards amongst care service providers, but, the Care Commission believes this was principally amongst managers. However, the Regulator is also committed to taking the message to the workforce.

“We get services to look at themselves according to the standards and give us a self assessment of whether they are meeting those standards. We have to rely, a lot of the time, on employers and managers to promote the care standards and to use to use them with their workforce, which a lot of them do. A couple of years ago I went to visit and early years service. They were being registered so they hadn’t actually begun, but all the staff were sitting down with a copy of the standards working out how they were going to deliver those standards in their rooms for one to two year olds and so on. Last summer I went to a care home and at the front desk were copies of the standards – all these little gestures add up when promoting the standards.”

The Care Commission’s belief is that through greater understanding, appreciation and awareness of the principles contained in the National Care Standards, sector workers will be better placed to deliver quality care to service users.

“The principles are absolutely vital,” affirms Roberts. “The principles that underpin the standards come from the UN Convention on Human Rights and the UN Convention on the Rights of the Child and they are about dignity, privacy, realising potential, equality and diversity, and safety. If people are subscribing to those principles in their day-to-day work then they are providing a good service, a service that is much more person-centred than many services. Services that are designed around an institution don’t necessarily follow those principles. The other reason for following the standards is that each year we will measure people against them.”

Of course, the standards are not just there as a yardstick for the workforce to follow or be judged against – as the regular for care services in Scotland the Care Commission has to take the standards into account in everything it does, just as the services it regulates must.

“The standards are not about minimum input – there are a few requirements, for example, on staffing levels and ratios that are written into appendices within the standards, but they are really about how to deliver a good quality care service and the sort of things you should be thinking about and how you approach the individuals receiving the service.

“We always let providers know which standards we are inspecting against in each inspection year. That’s another reason that people should live and breathe the standards. Having said that, these are the ministers’ standards so we do inform the civil servants that the standards need to be reviewed every few years in order that they retain a currency and that they are signposting the right legislation and the right good practice guidance.”

All too often the media chooses to highlight care services that have not been performing as well as they might, and sensationalist headlines make better tabloid reading than a positive story about a successful and well run operation, but the Care Commission are understandably keen to highlight as many of the great number of success stories within the sector as they can.

“We have a very strong commitment to being both a responsible and a responsive regulator. So we are always looking for examples of how people are meeting standards and we highlight many of these each through articles in our Care News magazine. In doing this we don’t just raise awareness of standards but also promote the fact that there is an inspection report. In each issue of Care News we have a spread in the form of a poster and we’ve been using this to promote the standards.”

Improvement and delivering better services, and for that matter, being a better regulator, is at the heart of the Care Commission’s agenda and also the National Care Standards. Roberts is clear about the areas in which development and improvement are coming.

“The key is how we modernise care regulation so that we concentrate our time where it really matters – how we can get a better understanding of care regulation amongst members of the public so that they know that they can actually give information about the quality of services, using the inspection reports, demanding service improvement where they think improvements need to be made, and be part of the whole regulatory process.

“Therefore we are pushing ahead with developing our registration and inspection processes by making sure that providers properly involve people who use services in the assessment of whether those services are meeting their needs. This is an ambitious and comprehensive change to the way we do things – with gradings and good self assessments that we will validate. From this we will have a far more straightforward measure of quality rather than proxy measures employed at the moment, the list of complaints, whether there has been involvement and requirements.”

The gradings initiative is a pioneering and innovative one and is a significant move away from a one-size-fits-all approach. What it means in real terms is that care services will not be given one overall ‘mark’ but rather will be graded on several aspects such as quality of staffing, quality of environment, quality of management and leadership – the theory being that not every service user has the same priorities and may place different levels of importance on certain aspects of the care service they receive.

“We are in the middle of our second set of pilots for the grading system” explains Roberts. “We’ve already piloted the new system in childminding and care homes and we’re spreading them across the other services. The feedback we’ve had from our forums has been that everyone wants the gradings system, including the service providers. A large proportion of service providers want to see those who don’t deliver good enough care ‘out’ because they feel that this reflects poorly on them and can give them a bad reputation.”

This concern about standards also extends to sector workers themselves and this is appears to be another reason why promotion of standards to the workforce is so important. The Care Commission are sometimes contacted by frontline staff who are frustrated with the quality of service or lack thereof provided by their employers or by the quality of management within their organisation. In addition to this, staff are interviewed confidentially during inspections of services so that they know they can speak freely.

“Clearly I would prefer that there were as few whistleblowing complaints as possible – it would obviously be much better if members of staff had the confidence to go to their management and get it sorted out – that is the ideal. However we do get people, including members of staff, service users and their families, who wish to complain to us anonymously or in confidence because they are concerned about the repercussions of complaining. Some of the most tricky whistleblowing investigations are ones where there is already a dispute between employer and employee.

{mospagebreak}“Our principles when investigating complaints are very about being open, transparent and objective – we have to listen. Complaints are a very good indicator of where things are going wrong. People have the right to come to Care Commission irrespective of whether they have direct to the service provider and it is through these kind of complaints that we have been able to identify some quite serious problems and therefore can demand improvement and it is those that lead to the very rare cancellation of services.

“That said, we want to promote and help develop a much more open complaints system where people can go to the provider and get the complaint dealt with at the point of delivery, wherever possible.”

The rate of upheld complaints has been steadily increasing which would suggest that the Care Commission’s work in educating people on what kind of complaints they can make to the regulator has been successful. However, Jacquie Roberts is acutely aware that the Care Commission itself must continue to improve.

“Every time we release guidance on care services we always include things that we as a regulator can do to improve, recent examples being involving more people in regulation especially care service users, publishing as much information as we can about quality, developing a grading system, targeting regulation of services that need to improve. Also, as a regulator, there is an inevitable attachment of beauraucracy and we’re doing our best to cut down as much paperwork as possible.”

The concept of ‘inclusion’, and the idea of involving care service users more in the regulation process is widely accepted to be a positive and progressive one, but in practical terms is it challenging to actually deliver? Jacquie Roberts believes that this is being achieved in the normal course of operations and is encouraged by recent results.

“In housing support services we’ve had a very good response to telephone surveys with people who use the services, and that happens also in adoption and fostering services. If you are actually going into a service like day care for children you can engage with the parents and the children in a group or in a care home setting you can ask the provider for the Care Commission to be invited to a residents association meeting to get feedback.

“When we are onsite conducting inspections we always interview service users. Involving service users is not a one-size-fits-all situation – involving three children and their families who use a childminder is very different to 150 older people in a care home, some of whom are very very frail and find it difficult to communicate, as well as their relatives.”

Another priority for the regulator is making their operations as proportionate and targeted as possible, making the time they spend with each service as effective as possible and as Roberts describes “going in where it matters.

“We have statutory requirements to visit certain types of services once a year and other types of services twice a year, including unannounced inspections for some 24hr services. As an example, because day care services for children have been generally doing very well the frequency with which we inspect those has been reduced this year. Similarly the frequency of inspection has been reduced for certain housing support services – registered social housing.”

While there have been no increases in the frequency of inspection for any types of service Roberts states that there are those for whom the frequency will not be reduced, such as care homes for older people, childminders and services for children under the age of one.

When asked to pinpoint single biggest challenge that the Care Commission faces, Roberts is in no doubt as to her answer.

“The biggest challenge is that we cover such a wide and diverse sector from childminders to private hospitals, from care homes for children and young people in trouble through to large nursing and care homes.”

Added to this remit will soon be the regulation of private hospitals specialising in cosmetic surgery. This diversity has necessitated the Care Commission recruiting sector specialists to manage the regulation of the wide range of services.

“When we started off we just had a Director of Operations, David Wiseman, but after two years we realised that we had to divide the business into adult services, children’s services and healthcare related services. Within those three directorates we are now developing a national approach to certain specialities like adoption and fostering or independent hospitals. We have a team of professional advisers with specialist expertise who can come and share a knowledge-base and specialist advice with some of our frontline inspectors, for example in areas such as infection control or tissue viability.

“It is also crucial that our frontline staff are very credible and trained in the process of regulation and fortunately we got the help from the Scottish Social Services Council and the required support from the Scottish Executive for specialist training and our frontline inspectors are now expected to get the RoCA qualification in care regulation.”

The National Care Standards are there for all to see – whether you are a staff member, an owner, a manager, a service user, a family member – they clearly represent what service users are entitled to expect from a care service and the Care Commission encourages one and all to use them.