Review of the National Care Standards
Consultation on the Draft Overarching Principles
December 2015
Scottish Care Response
We are: a provider and/or an organisation representing providers.
Scottish Care is the representative body for independent sector social care services in
Scotland. This encompasses private and voluntary sector providers of care home, care at
home and housing support services across the country. Scottish Care counts over 400
organisations as members, which totals over 830 individual services. Scottish Care is
committed to supporting a quality orientated, independent sector that offers real choice
and value for money. Our aim is to create an environment in which care providers can
continue to deliver and develop the high quality care that communities require and deserve.
In relation to older people’s care, this sector provides 88% of the care home places in
Scotland and up to 55% of home care hours. There are more older people in care homes
any night of the week than in hospitals - as at 31st March 2015 there were 892 care homes
for older people providing 38,164 beds to 32,771 residents any night of the year, with 89%
of these residents located within the independent sector.
We are responding to this consultation on behalf of the Scottish Care membership.
Members have also been encouraged to submit their own responses to the consultation.
We are happy to be contacted again as part of the National Care Standards Review
process.
Contact details:
Becca Gatherum
Policy & Communications Officer
Scottish Care
becca.gatherum@scottishcare.org
01292 270240
General Points
Scottish Care welcomes this opportunity to respond to the consultation on the draft
overarching principles of the new National Care Standards. We look forward to being a key
partner in the ongoing review of the Standards and to contributing constructively at every
stage of the process.
1
Scottish Care welcomes the overarching principles and sees them as an important
cornerstone for the provision, inspection and regulation of services in the future.
We approve of the overarching principles being rooted in human rights. By adopting a
human rights-based approach to all aspects of social care, Scottish Care believes there is an
opportunity to establish more positive relationships between service users, providers,
commissioners and regulators based on respect and mutuality, whereby each partner is
empowered to promote and protect the rights of the individual.
Scottish Care is interested to see how the overarching principles will connect to the
subsequent development of general and specific standards. We believe it will be important
that there is a commonality of language in all three components of the new National Care
Standards, and therefore the wording of the principles as the first step in this process needs
to be clear and concise. We would hope to see the terminology used in these principles
reflected in the standards themselves so that they can be embedded most effectively in
practice, given that the standards will be what services are inspected on. It is only by clearly
linking the standards to the principles that there will be a decisive shift in understanding
‘how’ human rights can galvanise a new approach to inspection and service delivery, rather
than them being an abstract and, at times, aspirational concept.
The inclusion of mini case study examples to accompany each principle may serve to bring
them to life and enhance understanding of how to apply them to practice. Alternatively,
these examples could be included in a separate guidance note which elaborates each
principle further or could be linked to the development of general and specific standards for
different care settings. Either way, Scottish Care believes it is important to ensure that
those who will need to apply the principles to their practice have a comprehensive
understanding of them and case studies would be an effective way to support this.
In order that human rights are truly placed at the centre of the National Care Standards,
understood correctly and utilised effectively, Scottish Care believes that the wording of the
principles needs to be changed from ‘I am entitled to’ to ‘I have the right to’. It is important
that the overarching principles are as strong as they can possibly be. Otherwise, there is a
danger that they will be diluted or not stand up to challenge when applied to specific
instances where someone believes their rights are at risk. ‘Entitlement’ can have negative
connotations and can imply a ‘claim’ to something which an individual or organisation has a
responsibility to uphold, without clarity of who this is. On the other hand, ‘I have a right to’
can be more empowering and implies a mutual responsibility to promote and protect these
rights. We believe this is the correct approach, given that all parties involved in an
individual’s care journey must commit to maximising that person’s rights in their decisionmaking and approaches. If the National Care Standards Review is to truly embrace a human
rights approach, there must be a willingness to use the language of human rights.
In a similar vein, Scottish Care believes that the overall wording of the overarching principles
needs to be as clear and simple as possible in order that all whom the National Care
Standards will apply to have a robust understanding of the principles, which need to be at
the heart of their practice. To this end, there are two specific points that Scottish Care
would wish to raise:
 Given that the overarching principles will be submitted to Ministers for approval
following the consultation and revision period, we are unclear as to whether
Ministers will only be approving the specific wording of the principles or whether
they will also be approving the definitions of these principles, as outlined in the
consultation.
 If the ‘This means…’ sections will be central components of the overarching
principles and the understanding of them, it is important that they are defined as
effectively as possible. Scottish Care feels that it is therefore problematic to use the
wording of the principles in their definitions (e.g. by defining the ‘I am treated fairly’
principle as ‘I am valued as an individual and I am treated fairly’). The Care
Inspectorate must take additional steps to resolve these issues, which can be found
in almost all of the current principle definitions. It is essential that the overarching
are as clear and easily understood as possible.
Finally, it is important that the review of the National Care Standards and the overarching
principles in particular reflect a ‘whole systems’ approach to protecting and promoting
human rights in an individual’s care journey. As part of this, the Review must recognise the
range of scrutiny, compliance and improvement powers and how these can be utilised.
Whilst providers very much welcome a human rights-based approach they remain
concerned that, given it will be their services which are inspected and graded upon these
principles and standards, they will be held solely accountable for protecting and promoting
human rights. Scottish Care believes this should not be the case and indeed, we don’t
believe this is how the Review envisages the development and implementation of the new
care standards. Providers are absolutely committed to playing their important part in
upholding the rights of the people they support, but the very nature of social care and the
complexity of human rights means there will often be difficult issues to balance. This can
include instances whereby care staff must make an unwanted intervention in an individual’s
life in order to protect their human rights or the rights of others, or whereby a barrier such
as resources or commissioning decisions limit the extent to which providers can fully uphold
all of the principles. It will therefore be important for the principles to reflect the mutual
responsibility for protecting and promoting human rights across all partners involved in an
individual’s care pathway, and to effectively recognise the need for positive communication
and risk-sharing at all stages.
Scottish Care strongly agrees with the outlined overarching principles. However, we
believe a number of them need to be slightly amended and have outlined our suggestions
as to how this should be done below:
Respected
Scottish Care believes respect is an essential principle. Every individual has the right to be
treated with dignity, respect, civility and courtesy, as Scottish Care outlined in its recent
launch of the Convention on the Rights of Adults and Older People in Care Homes. The care
someone receives must support and promote this principle, but it also applies to the
treatment of staff and the relationship between service providers and others. It should be
noted that relationship-based, respectful care is best provided when sufficient resources
(including time) are provided to do so.
Compassion
Again, Scottish Care welcomes compassion being prioritised through the overarching
principles. In the creation of the Scottish Care Convention on Rights, care home residents
were very keen to see compassion included as a central component of how care is
delivered. It is an important element of high quality care, alongside kindness and valuing
interactions with individuals. It may be more difficult to measure compassion but, if defined
effectively, it represents the shift towards a more holistic approach to regulation and
inspection which providers see as positive.
Included
Scottish Care believes this to be one of the most problematic principles in its current form.
Firstly, ‘included’ could be seen to be too weak and vague a principle in that ‘including’
someone does not necessarily imply meaningful involvement and understanding. As afore
stated, Scottish Care feels that the creation of overarching principles presents an
opportunity to outline essential human rights as robustly as possible and therefore the
strongest possible terminology should be used to minimise the risk of misuse or
misinterpretation.
By the definition provided, it is clear that this principle tries to incorporate too much and,
whilst all aspects outlined are equally important, it would be better to break this down into
separate principles. Otherwise, there is a danger that this principle is weakened by its
attempt to be all-encompassing and therefore loses meaning and value.
We feel that the right to a key role in information-sharing, decision-making and feedback
processes relating to an individual’s care can be detailed as one principle relating to
meaningful involvement as opposed to inclusion.
However, community life is an entirely different yet no less important concept and should
therefore feature as a separate principle relating to equal access, community life and
cultural and social activity.
Individuals who access care and support services have the right to play an active part in
community life in the same way that those unconnected to services do. They also have the
right to be involved in the full civic and political life of their local community and nation, and
to be supported to take as much part as they might wish in being able to exercise their
rights as citizens both locally and nationally.
This also demonstrates where a whole-systems commitment to the overarching principles is
essential, as there may be instances where a care service is not commissioned or resourced
in a way that enables them to fully uphold this principle. The Care Inspectorate must be
able to recognise these instances and challenge them where appropriate.
Treated fairly
Whilst we generally agree with this principle, the current definition is both unhelpful and
pointless in that it does not add anything to the principle other than to reiterate the term. It
is also not clearly distinguishable from the principle of being respected. Some further
thought must therefore be given to what this right means and how this is described.
From a Scottish Care perspective, it should relate to non-discrimination, individuality and
choice. Those who access care and support services should not be restricted by their
characteristics, lifestyle choices or personal preferences, or by unnecessary risk aversion.
They should be valued as individuals and be able to exercise choice and control, rather than
have a ‘one size fits all’ approach imposed on their care and support. Again, this principle
applies to the commissioning of services as well as the delivery of them.
A responsive service
Again, Scottish Care supports this principle but in the development of general and specific
standards below it, further consideration must be given to how this might apply to the
inspection of care services. It is absolutely true that services must be flexible and
accommodating wherever possible to an individual’s requirements and outcomes. Where
changes may not be possible, services still need to be responsive in their communication
with individuals to reach a balance between an individual’s rights and those of others, as
well as in balancing what can practically be achieved.
Where this would be problematic would be if it was applied solely to service providers
rather than as a shared responsibility across all partners, including commissioners.
Scottish Care suggests that this could be overcome by including an overarching statement
for the principles, detailing that ‘all of these rights need to be appropriately resourced/
funded/ supported at all levels in order to be enjoyed by the individual’. This would
effectively re-emphasise the fact that this principle, and the others, are a mutual
responsibility and that all the rights are inter-related.
Safe
Scottish Care welcomes this principle, especially its recognition of the need for care not to
become risk averse. We strongly believe that safety should be a positive consideration
rather than a restrictive factor in care and support provision. Any restrictions on the
grounds of safety should be personal and proportionate and should always seek to avoid
infringing on other rights relating to choice and involvement. The inclusion of this principle
needs to reflect a move towards supporting models of care delivery and inspection which
evidence positive risk-taking and a more holistic approach to decision-making.
Personal wellbeing
Whilst this is certainly not a negative principle to include, Scottish Care believes it could be
more meaningfully framed in terms of enjoyment and achievement of potential. Personal
wellbeing refers to much more than health and safety, but to a more holistic sense of
wellness which should always be realisable for people accessing care and support. What’s
more, the current terminology of this principle does not seem grounded in everyday
language and understanding in the way that the other principles are. Therefore an
adaptation to focus on enjoyment and achievement or ‘living well’ could potentially be
more empowering and relatable for those not au fait with the language of health and social
care (e.g. outcomes).
Other principles
As outlined above, Scottish Care believes that the principle around being included should be
split into two separate principles.
Other than this, we don’t feel there is a need for additional principles. In fact, to keep these
concise in terms of numbers and definitions would be more effective in ensuring
understanding and implementation of them through the Standards and in everyday
practice.
However, we do feel it would be important to add two overarching statements to the
principles:


“All of these rights need to be appropriately resourced/ funded/ supported at all
levels in order to be enjoyed by the individual”. This would reflect a whole-system,
shared obligation to promote and protect human rights as outlined in the principles.
“Each right must be upheld in so far as the promotion of the right doesn’t take
away/negatively affect the rights of others.” Emphasising that these rights (as with
many human rights) are not absolute and must always be balanced is important,
without implying that they can be diminished.
By adding these slight caveats as overarching statements, they would be sufficiently
recognised without diluting the absolute importance of each right. They simply serve to
emphasise the importance of a whole-systems approach and the need for effective
communication between all stakeholders to best promote and protect human rights.
To summarise, Scottish Care very much welcomes the principles and the adoption of a
human rights-based approach to the National Care Standards. If the amendments
suggested in this response are made, particularly around strengthening language and
clarifying definitions, they will go a long way towards transforming the overarching
principles from a vague, abstract concept to something which has real practical use and
meaning in an individual’s care journey.