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National Care Standards: Independent Specialist Clinics
Introduction
Independent clinics and independent specialist clinics
The Regulation of Care (Scotland) Act 2001 ('the Act') established the Scottish Commission for the Regulation of Care ('the Care Commission') and set out the care services that it will regulate. These services include independent healthcare services, one of which is
'independent clinics'.
Independent clinics are premises in, or from, which a
doctor or dentist1 provides
private services (that is, not under the NHS) on a day care basis.
This includes where the doctor or dentist supervises the provision of such services by someone else, for example a nurse. The term services includes consultations, investigations and treatments.
There is more than one set of national care standards for independent clinics. Each set covers specific aspects of the range of services that can be provided by independent clinics.
This set of national care standards for
independent
specialist clinics covers clinics privately providing the following services:
cosmetic surgery and treatment;
treatments where lasers are used (for example, for eyesight improvement, birthmark, tattoo or excess hair removal); and
weight management treatments.
There will be a further two sets of national care standards for services registered as
independent clinics. These cover other services provided privately by doctors, and private dental services. In addition, a set of national care standards has already been issued for independent hospitals. These cover all
services provided in, or by, an independent hospital, including
out-patient clinics.
'Independent clinics'
does not include premises in or from which services are provided
independently by:
beauticians and hairdressers;
alternative therapists (such as aromatherapists);
registered practitioners such as nurses, midwives and physiotherapists; or
slimming clubs and organisations.
Such services are not regulated under the Act and national care standards for independent clinics
do not apply to them.
Some of the services and treatments offered to adults by an independent specialist clinic may also be offered to children. All the standards in this booklet apply to the care and treatment of both children and adults. However, in addition, standard 13 and some of the references in Annex B address aspects of children and their care that are specific or unique, or both, to children. These include the rights of children, the responsibilities of those treating children, and the responsibilities of parents and guardians consenting on their behalf.
National care standards
Scottish Ministers set up the National Care Standards Committee (NCSC) to develop national care standards. The NCSC carried out this work with the help of a number of working groups. These groups had representatives from providers, including clinicians and managers, people who use services, professional bodies and registration and inspection staff.
In addition, the consultation process for the standards involves seeking the views of many others. As a result, the standards have been developed from the point of view of the person using the service. They describe what the individual person can expect from the service provider.
As part of the consultation for these standards, independent researchers held focus groups, made up of people who have used services provided by independent specialist clinics. The focus groups gave their views on how closely their care and treatment matched their expectations. The groups' views have influenced the standards and are included in them.
How to use the standards
In common with all the national care standards, this set has been written from the point of view of the user of the service (the consumer). For example, they cover:
The standards are grouped under headings that follow your route or pathway through the service.
If you are thinking about purchasing the services of an independent specialist clinic, you can use these standards to:
help you make your choice;
inform you on what to expect when you use the service; and
help you once you have had your treatment and have left the clinic.
If things go wrong, you can refer to the standards to help you raise concerns or make a complaint.
Independent specialist clinics will use the standards to find out what care and service standards are expected of them in offering services. The standards should guide the owner or manager of the clinic about whom to employ and how the service may be managed.
Independent specialist clinics and your GP
Your GP is familiar with your medical history and any prescription medications you are taking. This information can be important when considering a particular procedure or course of treatment for the following reasons:
everyone is an individual and your previous health record may influence whether a particular treatment is safe for you;
your previous medical history or current state of health may affect how effective a particular treatment is likely to be;
your previous or current prescription medications may affect the treatment you are considering and may be incompatible with some treatments;
some side effects and complications may be avoidable if the people providing your treatment are fully informed of your previous medical history and current state of health.
For these reasons, it is always a good idea to discuss any treatment or procedure you are considering with your GP. However, you have the right not to do so, if you do not want to. For the reasons given above, independent specialist clinics may want or need to contact your GP. The clinic will always seek your authorisation to do this. However, where you do not give authorisation, the clinic might decide that it is not in your best interests to proceed, and can decide not to treat you. Clinicians are not obliged to provide you with a treatment where they consider that the risks outweigh the possible benefits.
Useful questions to ask
The specialist clinic can answer your questions about treatments and costs when you are making enquiries, during a consultation, or in specially prepared leaflets and pamphlets. Many people will be considering buying services from a specialist clinic for the first time. Knowing what questions to ask can be difficult. During the development of the standards for specialist clinics, both the clinics and the users of their services were widely consulted. The questions below are based on the feedback from those involved in using and providing the services. You may want to use them to help you to make an informed decision.
The clinicians
Who will carry out the treatment?
What qualifications do they have?
How long have they been trained in this treatment?
How frequently do they carry it out?
Do they have professional indemnity insurance?
The cost
Do I have to pay a consultation fee if I decide not to have treatment?
What will be the cost of the treatment, including any materials I may need after it?
If there are any complications, will I have to pay to have them treated?
If I change my mind and decide not to complete the treatment, do I still need to pay the full cost for the treatment?
The treatment
Is the treatment right for me?
How long does the treatment take?
Is the treatment painful and if so what form of anaesthesia is used?
Is all equipment used sterile and used only for me?
What are the risks involved?
What are the complications and success rate of the procedure in this clinic?
Are there any other treatment options available for me to achieve the results I want?
Do you have any 'before and after' photographs that I can see?
Can I speak to anyone else that you have treated?
Will you want to inform my GP about my treatment?
After treatment
What type of care will I need after treatment?
Will I need pain relief following treatment?
Will I have swelling or bruising and can these be treated?
How long will the effects of treatment keep me away from my usual activities?
At what stage will I be able to judge the results of treatment?
How long do the results last?
If I need to see you in the period after treatment, will you be available?
What will happen if I am unhappy with any aspect of the treatment?
When can I return to work?
The record of treatment
Will you keep a record of my treatment and what form will this take?
Will my records or photographs be shown to anyone else for any reason?
Will you ask my permission before releasing my records, including photographs, to anyone else?
Can I get a copy of my records?
How long does the clinic retain records after someone's treatment is complete?
Links to NHS Quality Improvement Scotland
2
The Care Commission is responsible for regulating the independent healthcare sector (including independent specialist clinics), taking account of the national care standards developed and issued by Scottish Ministers for this sector.
NHS Quality Improvement Scotland (NHS QIS) sets standards and monitors performance in the NHS to improve the quality of healthcare in Scotland.
People using services should be able to expect that standards set by NHS QIS will apply, where appropriate, in both the NHS and independent healthcare sectors. These standards include a standard (9.4) to help make sure this happens in independent specialist clinics.
The Care Commission, in making sure these shared standards are met by independent specialist clinics, will liaise with NHS QIS. A written agreement (or 'memorandum of understanding') will cover the working relationship between the Care Commission and NHS QIS.
The principles behind the standards
The standards are based on a set of principles. The principles themselves are not standards but reflect the recognised rights which you enjoy as a citizen. These principles are the result of all the contributions made by the NCSC, its working groups and everyone else who responded to the consultations on the published standards as they were being written. They recognise that services must be accessible and suitable for everyone who needs them, including people from ethnic minority communities. They reflect the strong agreement that your experience of receiving services is very important and should be positive, and that you have rights.
The main principles
The principles are dignity, privacy, choice, safety, realising potential and equality and diversity.
Dignity
Your right to:
Privacy
Your right to:
have your privacy and property respected, and to receive the time, the space and the facilities you need and want; and
be free from intrusion as long as it is safe for you and everyone else.
Choice
Your right to:
make informed choices, while recognising the rights of other people to do the same;
know about the range of choices; and
get help to fully understand all the options and choose the one that is right for you.
Safety
Your right to:
feel safe and secure in all aspects of life, including health and wellbeing;
enjoy safety but not be over-protected; and
be free from exploitation and abuse.
Realising potential
Your right to have the opportunity to:
Equality and diversity
Your right to:
live an independent life, rich in purpose, meaning and personal fulfilment;
be valued for your background, language, culture, and faith;
be treated equally and to live in an environment which is free from bullying, harassment and discrimination; and
be able to complain effectively without fear of victimisation.
The Scottish Commission for the Regulation of Care
The Act set up the Care Commission, which registers and inspects all the services regulated under the Act, taking account of the national care standards issued by Scottish Ministers. The Care Commission has its headquarters in Dundee, with regional offices across the country. It will assess applications from people who want to provide specialist clinics. It will inspect the services to make sure that they are meeting the regulations and in doing so will take account of the national care standards. You can find out more about the Care Commission and what it does from its website (www.carecommission.com).
The Scottish Social Services Council
The Act created the Scottish Social Services Council ('the Council') which was established on 1 October 2001. It also has its headquarters in Dundee. The Council has the duty of promoting high standards of conduct and practice among social services workers, and in their education and training. To deliver its overall aims of protecting service users and carers and securing the confidence of the public in social services, the Council has been given five main tasks. These are: to establish registers of key groups of social services staff; to publish codes of practice for all social services staff and their employers; to regulate the conduct of registered workers; to regulate the training and education of the workforce; to undertake the functions of the National Training Organisation for the Personal Social Services. The Council has issued codes of practice for social service workers and employers of social service workers. These describe the standards of conduct and practice within which they should work. The codes are available from the Council website
www.sssc.uk.com .
How standards and regulations work together
The Act gives Scottish Ministers the power to publish standards which the Care Commission must take into account when making its decisions. It also gives Scottish Ministers the power to make regulations imposing requirements in relation to independent specialist clinics.
The standards will be taken into account by the Care Commission in making any decision about applications for registration (including varying or removing a condition that may have been imposed on the registration of the service). All providers must provide a statement of function and purpose when they are applying to register their service. On the basis of that statement, the Care Commission will determine which standards will apply to the service that the provider is offering.
The standards will be used to monitor the quality of services and their compliance with the Act and the regulations. If, at inspection, or at other times, for example, as a result of the Care Commission looking into a complaint, there are concerns about the service, the Care Commission will take the standards into account in any decision on whether to take enforcement action and what action to take.
If the standards were not being fully met, the Care Commission would note this in the inspection report and require the service manager to address this. The Care Commission could impose an additional condition on the service's registration if the provider persistently, substantially or seriously failed to meet the standards or breached a regulation. If the provider does not then meet the condition, the Care Commission could issue an improvement notice detailing the required improvement to be made and the timescale for this. Alternatively, the Care Commission could move straight to an improvement notice. The Care Commission would move to cancel the registration of any service if the improvement notice does not achieve the desired result. In extreme cases (i.e. where there is serious risk to a person's life, health or wellbeing) the Care Commission could take immediate steps to cancel the registration of any service without issuing an improvement notice.
Regulations are mandatory. In some cases not meeting a regulation will be an offence. This means a provider may be subject to prosecution. Not meeting or breaching any regulation is a serious matter.
Decisions by the Care Commission on what to do when standards or regulations are not met will take into account all the relevant circumstances and be proportionate.
You can get information on these regulations from the
Regulation of Care (Scotland) Act 2001, which is available from the Stationery Office Bookshop at a cost of 7.95 a copy. You can also see the Act on-line (see Annex B for the address).
You can also see the Scottish Statutory Instruments for the Regulation of Care Regulations 2002 on-line (see Annex B for the address).
Comments
If you would like to comment on these standards you can visit our website and send a message through our mailbox:
http://www.scotland.gov.uk/about/HD/CCD1/00017652/carestandardshome.aspx
You can also contact us at:
Care Standards and Sponsorship Branch
Community Care Division 2
Health Department
St Andrew's House
Regent Road
Edinburgh EH1 3AG
Tel: 0131 244 3520
Fax: 0131 244 4005
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