The Scottish Government

Evaluation of the National Care Standards Consultations

Ruth Whatling, Scottish Executive

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Main Findings

• Generally participants found the experience of being in the working groups and the National Care Standards Committee personally and professionally enriching.

• The interviewees generally felt that they had made valuable contributions to the development of the National Care Standards

• On reflection, most participants would have preferred the working groups to have been smaller and to have contained more service users, carers and ethnic minority representatives.

• All the interviewees felt that more time could have been available to develop the standards, and more administrative support would have helped. They also highlighted that there was insufficient time allowed for the public to respond to the written consultations.

• Many working group members felt they would have benefited from guidance on good consultation practice.

• Typically, the interviewees thought that the Executive made considerable effort to involve as many people as possible in developing the National Care Standards. In addition, they felt that the consultation methods used elicited useful views.

• Participants felt that some of the consultation events did not provide an appropriate forum for all service users to express their views, and that alternative methods should have been deployed.

• The working group members would have appreciated more feedback on their own work, including final copies of the standards their group had drafted and information about any further changes made.

• Finally, the interviewees were generally positive about the final published National Care Standards since they are written from the service user's perspective, are freely available and the new shared format brings the sets of standards together in a more cohesive way.

Introduction to the research

The aim of this research was to evaluate the consultative processes used in developing the National Care Standards. The National Care Standards, which cover a wide range of social care services, was a key proposal of the White Paper "Aiming for Excellence" (March 1999) which also resulted in the creation of a 'Scottish Commission for the Regulation of Care' (SCRC).

The first task of the research involved mapping these processes and from this exercise it was evident that working groups had a predominant role. Established by the National Care Standards Committee (NCSC), these working groups were responsible for drafting each National Care Standard (see table 2). The standards were then finalised by the NCSC following public consultation. Membership of the working groups consisted of representatives from the Scottish Executive, voluntary and statutory organisations, as well as service users and carers. Group members were expected to consult others about the draft standards. In total, 300 people participated in the working groups and the NCSC. As a result of this work, 19 sets of Care Standards were produced between 2000 and 2002 for implementation by the SCRC.

Research methods

Between September and December 2002, 44 in-depth interviews were conducted with those who had been involved in developing the National Care Standards. Purposive sampling ensured that people with a range of experiences (both within and outwith the working groups) were invited to participate (see table 1 below).

Table 1: Sample Breakdown

¹ Some interviewees have been placed in more than one category and therefore the numbers do not add up to 44
² The category 'professionals' also includes retired professionals

The interviews were based on a range of topic guides, which were adjusted according to the interviewees' role in the working group or editing team. However, the following themes were broadly covered:

Views about how the working groups operated

The working groups drafted the National Care Standards through consultation and discussion with their members and with a variety of people outwith the groups. Group members were chosen for their experience and knowledge of aspects of community, hospice and hospital care. For the majority of interviewees, membership was a positive experience, as they felt supported by the other members and felt encouraged to contribute to the development of the Standards. However, most would have preferred a more defined end to the work, and more information about what would happen to the standards they had drafted.

• Group membership

The main concern voiced by the interviewees was that there was insufficient representation on the working groups from service users, carers, black and ethnic minority groups and 'front-line workers'. However, many interviewees thought that the size of working groups sometimes prevented constructive discussions and felt that the groups were more productive when split into sub-groups. Typically, working group members felt more comfortable if there were others on the group with similar roles or backgrounds.

• Time

Some working group members, especially those representing small organisations, carers and service users, generally found it difficult to meet the time commitment required by the working groups. Despite this, the interviewees typically prioritised the National Care Standards work over their other commitments, although many thought that they would have been able to juggle their commitments more effectively had more time been allowed during the drafting of the standards.

Views about the effectiveness of the consultations

The working groups were encouraged to consult as widely as possible with relevant groups and individuals while drafting the standards. Most interviewees noted the considerable the commitment to the consultation process shown by the working group members. A variety of consultation methods were used by the working groups, including: face-to-face events; informal discussions with colleagues ('informal consultation'); and focus groups. In addition, each working group issued their draft standards in a written consultation. Reflecting on the consultation methods used, interviewees typically thought that they elicited useful and meaningful opinions, from which the material contributed to the development of the final National Care Standards.

However, several interviewees, particularly carers and services users, were concerned that some of the consultation methods used for their groups were inappropriate. For example, service users and carers often found the formality of the consultation events, and the large numbers in attendance, intimidating. Moreover, these groups were not asked about their preferred method of consultation.

Most interviewees were disappointed by the low response rate to the written consultations. To improve this, many suggested the need for a longer reply period outwith the holiday period. In addition, some felt that more could have been done by Scottish Executive to convince consultees that their views would be taken seriously. Despite this view, there was agreement that the responses were warmly received and contributed significantly to the development of the NCSs.

While interviewees were positive about the consultation process, many did not have previous experience of conducting consultations and felt that they would have benefited from guidance on good practice.

Views about the National Care Standards

Interviewees were generally positive about the final published standards since they: are written from the service user's perspective; are freely available; employ user-friendly language; and were well publicised on publication. However, there was concern noted by many of the interviewees that there was little scope for input into the final drafting of standards. A small minority of service users thought that the language used in the standards was complicated and some were not aware of whether alternative formats were available.

Key principles for future consultation events

Reflecting on their experiences, the participants in this research made a number of suggestions for future consultation events.

Working groups

• Keep groups small and involve a larger proportion of those affected by the policy (in this case service users, carers and ethnic minority representatives).

• Provide more time, administrative support and guidance on roles and how to do consultation.

• Consider the need for additional support for members less experienced in consultation processes (e.g. pre-meetings, guidance).

• Provide ongoing feedback to working groups about progress generally and about their contributions.

• Ensure that working groups are aware of and prepared for the completion and ending of the work.

Consultation

• Consider using a variety of different consultation methods to suit different audiences

• Provide adequate time for consultees to respond, taking account of holiday periods.

• Provide alternative formats according to the needs of the audience

Since the first 19 National Care Standards were completed in 2002, national care standards have been published covering childcare agencies. A number of other standards are currently under development including Standards for: independent specialist clinics; wholly private medical practices; and dental services. Many of the above suggestions have already been and will be taken on board in progressing the new standards. However, while the recommendations will continue to have implications for future consultations in this area, there are wider messages for consultation practice more generally.

Table 2: The National Care Standards Consultation Exercises