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promoting care in the communityThe NHS in
Scotland and Local Authorities work in close |
The White Paper "Designed to Care" set out a new vision for the National Health Service in Scotland based on co-operation rather than competition. This applies not only within the NHS in Scotland, but across the boundaries between health and the other agencies which affect people's lives. Providing care in the community is one of the areas where the collaborative approach pays dividends in terms of improved care, as NHS and local authorities work closely together in the interests of providing, responsive, comprehensive and high quality packages of care for individuals.
Modernising Community Care: An Action Plan published on 26 October 1998 developed this concept further and underlined the commitment to encourage and improve more effective joint working between agencies at the strategic, service organisation and service delivery levels. The Action Plan also sets out ways in which agencies can work on an integrated basis to secure better results for those who use community care services by focusing on better, quicker decision making, partnership working, and helping more people get care at home.
A Royal Commission to examine the system of funding of long term care for elderly people in the United Kingdom was confirmed on 4 December 1997. The Scottish Office was involved as appropriate in providing evidence at the request of the Commission. The Commission submitted their Report on 1 March 1999 and the recommendations made are under active consideration.
Continuing Care In The Community
The emphasis remains to provide co-ordinated, structured care and support for all vulnerable individuals and groups in a manner that responds closely to their assessed needs. The aim is to allow those requiring care to remain in their own homes and communities as long as that remains a practical and safe option, and where continuing care in a more structured setting is necessary, to provide that care and accommodation in the community and wherever possible in small domestic settings.
Nursing Home Care
A set of core standards for Nursing Homes was first published in 1997 and set the standards by which all nursing homes in Scotland would be assessed by Health Board registration and inspection teams. Every nursing home in Scotland is subject to at least two formal inspections each year. The standards guidance informs nursing home owners, residents, their relatives and the Health Boards (as the registration authorities) of the minimum quality standards that must be in place for a nursing home to operate in Scotland. An additional Chapter on palliative care standards was added in 1998 and further guidance on nutrition and hygiene were published during 1999.
The White Paper "Aiming for Excellence-Modernising Social Work Services in Scotland", which was published on 16 March 1999, proposes the creation of a new independent Scottish Commission for the Regulation of Care in order to develop consistent and improved standards of care throughout Scotland. Following the required legislation, this body will assume the responsibility for the regulation and inspection of all care homes in Scotland.
Framework For Mental Health Services In Scotland
The Framework for Mental Health Services in Scotland published in September 1997, provided a clear indication of the Government's commitment to delivering the concerted national and local action necessary to provide comprehensive, responsive care and support for people with mental health problems. The Framework required health, social work, housing agencies and their voluntary sector partners to work together to provide a complementary range of services which, as far as practicable, respond to assessed needs and integrate people with mental health problems into the normal life of the community.
A package of measures and funding has been provided to help support this process. The Mental Health Development Fund which encouraged the development of local community-focused services for those with mental health problems, provided £9 million of new resources to 2001. The Local Care Partnership Scheme also provided over £600,000 to support pilot initiatives designed to assist Health Boards to work in partnership with GPs, NHS Trusts, local authorities and other agencies in the effective and efficient local integration of health, housing and social care services provided for vulnerable groups and individuals. In addition, allocations were made to support initiatives across Scotland under both schemes during 1998.
The Scottish Development Centre for Mental Health Services has been established, with "start-up" financial support over three years, to provide advice and other support on the development of mental health services in Scotland.
The Mental Health Reference Group continued to support the best implementation of the Framework objectives in 1998. As one of the largest multi-disciplinary groups working in the NHS, during 1998/99 it is examining the interface between primary care, social work and specialist mental health services; the management of risk in mental health care; and a needs assessment for a comprehensive, local mental health service. The outcome reports in each case will be published in 1999.
Mentally Disordered Offenders
Guidance was published on 28 January 1999 setting out for the NHS, local authorities, Courts, Police, the Prison Service and others, the best organisation of care support and security for mentally disordered offenders. The paper announced improved treatment and facilities and a better co-ordinated approach to care and services involving all the relevant agencies.
A national needs assessment was agreed, to be carried out by the Scottish Needs Assessment Programme during 1999 with a view to completion by July 2000. Local initiatives for this care group that are being developed across Scotland are consistent with the published policy objectives.
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