NATIONAL CARE STANDARDS COMMITTEE MEETING
Conference Room 2, Victoria Quay, Edinburgh , Monday 27 June 2005
Note of the Meeting
Present: Adam Rennie (Chair), Marjory Barquist (Secretary), Irene Black, Jackie Brock, Leigh Edwardson, Linda Gregson, May Hendry, Janet Law, Jim McDonald, Stephen Mitchell, Mary McCann, Janis Pelosi, Jacquie Roberts, Raymond Taylor, Sarah Wedgwood, David Whiteoak, Steven Wilson.
1. Welcome and Introduction
1.1 Adam Rennie welcomed everyone to the sixteenth meeting of the NCSC.
1.2 Adam introduced May Hendry, joint chair of the Dental Standards Working Group, Irene Black, Care Commission Dental Advisor and Steven Wilson from NHS QIS who were attending for the discussion Paper 1, the draft National Standards for Dental Services
1.3 Adam also introduced Sarah Wedgwood, who is on secondment to the Scottish Executive Care Standards and Sponsorship Branch from the Care Commission.
2. Apologies
2.1 Apologies were received for Janie Allen, Pat Dawson and Suzanne Munday.
3. Note of Last Meeting and Matters Arising
3.1 There were three action points from the last meeting:
Revision to the NCS for Care Homes for Children and Young People
The Committee's recommendation has been accepted by Ministers. The standards were due to be reprinted and the reprints would include the revision. The Care Standards and Sponsorship branch would be writing out to all registered providers to inform them of the change to the standards.
Jacquie asked when copies of the NCS for Care Homes for Children and Young People would be available. Marjory advised that the reprints should be complete by the end of July.
(Update: The standards are now not likely to be available until mid-August)
Revision to the NCS for Independent Hospitals and Hospice Care.
The revised wording agreed by the Committee has been accepted by Ministers. The Hospice Care standards were due to be reprinted and the reprints would include the revisions.
Likewise, Errata slips outlining the revision to the standards for Independent Hospitals would be inserted into the stock currently held by Blackwell's. Any future reprints of these standards would incorporate the revision.
Future Meeting Dates
A schedule of future meeting dates has been issued with the meeting papers. Members were asked to note that these dates were provisional at present and would be subject to the Committee's future workplan, which the secretariat hoped to finalise and issue over the summer.
3.2 There were three matters arising since the last meeting:
- The secretariat had written to the Scottish Health Council to ask for a representative to replace Roy Paterson. No response had been received as yet but the secretariat would continue to pursue this.
- NHS QIS were still to confirm another representative to replace Frances Smith, who had deputised for David Steel. Steven Wilson indicated that this was likely to be Michael Bews.
- Awareness of the NCS. (Point 3.2 in the note of last meeting refers.) Jacquie Roberts asked what plans the Scottish Executive had to raise awareness of the NCS following the Omnibus Survey.
Linda Gregson explained that in addition to making the standards available free of charge, the Care Standards and Sponsorship branch had bid for a share of the Executive's advertising budget. However, it was not yet known whether this bid would be successful. As such, any plans for raising awareness would be dependent on the amount of money, if any that was awarded. It was agreed that if the bid was successful, the dependent on the amount of money, if any, that was awarded. It was agreed that if the bid was successful, the NCSC would have an opportunity to discuss ways in which it could be utilised to raise awareness of the NCS.
4. Paper 1. Draft National Standards for Dental Services
4.1 Adam invited Jim McDonald and May Hendry, joint chairs of the working group for the National Standards for Dental Services, to introduce Paper 1.
4.2 Jim provided background as to how the draft National Standards for Dental Services has been developed.
4.3 Adam advised the Committee that the standards had been read for plain English and legal references had been reviewed by Scottish Executive solicitors. Solicitors would also be asked to look over the final standards document before it was published.
4.4 Adam reminded Committee members that when considering the standards, they should focus on the standards from the perspective of private dental services, including mixed practices.
4.5 There were several issues which arose in relation to the draft standards. These were as follows.
Introduction & Annexes
4.6 The introduction had undergone significant change since the consultation document. A substantial amount of information had been taken out, revised or moved to the annexes.
4.7 The Scottish Executive felt that the document was to long and thought that perhaps some of the annexes could be removed. User feedback from the consultation was that whilst they found the information contained in the introduction and annexes interesting, they did not necessarily think that it belonged in the standards and felt a separate leaflet would be more appropriate.
4.8 After discussion, the NCSC agreed that all the information should remain in the standards document. Members understood the idea behind producing a leaflet but felt that it would be better to have all the information in one document.
4.9 Furthermore, the Executive and NHS QIS highlighted that the length of the document would likely decrease when the document went to print e.g. as pages would be double sided. Consequently, the document would not be any longer than some of the other standards documents.
4.10 Members felt that Annex D ' General Information about Dentistry' provided important and helpful information but felt that it was being buried in the document at present. It was agreed that Annex D would become Annex A.
Standards 1 to 15
4.11 There were no comments on Standards 1 to 4.
Standard 5.1
4.12 Standard 5.1 details with the information your dental service should provide when discussing treatment options, in terms of it being available privately or on the NHS options as they don't provide details of NHS Treatment. However, he did feel it would be appropriate for staff to provide details of NHS treatments but that they should provide NHS contact details where patients could find out where NHS services are provided in their area.
4.15 It was agreed that a bullet would be added to Standard 1.2 which required dental services to provide the contact details for the NHS Board so that patients could find out about the NHS dental services in their area.
4.16 There were no comments on Standard 6.
Standard 7.8
4.17 The original intent of Standard 7.8 was to ensure that information flowed between the individual's dental service and the dentist to whom they are referred. However, the user feedback suggested that this intent was unclear. Consequently, several attempts had been made to redraft the standard, none of which were satisfactory.
4.18 Following discussion, it was agreed that the Scottish Executive would redraft Standards 7.8 to simplify it and make the intent clear. The draft would be run past the joint chairs and NHS QIS for agreement.
4.19 There were no comments on Standard 8.
Standard 9.3
4.20 The Working Group had changed this standard despite no significant feedback from providers and positive feedback from users. The revision made was adding ' in the first instance' to the end of the first sentence of this standard.
4.21 The Care Standards and Sponsorship branch had concerns about this wording. Under the ROC Act, private patients are obligated to raise complaints with service provider in the first instance, although the Care Commission would encourage them to do so wherever possible. It was agreed that the phrase 'in the first instance' would be removed from Standard 9.3
4.22 Mary McCann was content that this would satisfy NHS complaints procedure. Furthermore, under Standard 9, the dental service should make the patient aware of their complaints procedure. As such, the dentist would have an opportunity to qualify the complaints procedure for NHS or private patients.
4.23 There were no comments on Standards 10 to 14.
Standard 15
4.24 In relation to Standard 15 generally, Jackie Brock advised that a key indicator of a child's health is their oral health. As such, she asked if there was any scope to include reference to what a dentist should do if they uncover very poor oral health, which could be a sign of child abuse or neglect.
4.25 The Committee agreed that this was a very important issue. Jim explained that when developing the Standard 15, the focus had been on abuse that may occur in the dental service.
4.26 It was agreed that the Care Standards and Sponsorship Branch would look at Standard 15 to see if there was scope for expanding it to cover detection of child abuse more generally in the dental service. Jacquie Roberts suggested that it might be possible to cover this aspect in Annex D by adding a bullet to the section on 'Looking after your own oral health.'
Standard 15.3
4.28 Standard 15.3 related to child protection procedures. Jackie Brock queried whether her understanding of Standard 15.3 was correct, that each dental service would develop its own child protection procedures. If so, she had concerns that these procedures could differ significantly across Scotland if there was no requirement to take account of national guidance.
4.29 Mary explained that the issue of child protection had received greater prominence in recent months, with several initiatives ongoing in dentistry to increase awareness amongst dentists and their teams, notably:
- Strengthening of both undergraduate and postgraduate training;
- Modification of the existing dental practice inspection documentation to include a question on awareness of child protection issues;
- Potential for the inclusion of the British Society for Paediatric Dentistry Child Protection Guidelines, in the National Dental Advisory Committee's Practice Support Manual. This is currently under development as part of the Dental Clinical Effectiveness Programme.
4.30 All agreed that this was a very important issue. It was agreed that the Executive would work with relevant colleagues on Standard 15.3 to make clear that each local child protection programme should take account of recognised national policies on child protection procedures.
General Issues
Sedation
4.31 Janis Pelosi noted that the issue of sedation was not specifically mentioned in the standards. The Committee agreed that this was covered under Standard 8, which states that an individual's care and treatment will be provided in line with all current best practice guidance. Mary McCann assured the Committee that extensive and specific guidance had been published pertaining to how dentists should behave in these circumstances.
Disclosure Checks
4.32 Jacquie asked whether enhanced Disclosure Checks for those working with children would be required to be retrospective. The generated substantial discussion by the NCSC.
4.33 Janet Law stated that she did not think that Disclosure Checks were required to be retrospective at present. However, she thought that there was a section on the Protection of Children ( Scotland ) Act 2003 pertaining to this issue, which has not yet been enacted. Once enacted, Disclosure Checks would be required to be retrospective.
4.34 The Committee agreed that this was an important issue which required further clarification. It was agreed that the Scottish Executive would seek advice from solicitors on this issue which would be fed back to the Committee.
Title of the Standards
4.35 The Care Commission has raised an issue with regard to the title of the document prior to the meeting. Under the Regulation of Care (Scotland) Act 2001, the Care Commission is required to take account of the National Care Standards in carrying out its regulatory role.
4.36 Linda stated that the Executive had spoken to solicitors who had advised that the title of the document could remain as it was. However, a qualifying sentence would need to be added to the introduction to make it clear that these are National Care Standards, as set out in the Act.
4.37 There were no other comments on the standards. Adam thanked the joint chairs for all their work on the standards, and also the Care Standards and Sponsorship Branch and NHS QIS. It was unclear at present whether any of the issues highlighted during the meeting would need to come back to the NCSC; members would be informed in due coarse. He hoped that most of the issues could be agreed via e-mail.
5.AOB
5.1 The Committee agreed that Adam, as chair of the NCSC, would write to the Health Committee regarding the review of the Regulation of Care (Scotland) Act 2001 to highlight the importance of raising awareness of the NCS.
5.2 It was highlighted that some members of the NCSC would be appearing at the Health Committee. They agreed that it would be useful to have details of when all the sets of NCS were published and the commencement dates for regulation of care services regulated by the Care Commission. It was agreed that the secretariat would issue this information with the note of meeting.
Date of Next Meeting
6.1 The next meeting of the NCSC was provisionally set for 10.30am, Monday 26 September, Victoria Quay, Edinburgh.