ADDING LIFE TO YEARS
ANNUAL REPORT 2002-03
CHAPTER 5: QUALITY IMPROVEMENT
NHS Quality Improvement Scotland Standards
A health service that has older people as its major consumer will need to be more clearly focused on their needs and wishes. To ensure a healthy and equitable Scotland, there are a number of challenges to be addressed.
Adding Life to Years and the accompanying Information and Statistics Division report The Health and Well-being of Older People in Scotland set out to identify the challenges facing the NHS, social services and local authorities. Many organisations are, or have been, involved in addressing these challenges:
the Scottish Commission for the Regulation of Care;
Age Concern Turning Their Back on Us;
the Scottish Executive Mental Health and Well Being Support Group;
Scottish Health Advisory Service (SHAS); and
the Clinical Standards Board for Scotland (CSBS) Clinical Standards for Older People in Acute Care.
These important existing documents will provide an important baseline for the work of NHS Quality Improvement Scotland, formed in January 2003 when the Clinical Standards Board for Scotland merged with the Scottish Health Advisory Service (SHAS) and a number of other bodies to form a new independent health and health care inspectorate for Scotland.
Working Group on Quality of Healthcare Services for Older People in Scotland
It is critical to move forward the agenda on the quality assurance of healthcare services for older people in Scotland. An NHS Quality Improvement Scotland Working Group on Quality of Healthcare Services for Older People in Scotland was established in February 2003. Its aim is to develop a set of draft standards for older people's services to improve the overall experience of users of NHSScotland. These standards will combine existing clinical standards and quality indicators for older people, and will apply to joint working across both the primary and acute settings. There will be wide and open public consultation on these draft standards at a series of meetings held across Scotland. Recommendations will be made on a review process both to monitor the service and provide feedback to service users and providers.
The standards will apply to all older people moving through a variety of settings in NHSScotland, not just hospitals. The final standards will be published in the early part of 2004 and plans for reviews determined thereafter.
National Care Standards for Older People in New NHS Care Settings
The Scottish Executive is committed to achieving better quality, consistent standards of care focused on the needs and wishes of the people who use services. In pursuit of that commitment the Regulation of Care (Scotland) Act 2001 requires Scottish Ministers to prepare and publish national care standards covering the range of care services regulated under the Act. The Executive took a consultative approach to the development of the standards. As part of that process, a National Care Standards Committee was set up which, with its associated working groups, has developed the standards in consultation with a wide range of stakeholders including service users. Scottish Ministers are also required to keep the standards under review. The Scottish Commission for the Regulation of Care (the Care Commission) must take account of the standards when regulating care services under the Act. As part of its remit, the Care Commission is required to monitor improvements and advise Ministers about trends in the provision of quality care services. The focus of regulation by the Care Commission is on continuous improvement. In regulating against the standards, the Care Commission will identify areas for improvement and agree an improvement plan and timetable with individual providers.
Nineteen sets of standards covering a wide range of client groups have been published so far. These include care homes for older people, support services and care at home. The standards are based on a set of principles which includes dignity, privacy and choice. These principles recognise that services must be accessible and suitable to everyone who needs them. The standards describe what each individual person can expect from the service provider. They focus on the quality of life that the person using the service actually experiences. For example, the standards for care homes for older people includes standards on 'your environment' which sets out the physical standards, such as room sizes, for existing care homes and for new care homes. There is also a standard on 'eating well' which states that the meals provided in care homes should be varied and nutritious, take account of food preferences and special dietary needs, and that where help is needed to eat or drink this will be provided.
The Care Commission also has responsibility for dealing with complaints about both individual care services and their own handling of the regulation of the services. Care service providers are required by legislation to establish a complaints procedure for the service they provide. The standards advise that providers should make the people using their services aware of this and of the procedure for making a complaint directly to the Care Commission. Families, relatives, representatives, the public more generally and staff can also raise concerns about care services with the Care Commission. The Care Commission will investigate complaints and tell the complainant what it has found out and what action will be taken.
One of the issues arising from the Adding Life to Years report was concern about ageism in NHSScotland and the need to achieve a widespread and visible improvement in the quality of services for older people. The development of the national care standards, together with the work of the Care Commission, are examples of excellent practice towards the eradication of ageism.