Bridging the Standards with practice

Exploring Scotland’s Health and Social Care Standards
Published on 22 May 2019

Over 2018/19, Iriss worked with project partners at East Renfrewshire Health and Social Care Partnership and Perth and Kinross Council, to develop a series of partnership meetings, which explore the use of the new Health and Social Care Standards for care at home services for older people.

The meetings were designed to be open and informative spaces for practitioners across care at home and healthcare services.

The project launched as a collaboration between Iriss, the Health and Social Care Standards Implementation Team and the Care Inspectorate.

Meeting 1: Why are you here?

The groups explored what they wanted to achieve and already understood the Standards, and their concerns and potential barriers to implementation.

Barriers and concerns highlighted include:

  • Roles, responsibility and skills
  • Recruitment and retention
  • Time, task and capacity
  • Interpretation of the standards
  • Application of standards in daily practice
  • Expectations of workforce
  • Workforce understanding of the standards
  • How the factors link to the principles
  • Proportionality
  • How it will work in crisis and emergency care
  • The need to move away from blue sky thinking

Meeting 2: A helpful insight

Henry Mathias, Head of Professional Practice and Standards at the Care Inspectorate gave an insight into the standards.

Learning at Perth and Kinross from meeting 2

  • Consider other NHS colleagues who should be involved
  • An insight into why the standards have changed
  • More person-focused approach to inspections and standards
  • Using more simplified language
  • Changes to how future inspections will be done
  • Good to learn other partners experiences/knowledge of the standards

What would you like to address in future meetings?

  • Focus on the new aspects of the standards, especially compassion
  • Commitment to a joint partnership approach
  • Consideration of the standards from a strategic context
  • Connection and opportunities for collaboration
  • How to link descriptors to evidence
  • Creating tools that could support staff development
  • How do we inform service users and check their understanding of the standards?
  • Are we working towards the same outcomes?
  • Outline a plan and critical milestones for the project
  • Develop a collective set of outcomes for the project
  • Look at how we can disseminate our learning across the sector, looking at more creative and inclusive outputs

Learning at East Renfrewshire from meeting 2

  • Understanding how the Care Inspectorate will ensure consistency in a way that scores are inspected and graded
  • More use of qualitative and quantitative methods
  • Inspectorates will go out experiencing care on a more one-to-one basis
  • More time will be spent talking to practitioners
  • There needs to be more input and guidance from the Care Inspectorate

What would you like to address in future meetings?

  • Greater input from other agencies in health and social care
  • To meet some NHS staff to understand what their views are on the standards
  • Need for a sharing event
  • To document the partnership journey
  • More collaborative thinking / wider integrated thinking
  • Thinking about why home care providers don’t communicate with each other?
  • Identify which standards meet what types of outcomes
  • Wider participation at workshops
  • Input from health
  • Workforce development regarding the new standards
  • Breakdown discussion regarding quality framework to HSCS
  • Explore how an individual service can be satisfied that their support workers are using HSCS appropriately
  • Working in silos
  • Look at compassion

Meeting 3: The language of the Standards

The language of the Standards was explored at Perth and Kinross. It involved a break down of the meaning of the principles to understand how to communicate, test and assess whether they were being delivered. This prompted a discussion on ‘compassion’ and a call-out for stories.

Partners worked in groups to share anecdotes and experiences of how they or their organisation deliver compassionate care. They jotted down words associated with these experiences and developed some further questions that could be discussed in future sessions.

What does compassion look like?

  • Creating a safe environment
  • A space that communicated compassion without words
  • Being in the space with someone, both emotionally and physically
  • Proximity to a person
  • Can be a reassuring touch
  • Responsive body language

What does it feel like?

  • Being accepted
  • Being patient
  • Connecting with someone in a particular space or moment
  • Connection
  • A sense of justice and fairness
  • Sharing your relevant experience

Compassion in a care home setting

Here’s an example of a story submitted by Fiona King, Manager at Auchtermairnie Care Home in Leven.

Our care home is set in a semi-rural location so maintaining connections with the local communities can be a challenge.

We have devised our own promoting excellence in dementia care strategy where we recognise and enable all our residents whether they are living with dementia or not, to stay connected with their communities.

We strive to meet ‘I have the right to be included in my community’ by various means in order that our residents can remain connected and be active participants in local community events, local church groups and community groups.

Over the last year we have tried to develop better links with our local community–local church group / primary school and community shed. This has been quite difficult to achieve as we have no footpath from the nearby village to the care home.

However, our residents are now being invited to attend local school shows and concerts. Several of them are retired school teachers and our residents now receive pen pal type letters from the local school children.

Residents can attend in-house monthly church service. We also assist our residents to continue to attend church services (staff escort when necessary). This provides our residents with opportunities for friendship as well as meeting their spiritual needs. Residents who are no longer able to attend church services are visited by church elders.

Following discussion between ourselves and volunteers from our local community shed we have had several sensory aprons and lap tray activity boards made for our residents living with dementia–which gives our residents pleasure and purpose.

Also, our residents are assisted to access technology in order to keep in contact with family and friends. They use Skype / family portal on our computerised patient software programme.

We find about what matters to the individual by use of life story books / talking to the resident and their families. Also, by the completion of hopes and dreams document each January, findings are then used to develop our activities programme and individual personal outcomes.

A resident who loved horses was assisted to go to a local stable and spend time with horses and her daughter. It was great to see this resident so happy and animated.

Care home manager is a dementia ambassador and I am invited to attend locality planning meetings – ensure that the interests our residents are promoted within the wider community.

I am always surprised when relatives state that they did not think that the individual living with dementia can still attend clubs when they move into a care home.

The principles

Members of the group had expressed that they found the language of the Standards abstract.

Using a language-based activity, we explored a human rights approach to care and an insight into what the draft methodology and framework might be emerged.

The following questions of the Principles were asked:

  • What do they sound like to someone receiving care?
  • What do they feel like for a person receiving care?
  • What do they look like to someone viewing this transaction?
  • What language would you use to describe them in everyday life?

Examples of words and phrases the group assigned to the principles

Dignity and respect: time, silence, trust, emotional intelligence, non-judgmental, understanding outcomes, not making assumptions, empathy.

Compassion: Being patient, responsive body language, self aware, listening, kindness.

Be included: Being open and honest, joint decisions, listening, asking, respect wishes.

Responsive care and support: Responsive, reflexive, adaptable, care delivered on time.

Wellbeing: Realistic; quality of life; understanding person; choice; physical, emotional, psychological, spiritual; resilience; confidence; not just absence of ill health.

The wind down

It became clear with each session that the two localities needed different things. By meeting 4 in East Renfrewshire there had been a large gap between meetings, resulting in a lack of momentum and energy.

The meeting resulted in the following reflections:

  • Providers and stakeholders are not overly concerned about the new Standards
  • Partners welcome the more holistic approach to care, which is something they have always aimed to deliver, so feel it’s not a new thing
  • Partners are more concerned about how the abstract nature of the Standards (language and grading) will contribute to the inspection process - it is already disjointed. And how the abstract nature of the grading system gives more agency to inspectors, which is feared will add to greater inconsistency and lack of clarity.

Both inspectors communicated that they did not have all the answers - the only framework or methodology they had was specific to care home inspection as the care at home framework had not been rolled out yet. They could not elaborate on the evidence statement or highlight ways to evidence or self-evaluate services, which the group would have found useful.

Reflections from partners

JJ Turner, Principal Commissioning Officer at East Renfrewshire

The project started off well. Our contracted care at home providers were involved in several ‘tests for change’ projects and to make sure we did not overload them with meetings, the invites went out to a wider pool of care at home providers who were part of our care and support framework. The attendance was good. At the meeting was Iriss, and the HSCP and providers. There was no Care Inspectorate presence and the providers noted their absence.

The Care Inspectorate attended the second meeting and the impetus of the first meeting was perhaps lost as a result as the providers focused on querying the Care Inspectorate about decisions and evidence. One of the mains themes that did come through was the disconnect between service users’ experience through ‘health’ and through ‘social care’.

The meetings became a bit disjointed after this and the impetus of the project was lost. There were a lot of mitigating factors in relation to this. The HSCP were involved in a significant provider failure which was taking up a lot of the commissioning team’s time and there were difficulties in availability of the Care Inspectorate which was impacting on the gravitas of the project.

By the time this was all resolved, there was less appetite for the project from our providers and the next meeting to be arranged resulted in only one provider turning up.

A meeting was held with Iriss, the Care Inspectorate and the HSCP’s involved in the two projects where it was decided to reboot the project but it never really got off the ground. Again, there were problems within the HSCP with one of the principal commissioning officers moving to another post with the remaining one undertaking the work of both posts. Despite an agreement to become more involved, the Care Inspectorate pulled out of the project again and the meeting that had been arranged was cancelled due to ill-health.

Once the meeting had been re-arranged, the Care Inspectorate were back on board, however, the impetus of the original project aims was lost and the focus for providers was back to getting answers from the Care Inspectorate about inspection criteria rather than everyone working in partnership.

On reflection, there are a number of things that could have occurred to make this project a success:

  • The Care Inspectorate should have maintained their commitment to be involved in the process from the start until its conclusion.
  • The commissioning team should have made the project more of a priority regardless of the other competing demands at the time (there are always competing demands).
  • There should have been set post meetings to discuss the learning from each workshop between IRISS, the CI and the HSCP which would then plan out the next workshop. These should have been arranged for the week after each workshop and diaried in as a commitment. This would have maximised the stakeholders ability to keep the project on task and move towards a successful conclusion.

Colin Paton, Quality Assurance and Performance Team Leader at Perth and Kinross Council

This experience has been very enjoyable, thought provoking and challenging. It has at times brought around more questions than answers and has taught me to be patient.

The challenging part to the partnership meetings was trying to get the group of people together and ensure buy-in from the different adults’ services. At the first partnership meeting, Ali had come well prepared for this challenge and was able to start to help the group realise the journey we all needed to take and importantly at this point the destination she hoped we would get to. The challenge was not all turned up for this meeting, as not all understood its importance. The other challenge in the room was the mixture of different services from third sector and Health and Social Care Partnership, with varying understanding of the Health and Social Care Standards. Once again Ali was able to give a brief introduction to the Standards and their relevance to our journey. Although Ali had tried extremely hard to get representation from the Care Inspectorate to come along to introduce and open the first partnership meeting, she had no success. This was not only a challenge on this occasion but became a recurring theme throughout the partnership meetings. This meant that many questions were probably unanswered despite Ali trying her very best.

The Health and Social Care Quality Standards partnership meetings along with support from Iriss Health and Social Care Standards: my support, my life started in September 2017 before the roll out of the Standards used for inspection from April 2018. The purpose of this project was to take the opportunity to explore, understand and implement the new Standards for health and social care with support from partners. This would build up stronger relationships between key stakeholders, model partnership processes and provide time to explore the implementation of compassionate relationships in practice. The HSCP recognised this as an opportunity to get on board and be ahead in embedding the Standards and principles, and use it as a platform to enable meaningful discussions with practitioners around person-centered care and flexible support.

The work undertaken at the four sessions has helped to shape important parts of work within the HSCP. We have used the Standards to help develop team plans/locality plans by relating the Quality Standards and the National Health Wellbeing Outcomes to the HSCP strategic aim, helping all staff to recognise the golden thread. The five principles have been used to give a focus to HSCP Joint Improvement Networks as evidence in position statement 6.3. The next steps are to ensure a more global Perth and Kinross approach so staff are using the Standards and principles to underpin their practices. A workshop was held at the 2019 Perth and Kinross Social Work and Social Care conference.

The Chief Social Worker proposes that we take one of the principles and make this a focus for future work, to not only strengthen the outcomes for children, adults and carers within Perth and Kinross, but using the Health and Social Care Standards as a vehicle to improve relationships.

Further reading

Header image is Tay Rail Bridge before Sunset by Matthew Jackson on Flickr and is licenced via a Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0) licence.