New framework to assess quality

How good is the care and support in a service, and what difference is it making? These questions will be the primary focus of inspections of care homes for older people services conducted by the Care Inspectorate from May when the new Health and Social Care Standards will be used across Scotland.

As the new standards are significantly more rights-based, person-led and outcome-focused than before, the Care Inspectorate is changing its inspection model to reflect this focus. Its inspections will now have an emphasis on assessing outcomes for people, a more proportionate approach to services that perform well, and a focus on supporting improvement in quality.

A new quality framework will help inspectors answer key questions about how good the quality of care is, what difference it is making, and what contributes to that quality of care.

This framework is based on the European Foundation for Quality Management approach, specifically its ‘excellence model’. This tool is used widely across many sectors and adapted by the Care Inspectorate for use in care settings using the new Health and Social Care Standards.

The benefit of this new quality framework is that it is a tool that can be used by care services to self evaluate their own performance, and can help support improvement too.

The framework was piloted in care homes and the results are now being evaluated, in consultation with people experiencing care, their carers, and care providers, to help shape the final quality framework for care homes for older people from May 2018.

During 2018/19, the Care Inspectorate will be developing the framework with illustrations for other types of care and settings. We are working collaboratively with Education Scotland in respect to early learning and childcare.

Key aspects of the inspection process 

The new inspection framework builds on the existing model of inspection but tries to make it even more outcomes-focused. It is based around assessing how good the care and support is, and the difference it is making to people experiencing care. It also looks at the factors that enable that care to be high quality – staffing, leadership, the setting, and key processes (like care planning).

The framework, which is primarily designed for self evaluation, contains a series of quality indicators and quality illustrations which allow both services and inspectors to compare current performance against a clear benchmark. The quality indicators set out the key themes and areas of practice that staff, managers and inspectors should focus on – although not every quality indicator will be inspected at every inspection.

The quality illustrations are drawn from the new Health and Social Care Standards, and other key practice documents. They describe what the Care Inspectorate expects to see at a “very good” level, in respect of each of the quality indicators, and what it might see if a service is operating at a “weak” level. This allows care staff to self-evaluate their own performance against the framework using the same quality measure that inspectors will use.

Feedback from the pilots in care homes for older people was very positive, and helped refine the framework and approaches being used. The illustrations will be different for different types of settings, with lots of consultation and testing before they start in each service type.