The Scottish Government

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Introduction

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 clinics ¹ in or from which a doctor or dentist² 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 covers privately provided general practitioner and medical consultant services. These private services can be provided in a variety of settings, including private GP practices, private consulting rooms, beauty salons and the practitioner's own home. Private services include those provided in clinics or practices that only provide private services and in those that provide both NHS and private services ('mixed' provision). The standards cover care and treatment in and from the practice/clinic premises, including home visits.

There are a further two sets of national care standards for independent clinics. One set, covering independent specialist clinics (clinics that specifically provide - cosmetic treatment and surgery; weight management; and treatment using lasers), was published in March 2004. The other set, which was developed in partnership with NHS Quality Improvement Scotland ( NHSQIS) as a common set of standards for NHS and private dental services, was published in December 2006. In addition, a set of national care standards for independent hospitals, which cover all services provided in, or by, an independent hospital, including out-patient clinics, was published in March 2002.

These national care standards for independent medical consultant and general practitioner services include specific standards for mental health services (standard 16) and services for children and young people (standard 17). Standards 1 to 15 apply to all services. In addition, standard 16 applies to mental health services and standard 17 to children and young people's services. Standards 16 and 17 are additional and specific for the services they refer to.

The 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 representation from providers, including clinicians and managers, people who use services, professional bodies such as the Royal College of Nursing, and registration and inspection staff. In addition, the consultation process for the standards involved 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.

Using the national care standards

In common with all the national care standards already published, these standards have been written from the point of view of the user of the service. For example, they cover:

• your safety;
• qualifications of the people treating you;
• what happens if something goes wrong; and
• financial safeguards.

The standards set out the quality of care you can expect and are grouped under headings that follow your pathway or route through the service, from making an appointment through to your discharge.

If you are thinking about using the services of an independent medical consultant and general practitioner, you can use the standards to help you decide what service to choose and inform you about what to expect when using the service.

If things go wrong, you can refer to the standards to help you raise concerns or make a complaint (see Standard 14: 'Expressing your views').

All providers must provide a statement of function and purpose when applying to register their service. On the basis of this statement, the Care Commission will determine which national care standards will apply to the service that the provider is offering.

Providers will use the standards to find out what is expected of them in offering services. The standards make it clear that everything about the service should lead to you enjoying a good quality of life. They should guide the owner or manager over whom to employ and how they should manage the service.

Useful questions to ask

Many questions you have about the services provided (including consultations, investigations and treatments) and their costs will be answered by the service, perhaps when you are making enquiries, maybe during a consultation or in specially prepared leaflets and pamphlets. Many people will be considering buying services from a private medical service for the first time and knowing what questions to ask can be difficult. Below are some questions that you may want to consider using to help you make an informed decision.

The clinicians

• Who will I have the consultation with?
• What are their qualifications and experience?
• What are their qualifications or experience in dealing with my problem(s)?
• Do they have professional indemnity insurance?

The cost

• What will be the cost of the consultation and what does this cover?
• What other costs ( e.g. investigations) might be involved in the consultation?
• What will be the cost of the treatment and any associated medicines?
• Is the cost of any follow up treatment included? If not, how much will it cost?
• If there are any complications will I have to pay to have them treated?
• What are the arrangements for payment?
• Will my medical insurance cover the cost of my treatment?

The consultation, investigation and treatment

• How quickly will I get an appointment?
• How much time is allocated for consultations?
• How quickly will any investigation or treatment be carried out?
• How long will any investigation or treatment take?
• Can I speak to anyone else who has had the same treatment?
• Are there any risks involved with my treatment or investigation and what are they?
• Can I bring someone with me if I want?
• What are the out-of-hours arrangements?
• What happens if, at any point, I want to revert to receiving my treatment from the NHS?

After the consultation, investigation or treatment

• What type of care will I need after my treatment or investigation?
• Who will be available to see me in the period after if required?
• Who do I contact if I think something has gone wrong?
• What will happen if I am unhappy with any aspects of the consultation, investigation or treatment?

The record of the consultation, investigation and treatment

• What kind of record will you keep of my consultation, investigation or treatment?
• Will my records be shown to anyone else for any reason?
• Will I be able to get copies of my records and results if I want them?
• If I want to see my records what are the arrangements for this?
• Will you keep my consultation and treatment private from my GP if this is what I want?

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 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:

• be treated with dignity and respect at all times; and
• enjoy a full range of social relationships.

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:

• achieve all you can;
• make full use of the resources that are available to you; and
• make the most of your life.

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.

Links to the NHS Quality Improvement Scotland

The Care Commission is responsible for regulating the independent healthcare sector (including independent medical consultant and general practitioner services), taking account of the national care standards developed and issued by Scottish Ministers for this sector.

NHS Quality Improvement Scotland ( NHSQIS) 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 NHSQIS will apply, where appropriate, in both the NHS and independent healthcare sectors. These standards include a standard (12.5) to help make sure this happens in independent medical consultant and general practitioner services.

The Care Commission, in making sure these shared standards are met by independent medical consultant and GP services, will liaise with NHSQIS. A written agreement (or 'memorandum of understanding') will cover the working relationship between the Care Commission and NHSQIS.

The Scottish Commission for the Regulation of Care

The Regulation of Care (Scotland) Act 2001 (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 private medical services. 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).

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 medical consultant and general practitioner services.

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 the Care Commission has concerns about the service, for example as a result of an inspection or a complaint investigation, it 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 on 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 time scale for this. 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 what these regulations are from the Regulation of Care (Scotland) Act 2001, which is available from the Stationery Office. You can also see the Act on-line (see Annex B, 'Other useful references' for the address).

You can also see the Scottish Statutory Instruments for the Regulation of Care Regulations 2002 on-line (see Annex B, 'Other useful references' 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:

www.scotland.gov.uk/health/standardsandsponsorship

You can also contact us at:

Tel: 0131 244 5387
Fax: 0131 244 4005

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