Response to Health & Sport Committee inquiry into regulation of care

Consultation body

Scottish Parliament, Health and Sport Committee

Response date

September 2011

Focus of consultation

Does the regulatory system ensure care services for older people are providing good quality and appropriate care?

Inspection reports

Inspection reports do not represent the quality of everything the service does. They represent the quality of what has been considered at a particular inspection. In addition to this it is more challenging to inspect home care services and what is actually happening in an individual’s home.

The relationship between the inspector and service provider is important; it should be one that allows for development and improvement, outlining areas of weakness and advising on how services can be improved upon.

The inspection methodology does provide an onus on service providers to involve people who use services and carers in both their own care arrangements and also in assessing and improving all aspects of the services. Higher grades are attained by providers who are able to evidence such involvement. However, opportunity for inspectors to engage directly with service users is also important.

Remember I’m still me

The Remember I’m still me report highlighted serious concerns with the standard of care in care homes for people with dementia following the joint Care Commission and Mental Welfare Commission inspections in 2009. This demonstrated what was happening in practice, as opposed to policies and objectives. The outcome of this report provided an impetus for improving practice.

The report highlighted the poor response in care home settings to behaviours that staff and carers find challenging. It found evidence of multiple and inappropriate prescribing of psychoactive medication. The Scottish Government has commissioned a specialist academic baseline assessment on current use of psychoactive medication for those with dementia. This will provide a benchmark for measuring reduction in the inappropriate use of this medication. However, it will also be important to measure the development of alternatives to medication.

Dementia Care Inspection Tool

The Dementia Care Inspection Tool provides a useful guide for inspectors in identifying good practice in service provision for people with dementia. The tool covers awareness of the individual, environment, activities, medication, staff knowledge and skills and access to health care.

There are a number of measures that should lead to improvement; however, time is required for their impact to be established. In addition to this there has been a change to the regulating body and inspection methodology, with a greater focus on unannounced inspections and proportionate inspections based on risk. Frequency of inspections being determined by the assessed risk and history of performance of the service should provide greater opportunity to pick up where service providers are performing poorly.

Standards of Care for Dementia in Scotland

Whilst the National Care Standards provide the basis of inspection, the Standards of Care for Dementia in Scotland will also be crucial to measuring service quality for people with dementia. The regulatory body will have an important role in measuring the extent to which these Standards and Promoting Excellence are implemented by service providers.

Those working with people with dementia need to be equipped with the right set of skills and understanding of the illness to deliver appropriate care that respects dignity and improves quality of life and wellbeing.

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