Iriss Activity Review 2015-16

The Institute for Research and Innovation in Social Services have published an annual activity review for 2015-16, which provides a snapshot of their recent work.

Introduced by Peter MacLeod, Iriss Chair, it includes a summary of IRISS’ project work, lessons learned from it and what they aspire to going forward.   A lot of this work has been undertaken in partnership with Scottish Care and the independent sector.

The Annual Activity Review can be accessed here: http://www.iriss.org.uk/sites/default/files/iriss-activityreview-2016.pdf

Falls and fractures in care homes

The Care Inspectorate has launched a drive to improve the way care homes across Scotland protect residents from the danger of falls.

As part of Care Home Open Day on Friday 17 June, the Care Inspectorate launched a new good practice resource full of information on how best to prevent and manage falls. It will be distributed to every care home in Scotland and help them minimise the risk of falls, and better support people who do experience a fall.

Older people in care homes are three times more likely to fall than older people who live in their own home. The rate of emergency admissions to hospital as a result of a fall is also almost four times higher among care home residents than older people living in their own homes.

Cabinet Secretary for Health & Sport, Shona Robison, offered her support for the resource.

She said: “The prevention and management of falls and the prevention of fractures is an important issue in maintaining quality of life and independence for older people. This includes older people in care homes.

“This is a tremendous resource which will help care homes take a proactive approach to preventing and managing falls and preventing fractures.”

Karen Reid, the Chief Executive of the Care Inspectorate added: “We know that the majority of care homes in Scotland provide safe, compassionate care and it’s our job to help all care services improve the standard of care they provide.

“Falls are a contributory factor for many people moving into a care home, but staff there can play a really important role in helping older people to stay active safely.

“Many falls are minor, but any fall can be really traumatic for older people and their loved ones – especially if that causes a fracture or the person needs to go to hospital.

“We expect care homes to better minimise risk and support people who experience a fall.

“This new resource will help all care homes think about the ways they can minimise the risk of falls and provide better care and support to residents and help reduce health and social inequalities for older people.”

The resource is available here: http://cinsp.in/fallsandfractures

The revised resource was created with support from the Care Inspectorate and NHS Scotland.

Dementia Inspection Focus Area (IFA)

An important update from the Care Inspectorate

The Care Inspectorate are always looking to support improvement by promoting and showcasing best practice and innovation in services who care for and support people living with dementia. This inspection year 2016/17 they will be carrying out 150 dementia focused inspections in care homes for older people across Scotland.

The services having this type of inspection have been randomly selected and will give a national picture of how the Dementia Standards have been applied into practice and changed the lived experience of people living with dementia.

The Care Inspectorate are hoping to be able to show how care homes are supporting people to live with meaning and purpose, staying connected to their families and communities and having their health needs met. There may be areas for development and improvement and they are committed to work in partnership to see positive changes.

For more information and links to resources please go to: http://hub.careinspectorate.com/improvement/spotlight-on-dementia/

Heather Edwards, the Care Inspectorate’s Dementia Consultant, would be happy to provide support to your service over the coming weeks & months in relation to dementia practice.  She can be contacted at [email protected]

Be part of Luminate 2016

Are you planning creative activities or events in Scotland this October that are aimed at older people or have a theme related to ageing?

Luminate, Scotland’s creative ageing festival, would like to invite you to be part of the fifth edition of the festival.  If you’re planning creative activities or events in Scotland this October that are aimed at older people, or that have a theme related to ageing, why not put them forward to be part of Luminate 2016? You would be featured in a nationwide programme and marketing campaign, and have the chance to meet other event organisers who are running similar activities across Scotland.

The online proposal form is now live. Deadline for submissions is 5pm on Wednesday 29 June for inclusion in the printed festival brochure and on the Luminate website. Proposals submitted after this time will be eligible for inclusion on the website only and the deadline for submission of events to be included online only is 5pm on Friday 5 August.

Please click here to put your proposal forward and find useful documents to help you prepare your submission

NCHC Reform – Take part in important provider survey

This Scottish Care survey is aimed at getting providers initial thoughts so these can inform the development of any new framework

As part of this year’s National Care Home Contract settlement, Scottish Care, COSLA and the Scottish Government made a joint commitment to Reform of the NCHC, as part of the wider reform of Social Care.

The NCHC has provided a degree of stability to the sector over the past 10 years, and has also formed the basis of a strategic partnership between the providers, commissioners and policy makers at a national level. At the same time, given the progress of Health and Social Care Integration and the changing landscape of care, there is a need to ensure we have a Care Home framework and process in place which is fit for purpose going forward.

The Reform Agenda includes:

  • Responsiveness to local Strategic Priorities, local capacity requirements, and local market conditions
  • A focus on innovation and new models of care
  • A re-examination of the cost of care home provision to provide the basis for sustainability and investment
  • An appraisal of local commissioning and procurement options
  • Greater emphasis on service user choice and control

The Reform work is underway with the goal of having the key elements of a new framework available for consultation by the autumn. Central to this is having a clear picture of stakeholders’ views on how the existing NCHC has worked and what they think most needs to change. This is an exercise, nationally and locally, that everyone has to feel part of.

This survey is therefore aimed at getting providers initial thoughts, so these can inform the development of any new framework. Please take the opportunity to tell us what you think.

The survey can be accessed here: https://www.surveymonkey.co.uk/r/nchcreform

There is a strict deadline of Monday 4 July for this survey.  There will be no extension beyond this so please ensure you complete it as soon as possible.

Finalists announced for Scottish Care Awards

The nominations for the 206 Care at Home & Housing Support Awards have now been judged and the finalists announced.

The Care Awards finalists for 2016 are:

CAH Carer of the Year:

  • Paul McConnachie, Voyage Care
  • Aspire Care Team
  • Fiona O’ Driscoll SCRT

HSS Carer of the Year:

  • Health & Wellbeing Team, Loretto
  • Laura McConnachie, Aspire Housing & Personal Development Services
  • Carol Graham, Loretto

Management & Leadership Award:

  • Karen Johnson, NG Homes
  • Joeanne Hamilton, Community Care Choices
  • Sharon Fleming, Loretto

Learning & Development Champion/Trainer:

  • David Roxburgh. Loretto
  • Christopher Hogsden, Blackwood Homes & Care

Care Services Co-ordinator/Administrator:

  • Amanda Allan, Home Instead Senior Care Glasgow North
  • Angela Giles, Loretto
  • Karen McDerment, Mears

Personalisation & Partnership Award:

Lousie McGlone, Colin Hamilton & Paul Copeland, Aspire Housing & Personal Development Services
Highland Care at Home Improvement Group, Providers, NHs Highland & SC LILs
Bluebird Care in Partnership with various organisations

Individual Service User:

  • Angusina Morrison, SCRT Ltd
  • Eoghan Cowan, Cairllum Care
  • Emma McAuley, Aspire Housing & Personal Development Services
  • Mandy Mckenzie, Blackwood Homes & Care

Housing Support Services Provider of the Year:

  • NG Homes Housing Support Service
  • Aspire Housing & Personal Development Services
  • South Lanarkshire Young Persons Intensive & Carlisle Road Outreach, Loretto Care

Care at Home Provider of the Year:

  • Baillieston Community Care
  • Home Instead Senior Care Glasgow North
  • Prestige Nursing & Care Edinburgh

Congratulations to all our finalists and to all who were nominated.

We look forward to meeting you all at the Awards Dinner on Thursday 23rd June 2016 at the Marriott Hotel, Glasgow

Scottish Care Consultation on the Scottish Law Commissions Report on Adults with Incapacity 2016

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Consultation on the Scottish Law Commissions Report on Adults with Incapacity 2016

March 2016

If you would like to download this Consultation you can do so here:

www.scottishcare.org/wp-content/uploads/2016/06/AWI-response-Scottish-Care-March-2016.pdf

 

In October 2014, the Scottish Law Commission (‘the Commission’) published a report on Adults with Incapacity which focussed on the question of deprivation of liberty as it relates to persons who may be subject to the Adults with Incapacity legislation and associated issues. The report made a number of recommendations and contained a draft Bill, amending the Adults with Incapacity (Scotland) Act 20002 (‘the 2000 Act’) and the Mental Health (Care and Treatment)(Scotland) Act 20033 (‘the 2003 Act’).

The Commission’s report concluded that adults without incapacity are being confined to hospital wards and residential facilities in Scotland without any underlying legal process which is contrary to Article 5 of the ECHR.

This consultation sought views on specific matters raised in the Commission’s report, with particular reference to the Commission’s draft Bill and how that would work alongside the existing legislation. It also sought general views on wider aspects of the 2000 Act that may benefit from review. The findings from this consultation will inform the decisions regarding any wider review of the 2000 Act.

To view the full consultation paper, see https://consult.scotland.gov.uk/integration-partnerships/report-on-adults-with-incapacity/user_uploads/410293-p3.pdf

 

 

  1. Are you responding as an individual or an organisation?

Organisation

 

  1. What is your name or your organisation’s name?

Scottish Care

 

Scottish Care is a membership organisation and the representative body for independent social care services in Scotland. Working on behalf of a range of small, medium and large providers across private and voluntary services, Scottish Care speaks with a single unified voice for both members and the whole independent care sector.  This includes those who use independent sector care services.

Scottish Care counts over 400 organisations as members, which totals almost 900 individual services across Scotland. The private and voluntary sectors are significant providers of social care – in 2015, these sectors provided 83% of care home places and contributes to 55% of home care hours for older people.

 

 

  1. What is your email address?

 

[email protected]

 

  1. The Scottish Government generally seeks to publish responses to a consultation, in summary and where possible in detail. We would like your permission to publish:

 

Response along with full name

  1. We will share your response internally with other Scottish Government policy teams who may be addressing the issues you discuss. They may wish to contact you again in the future, but we require your permission to do so. Are you content for Scottish Government to contact you again in relation to this consultation exercise?

 

Yes

 

 

QUESTIONS RELATING TO THE DRAFT BILL PROVISIONS ON COMMUNITY SETTINGS

1 . Is a process required to authorise the restriction of an individual’s liberty in a community setting (beyond a guardianship or intervention order), if such restriction is required for the individual’s safety and wellbeing?

Scottish Care is undecided as to whether an additional process is required to authorise restriction of liberty.  We certainly support any steps which safeguard against unnecessary or excessive restrictions on an individual’s liberty and do believe that improvements need to be made to the current legislation and processes.

Importantly, the previous legislation provides mechanisms for the deprivation of liberty which are not only in direct contrast to ECHR Article 5 but which are discriminatory as they don’t offer adults with Incapacity equal recognition before the law.  There is a danger currently that adults with incapacity can have their rights legally limited as a consequence of poor mental health and laws designed to protect their rights can be ignored with impunity.

We therefore welcome new approaches which are robust, non-discriminatory and in line with the ECHR.

Both the care sector and the regulatory bodies are increasingly aware of and committed to the protection of the human rights of those who access care and support services, and there absolutely must be equality of rights whether someone requires care and support services or not, and whether they have conditions which require interventions to protect their safety and wellbeing or not.

However, the establishment of a new process to authorise restriction presents two significant challenges.  Firstly, it places significant obligations on various health and social care professionals when capacity is already a concern, which has real implications in terms of timescales and effectiveness.  Secondly, an unintended consequence of this process could be the growth of an unhelpful and inaccurate perception that health and care services, and care homes in particular, are places where an individual’s autonomy and liberty are under real threat and whereby restrictions are the norm. This couldn’t be further from the truth, and in fact these services work to promote and maintain independence, safety and wellbeing at all times.

Therefore, we believe that steps which promote discussions, evidence and approval in relation to restrictions on liberty are absolutely the right thing to do.  However, we are not entirely convinced that this new process would be the right way to do it and that other approaches such as training, awareness raising or guidance couldn’t produce more positive outcomes.  It is well known that new, top-down legislation is not necessarily the best way to influence change at a practice level. We would therefore encourage the Scottish Government to undertake further engagement with health and social care organisations, providers and people who access care and support to better ascertain the best way forward.

  1. The proposed legal authorisation process will not be required for a person who is living in a care home where the front door is ordinarily locked, who might require seclusion or restraint from time to time. Do you agree that the authorisation process suggested by the Commission should not apply here?

Yes.

As the consultation document helpfully highlights, there are approximately 35,000 people in care home services, 20,000 of whom are likely to be living with a degree of cognitive impairment.  It would be entirely inappropriate to require authorisation for all these individuals when interventions relating to their liberty are expected to be low-level, infrequent and temporary.  The nature of the care home population means individuals are likely to have higher support needs, complex conditions and fluctuating capacity, and they have been assessed as requiring help to live safely and well.  Therefore care homes will have to implement measures such as locked front doors in order to uphold their responsibilities in relation to duty of care.  To require an authorisation process for the majority of care home residents who fit into this category would be wholly unacceptable and would be a significant intrusion on and restriction of the rights of other residents. In essence this would be practicably unworkable. The authorisation process should only be required for individuals for whom restrictions on their liberty are substantial, very frequent and for significant periods of time.

  1. In proposing a new process for measures that may restrict an adult’s liberty, the Commission has recommended the use of ‘significant restriction ‘ rather than deprivation of liberty and has set out a list of criteria that would constitute a significant restriction on an adult’s liberty. Please give your views on this approach and the categories of significant restriction.

We support the use of ‘significant restriction’ rather than deprivation of liberty.  We believe it would allow for more effective, accurate and consistent application that isn’t subject to changes in jurisprudence.  The language more precisely reflects the intentions underpinning it and the realities of how it will be understood and applied in practice, since we are talking about restricting liberty where necessary and in balanced ways rather than depriving – a term which implies a lack of cooperation and proportionality.

However, we would want to see further clarification in relation to the defined categories in order to aid understanding of when ‘significant restriction’ is to be implemented.  For instance, under their duty of care, there is unlikely to be many instances whereby care home staff would be able to permit a resident to leave the premises entirely unaccompanied or without any mechanisms to be able to locate them (e.g. the use of GPS systems for some residents with dementia who like to go out in the community).  These residents may be accompanied by a member of staff, a relative, friend or piece of technology but if none of these systems were in place and care home staff enabled residents to leave the premises at will and without careful monitoring and recording, serious questions would be asked as to how the service was protecting and promoting those persons’ safety, health and wellbeing, not least by regulatory bodies.  The same applies to restricting access to areas of the premises – there may well be entirely legitimate and reasonable decisions taken to restrict access to areas which present a risk to safety such as cleaning cupboards and kitchen areas.  Additionally, the protection of other residents’ rights mean there may be legitimate reasons to restrict access to other individuals’ bedrooms and bathrooms.  Few people, when the decision-making and risk-assessments related to these areas are clear, would raise concern with those restrictions.  We don’t believe the intention of the Commission’s report is to require authorisation of these sorts of restrictions but if care staff and other health and social care professionals are to implement authorisation correctly and effectively, the criteria need to be explained in much clearer ways and perhaps with supporting practice examples and case studies.

On a separate matter, Scottish Care has some concerns in relation to the assignment of a ‘relevant person’ and the duties attached to this. The new bill, on paper, looks to offer stronger accountability mechanisms, for example, “The care home manager must complete a Statement of Significant Restriction (SSR) which is to specify the way in which the adult’s liberty is to be restricted and why. Thereafter a report is required from a Mental Health Officer (MHO) and a medical practitioner as to the appropriateness of the proposed restrictions”. Whilst clarity around accountability is important and positive, it’s essential that this process is fully implemented, robust and that specific resources are in place to oversee it.  We would be concerned about the implementation of this without careful consideration being given to the capacity and skills of care home managers to be able to do this effectively.  We understand there are similar concerns in relation to the capacity and resources of MHO’s.

 

  1. The authorisation process provides for guardians and welfare attorneys to authorise significant restrictions of liberty. Do you have a view on whether this would provide sufficiently strong safeguards to meet the requirements of article 5 of the ECHR?

The new legislation could benefit from a stronger move away from substitute decision making- where decisions are made on someone’s behalf towards supported decision making- where someone is supported to participate in decisions that affect their life in a free, meaningful and active way without discrimination.  Whilst this may present challenges in relation to capacity, that is not an excuse to not make every effort possible to enable an individual to be involved and informed as far as possible and this should be evidenced.

There are also issues in relation to what authority a guardian or welfare attorney has, and whether their decision-making powers extend into this area (e.g. those with only financial powers).

It should also be recognised that conflicts of interest may exist between the relevant person (as defined) and the guardian or welfare attorney.  Additional attention may need to be given in determining what action is in the best interests of the individual to whom the restriction relates to and how opposing views can be mediated in the most beneficial way.

From a human rights perspective, to take different approaches in hospital and community settings in relation to the guardian or welfare attorney’s decision-making power is problematic. In hospital settings, not recommending the involvement of attorneys and guardians in the process of authorising ‘detention’ because of a concern that such involvement might undermine the delivery treatment assumes that the delivery of treatment is the priority. However, if the adult in question has decided that they want their attorney or guardian to be involved in decisions about their care, treatment and support then this would be contradictory to their wishes. It contracts principles of participation, non-discrimination and empowerment.  It also implies that delivery of treatment in hospitals takes priority over delivery of care in community settings, which can be equally critical in someone’s health and wellbeing.

If a guardian or welfare attorney does not authorise the restriction, there are significant implications for referral to sheriffs.  These implications are in relation to cost, timescales, resources and capacity and we believe further consideration needs to be given as to whether this is the most appropriate and effective route or whether there are other options for reaching a resolution.

 

  1. The Bill is currently silent on whether it should be open to a relevant person to seek a statement of significant restriction in relation to a person subject to an order under the 1995 or 2003 Acts which currently do not expressly authorise measures which amount to deprivation of liberty. Please give your views on whether these persons should be expressly included or not within the provisions, and reasons for this.

Without expertise in relation to Criminal Justice or community compulsion orders, we do not feel able to make comment on this area.

However, the Scottish Government must give consideration as to how this will apply to individuals living in the community but out-with care homes who may require restrictions to their liberty, in particular those in supported accommodation or in tenancy arrangements.  Given the policy drive to support more people to live in their own homes for longer, we expect to see more people who would traditionally have accessed residential care settings being supported at home.  Therefore consideration must be given and decisions clearly outlined as to how this applies to both individuals in those settings and the professionals operating and involved in those support settings who may have accountability for authorising restrictions.

 

6.The process to obtain a statement of significant restriction would, as the bill is currently drafted, sit alongside existing provisions safeguarding the welfare of incapable adults, and require the input of professionals already engaged in many aspects of work under the 2000 Act, such as mental health officers and medical practitioners.  Please give your views on the impact this process would have on the way the Act currently operates.

We perceive there to be significant challenges in relation to the viability of implementing this bill on top of existing legislation, as well as to how the various Acts will harmonise and complement each other.  All efforts must be made to make the legislation landscape as clear and simple as possible if it is going to successfully influence practice.

What’s more, the Scottish Government should take steps to cross-check this Bill with other existing health and social care legislation, in order to ensure they are as joined up as possible and are truly protecting the rights of all.  Whilst we know that the most vulnerable in society can be those who are most at risk of having their rights violated, it is important to remember that rights are universal and need to be held in equal regard and upheld fully for everyone.  Therefore the correct balances must be struck if the most positive outcomes are to be realised.

The Scottish Government must also think carefully about the role and input of regulatory bodies such as the Care Inspectorate in understanding and monitoring the appropriate use of SSR’s.

 

 

QUESTIONS ON THE POWER TO MAKE AN ORDER FOR CESSATION OF UNLAWFUL DETENTION

1.Is a process required to allow adults to appeal to the Sheriff against unlawful detention in a care home or adult care placement?

Yes.

Whilst we fully support mechanisms which enable people to challenge decisions that are not in their best interests, very careful consideration must be given to how this will be perceived and used in practice.

We would hope that decisions to place an adult in a care setting such as a care home are made after comprehensive discussions and assessments, which involve and inform both the individual requiring care and their relatives.  Whilst undoubtedly a move to a care home can be difficult, it should always be taken as a result of a true belief and mutual agreement that it is the best setting for meeting an individual’s health and wellbeing outcomes.  Therefore there should be very few instances where it can be perceived as unlawful detention, given that it is quite different from practice which takes place in relation to restriction within that care setting.  If this instance was to occur, all parties would need to give careful thought as to the intentions behind and outcomes of such a process.

As previously outlined, it could have very negative effects on how different care settings are perceived given that it implies care homes would be somewhere where people were being held against their will.  At a time when we need to be promoting choice for individuals in relation to a range of quality care settings, we need to be very careful not to unhelpfully and unintentionally restrict that choice through inaccurate perceptions of what care in that setting will look like.

Therefore we are not against the inclusion of mechanisms to help people challenge decisions, but would want much more detailed deliberation to be given to this element.

  1. Is the proposed approach comprehensive?

No.

Are there any changes you would suggest?

It’s absolutely vital that this process is accessible, effective and used only in instances where there are very legitimate concerns around unlawful detention, and not just when different parties with a stake in an individual’s care and support are in conflict.

 

NEXT STEPS AND WIDER REVIEW

The Scottish Government is also currently consulting on the Draft Delivery Plan 2016-2020 United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). That plan includes the following commitment: –

We will consult on the Scottish Law Commissions review of the Adults with Incapacity Act in relation to its compliance with Article 5 of the ECofHR, specifically in relation to Deprivation of Liberty and thereafter carry out a scoping exercise in relation to a wider review of the Adults with Incapacity legislation. All responses to this consultation will be carefully considered as part of the scoping process in relation to a wider review of Adults with Incapacity legislation .

To further assist that process we would therefore welcome responses to the following questions:

  1. Over and above the question of deprivation of liberty considered by the Commission do you believe the 2000 Act is working effectively to meet its purpose of safeguarding the welfare and financial affairs of people in the least restrictive manner?

In most instances it is our belief that the substantial elements of the Act are working effectively. In practice we believe that there needs to be a greater degree of clarity between the inter-relationship between the AWI Act, Adult Support and Protection and the Mental Health Care and Treatment Act, particularly as they may be engaged within a care environment. We would like to see greater evidence that the principles of the Act, particularly best interest, the encouragement of the adult to make his or her own decisions and manage his own affairs, and the development of the skills needed to do so were given greater emphasis in practice. We have anecdotal evidence that too much reliance and trust is placed upon the status of a Guardian without adequate and more frequent exploration of a Guardian’s abilities to exercise the Act’s principles in the fulfilment of their duties.

 

In summary, it is our hope that additional legislation will not hinder care being given, often due to mental impairment, under difficult circumstances. What is required is a practical, supportive model for delivering care (that might involve appropriate and proportional restrictions on liberty) which enables care staff to provide support in a way that prioritises care over paperwork, but which also protects and promotes the rights and wellbeing of individuals requiring care interventions.

 

Scottish Care response to SSSC Consultation on the Codes of Practice and Fitness to Practise

 

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Consultation on the Codes of Practice and Fitness to Practise

January 2016

 

If you would like to download this Consultation you can do so here:

www.scottishcare.org/wp-content/uploads/2016/06/Response-to-the-Consultation-on-the-Codes-of-Practice-and-Fitness-to-Practise.pdf

 

The Scottish Social Services Council (SSSC) carried out a consultation on the revised Codes of Practice and the implementation of fitness to practise.

 

The consultation had two parts:

Part A: Revised Codes of Practice for Social Service Workers and Employers

Part B: Implementation of fitness to practice

 

For more information about the consultation, see

http://www.sssc.uk.com/about-the-sssc/multimedia-library/publications/206-consultations/consultations-by-the-sssc/codes-of-practice-and-fitness-to-practise-consultation-november-2015

 

Part A:       Revised Codes of Practice.

We are: a provider and/or an organisation representing providers.

 

Scottish Care is the representative body for independent sector social care services in Scotland. This encompasses private and voluntary sector providers of care home, care at home and housing support services across the country. Scottish Care counts over 400 organisations as members, which totals over 830 individual services. Scottish Care is committed to supporting a quality orientated, independent sector that offers real choice and value for money. Our aim is to create an environment in which care providers can continue to deliver and develop the high quality care that communities require and deserve.

In relation to older people’s care, this sector provides 88% of the care home places in Scotland and up to 55% of home care hours. There are more older people in care homes any night of the week than in hospitals – as at 31st March 2015 there were 892 care homes for older people providing 38,164 beds to 32,771 residents any night of the year, with 89% of these residents located within the independent sector.

We are responding to this consultation on behalf of the Scottish Care membership.

Members have also been encouraged to submit their own responses to the consultation.

 

Changes to the Employers Code: Code 1:

Scottish Care is committed to ensuring that those recruited to work in social care services both have appropriate values and attitudes and can develop skills and knowledge to work most effectively in supporting others. We agree with the change from assuming those entering the professions already have these attitudes and skills towards a position of recognising in the individual being recruited the capacity and the potential of gaining such knowledge and skills.

 

In recruitment practice we recognise the critical importance of ensuring that those recruited meet safe recruitment best practice. However, many providers struggle with balancing this commitment with being able to access appropriate information on applicants in a context where many have no prior employment, where the use of references has changed considerably over the years, and where previous employers are taciturn at best and unwilling at worst to provide references. Whilst accepting this code we would encourage all stakeholders to work together to ensure that the principles of safer recruitment are achievable in practice.

 

The new Code 1.6 requires of the employer a duty to report any impairment of fitness to practise of staff. As will be made clear below in our Part B response we have considerable concerns about what this in practice will mean for providers, their ability to meet this duty and whether there has been provided to date sufficient clarity for providers to enable them to recognise that they are indeed fulfilling this duty. We have particular concerns over the subjective interpretation of the phrase ‘any issue about workers whose fitness to practise is or may be impaired.’

As will be stated more fully below we have equal concerns that this new duty may place at a disadvantage employees and registrants of social service organisations in comparison to others working within other sectors.

Therefore in response to this addition Scottish Care at this present time is unsure about this new Code without the provision of further clarity and guidance.

 

Code 2:

 

We welcome new code 2.3 though regret that the language used is so dated. Given the importance of future proofing these Codes we believe strongly that the continued use of terminology such as ‘service users’ to be outdated, for some offensive and non-descriptive of the supported person-provider organisation- worker relationship dynamic. The importance of actively engaging with those who are supported and use services is self- evident and we would hope such engagement is recognised by those who commission provider organisations by the means of an appropriate resource allocation which recognises the centrality of such engagement.

Scottish Care also welcomes strongly the establishment in all employer organisations of systems which will allow staff to whistle blow when they feel working practises are for any reason unsafe or inappropriate.

As we move towards more integrated service delivery and supports we welcome the addition of Code 2.7 and the importance of employers ensuring staff employed by them are able to meet their own professional codes. However in our own consultation with members there was a concern expressed about a perceived lack of clarity on the inter-relationship between different codes and we would hope the Guidance which will accompany the Codes

 

 

will practically assist employers in contexts where staff are working under multiple professional codes.

Therefore whilst welcoming the new additions we are concerned about the mechanisms by which they will be achieved.

Code 3:

 

Scottish Care believes that the role of continuous learning and development for employees within the sector is absolutely critical and our members are equally committed to ensuring that this is achieved. However we must state at this point that the ability of employers to meet this Code (and indeed all the Codes) is increasingly challenged by the failure of commissioning bodies to prioritise the learning and development of staff who work directly with the supported individuals on whose behalf they commission services. We believe that some means requires to be found, either through duties or scrutiny, upon authorities who commission services to do so at rates which enable the employer to meet his or her duties under the Codes.

The new Code 3.5 on the importance of good and regular supervision is to be applauded but again we must at this point highlight that within increasingly tight operational environments the ability of provider organisations to not only meet this new duty but to do so in a manner which builds the capacity of the employee is challenged at best if not increasingly impossible to achieve. Reflective practice and the capacity to supervise and learn through such supervision both necessitate the dedication of time and resource which few providers are able to give or afford.

So in Code 3 whilst in principle we warmly welcome the additions we are unsure about whether they are practicably achievable.

Code 4:

 

Whilst in broad terms we approve of the updating of 4.2 we are concerned at the lack of clarity in relation to the term ‘fitness to practise’. There are clear legal duties which already exist and which are placed on any employee in terms of the Equality Act 2010 in relation to behaviour which is bullying, discriminatory, intimidatory or exploitative. We are clear that such duties of reporting and whistleblowing, the duty of care to colleagues and to those who use services and supports, should be rigorously embedded in employment practice and enforced b organisational culture and systems. We are equally clear that employers and employees have duties in relation to adult safeguarding in relation to harm which may be caused by deliberate, accidental, neglectful practices in care and support. Indeed the description in the Codes currently, we would contend, does not go far enough in recognising the impact of negative psychological and emotional behaviours. We are clear that the duty of candour enhances and underpins much of the previous legislation.

 

 

What we are unclear about is what in addition to already legally required employee behaviour ‘fitness to practise’ adds.

We continue to agree with 4.4 but would like to see Guidance which would include an understanding that ‘trauma’ might not only be dramatic or unexpected incidents but would encompass the continuous emotional impact of grief and loss upon employees.

We agree with 4.5 about the importance of policies respecting ‘wellbeing, equality and diversity’ of workers and indeed would have liked to have seen this enhanced with the addition of a specific duty to help to foster the human rights of employees, and those who use supports and services in line with the forthcoming new National Care Standards.

Again we have concerns with the breadth of the phrase ‘fitness to practise’ in 4.6 and believe the lack of clear examples here is unhelpful.

 

 

Changes to the Code for Social Service Workers:

 

 

As has been stated before in previous responses Scottish Care has and does warmly welcome the review of the Codes and in particular recognises that the existence of a Code for workers assists in giving dedicated individuals a sense of professional identity and status which is important both for the individual and for the sector as whole. We profoundly believe that the right Codes assist and foster public confidence in the work of those offering social care and support.

Code 1

 

The personalising of the statements within the Codes by the insertion of the first person is warmly welcomed as too is the positive emphasis on taking action to ensure respect for other cultures and diversity. We also welcome the importance of working alongside those who receive supports and altering practice where appropriate in response to feedback.

We would like to have seen the insertion of human rights in 1.5

 

Again throughout the Codes we believe serious attention needs to be given to the terminology of ‘service users’.

Code 2:

 

Welcome. No comments.

 

 

Code 3:

 

Code 3.1 rightly encourages the promotion of independence but it should also be recognised that individual choice has primacy over a desire for independence, so we would insert, ‘where desired’ to ensure personal autonomy.

Code 3.2 is to be applauded because it clearly describes for the worker circumstances where they have to act without the use of ‘fitness to practise’ as a term – we would have valued such clarity in the Employers Code rather than the nebulous use of ‘fitness to practise’ and its open-ended nature of requirement. Unfortunately the term appears in 3.5 without description and we are again concerned that most workers will not be clear what in addition to that descried at 3.2 is meant by the phrase and thus they may unwillingly fall foul of the Code.

The duty to co-operate with investigations and hearings we would agree is an appropriate addition.

Code 4:

 

Welcome additions. No comment other than welcoming an emphasis on positive risk enablement and personal choice, control and autonomy.

Code 5:

 

Welcome additions and no comment.

 

Code 6:

 

Again we have concerns over 6.3. The placing upon a worker of a duty to report ‘personal difficulties’ beyond the legal requirements which already exist strikes many as unfairly disadvantaging a social care worker compared to other employees. Further it is not clear at all what may constitute a ‘personal difficulty’, who the arbiter of such difficulties might be and what action an individual worker or employer needs to take when they are unclear about the subjectivity of such ‘difficulties’.

It is wholly acceptable that there should be a duty to inform SSSC about behaviours or conduct which have been a clear breach of the Codes but we are deeply concerned about the subjectivity of phrases such as ‘personal difficulties. We believe this duty places unwanted and unnecessary additional pressure upon a worker and may have a wholly negative impact on recruitment and retention in a sector which doesn’t need any additional challenge.

Equally we are deeply concerned about the requirement to report to the SSSC information relating to health. Given the reforms within the Equality Act 2010 in relation to health and

 

 

disability within employment and recruitment practice we are unclear as to the what may constitute an appropriate health declaration, who assesses this and what the consequences might result both for an employer and employee were such assessment to later be determined as erroneous.

We welcome 6.8 and 6.9 though again highlight the importance of those who commission adequately resourcing a worker’s ability to learn and develop knowledge and skills.

General comment:

 

In general terms we believe the Codes where they have been altered have positively reflected the values and attitudes necessary within the social care workforce. If used well they offer the potential in giving both employers and workers a sense of professional identity and confidence.

Our specific and very real concerns relate to the concept of ‘fitness to practise’ which in its current articulated form in the Codes is nebulous, subjective and unhelpful. A professional Code should offer supportive clarity to employers and workers and where there is a lack of clarity that negatively impacts upon conduct and behaviour and risks the very confidence which such Codes seek to engender in both professionals and the wider public.

We believe that serious further work needs to be undertaken to ensure that there is much sharper clarity in relation to the mutual responsibilities of worker and employers in relation to fitness to practise and the inter-relationship between these Codes and other employment legislative requirements.

In their current format we have very real concerns that employers may in upholding action under ‘fitness to practise’ may find themselves in breach of other employment legislation. In current form we are not convinced that elements of the new Codes, specifically ‘fitness to practise’ duties, do not contravene the Equality Act and put those who may be defined under that Act as ‘disabled’ at a discriminatory disadvantage and result in their less favourable treatment. Equally we can foresee circumstances where on the grounds of age an individual may under the Codes be deemed as having ‘difficulties’ in their support and care but which would if exercised upon be a breach of the Age Regulations of the Equality Act which commenced in 2011 and which would certainly not foster equal opportunities in the workplace.

Part B.

 

Introductory comments:

 

We have already cited above not insignificant concerns re Fitness to Practise as they have been alluded to and incorporated into the Codes.

 

 

As an organisation Scottish Care has already articulated (in the 2013 consultation process for instance) its own positive response to a move from the current ‘conduct’ process towards what to date has been described as a ‘fitness to practise’ process. One of the reasons we welcomed such a move was that it would assist by adding clarity for workers and employers alike on what behaviours or conduct would be a clear breach of acceptable practise. We still accept the value of such a move.

However, what has become clear under the current Review process, is that there are very real dangers with this change unless there is a sharper clarity given to what is meant by and how ‘fitness to practise’ is defined both in practical terms for workers and employers and in legal terms especially in relation to existing employment law and best practice.

In terms of the reasons given for the change, therefore, our most heightened concerns relate to the consideration of health when it impacts on an individual’s ability to work with others and to do so safety. Equally we are concerned about how ‘competence’ is defined in relation to employment practice.

We recognise the desire to make a change is rooted in the reality that not all cases coming before the SSSC are purely about an individual’s conduct but relate to health and competence which may negatively impact upon the safety of those being cared for or supported. We further recognise that this move is occurring within a wide range of professional bodies.

The Consultation details its belief that the action is not in breach of current equality legislation in that no rule will be set in place which will directly or indirectly discriminate on the grounds of treating an individual less favourably. Indeed together with SSSC, Scottish Care values the diversity of our workforce and wants to ensure that all, regardless of disability, are able to achieve to their full potential within the social care workforce. We are content that the SSSC does not ‘set a list of health issues that will always mean fitness to practise is impaired’. However we are concerned , for instance and perhaps especially in relation to mental health issues, that many workers may believe that periods of mental un- wellness may make them unable to remain as a registrant or may prevent them from entering employment. We are concerned that many staff in highly vulnerable periods of their personal lives will have the added burden placed upon them of determining whether they are ‘fit to practise’ when there is no evidence they pose a risk to those they care for and support. The Consultation argues that it ‘will not treat all people who are ill or have a certain type of illness or disability in a different way from everyone else. We would argue that this cannot be the case by dint of the fact that we are, through the Codes, expecting individuals who for instance live with mental health issues (and are not ill), as different from others and thus potentially in a discriminatory manner as defined by the Equality Act. We are also not convinced that the enactment of the current proposals assist the SSSC in

 

 

meeting its Public Sector Equality Specific duties under the Equality Act. How does the proposed action assist in ‘advancing equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it;’? The Duties also place a requirement on positively contributing to the creation of a more equal society through advancing equality in all their policies. We believe the proposals risk that duty.

The Consultation narrative notes that responses will vary from case to case and it is this very subjectivity in determining the extent to which a disability or illness or health condition impacts on ability to meet the Codes which places employers in a challenging situation and places the worker in a potentially discriminatory stance. At best we request much greater clarity especially in relation to assisting a worker to determine for themselves whether or not they are required to inform their employer and/or SSSC.

Specific responses:

 

Q1:

 

It is clear what applicants must declare but we are concerned that being dismissed on the grounds of health by one employer may not be grounds for being unable to work in social care. We believe that this requirement risks current equality and employment legislation and would require clearer evidence that this is not the case.

Q2.

 

Again asking an individual whether they have a condition that impact on their ability to provide safe and effective care is potentially discriminatory and subjective. Who is to determine whether some conditions affect and some do not? Before I commence a career in care how would I know what ‘safe and effective care’ is and how would I be able to adequately determine whether any health condition negatively affects that? Although there will not be a ‘list’ we fear that over time such a ‘list’ will develop in practice.

Q3.

 

It is clear.

 

Q4.

 

Again whilst this is clear what are the boundaries of such alerting? If one is experiencing depression for instance after a bereavement is that something requiring an alert? If one breaks a leg in an incident, does that require an alert? Who determines whether or not a condition is being ‘managed’? and by whom? So therefore we are not clear about this requirement.

 

 

Q5/6.

 

We have especial concerns at the level of expectations being placed on employers.

 

At recruitment the employer is reliant upon an applicant fully disclosing a health condition and having knowledge of the extent to which it may impact on their ability to undertake a role. This places additional onus and pressure upon an employer and we are not clear what the consequences may be for the employer if a registrant fails to disclose all health issues. Equally we are not clear how requesting such information relates to the prohibitions on health related questions in the Equality Act and associated employment best practice.

What are the thresholds for medical capability for doing the job? An employer has responsibility for making reasonable adjustments to ensure somebody who may have additional workplace needs can enter and stay in an organisation. How does this relate to the proposed approach?

Competence: Q.7.

The process for telling SSSC about conduct issues is clear and unchanged and we welcome this. We are concerned that the Consultation has not fully described how conduct will relate in the future to fitness to practise especially as there is a stress on moving away from conduct approaches.

There is a reasonable clarity on the grounds where competence must be referred but employers would require reassurance that they are not exposing themselves to legal action by referring an individual to SSSC where an investigation has not commenced and where they (the employer) have not concluded any investigation and arrived at a decision re competence.

Q8/9.

 

Our members are extremely concerned at the level of scrutiny and requirements placed upon them as employers to make decisions about medical and health competency and at what points they are required to refer. We do not believe the follow chart and associated statements give sufficient guidance or details how approaches relate to current employment practice.

Q 10

 

This is clear.

 

 

Q11.

 

See above comments.

 

Q12.

 

We have considerable concerns over acting on the health of current employees as has been articulated above. Unfair dismissal on the grounds of medical capability could be catastrophic to an organisation both in terms of reputation and resource. This would automatically apply if a tribunal felt that procedural fairness was not followed or was compromised. Our members are very concerned that the vague, subjective nature of ‘fitness to practise’ compromises procedural fairness.

General comments

 

There are additional observations we would make:

 

Scottish Care represents many hundreds of providers many of whom are small and medium care enterprises who do not have in-house human resource staff or organisations. We are concerned that the changes towards a fitness to practise model will add a considerable amount of additional work and responsibility upon these already stretched organisations.

We are aware that were these new procedures to be introduced there would at the outset be a considerable amount of change to recruitment and management practices.

We would be like to know if there will be any assistance, e.g., by means of a helpline for employers or indeed workers struggling with fitness to practise issues. Some support mechanism would greatly assist both employers and workers especially in the early implementation of any changes.

 

Employers are very well aware of the time consuming nature of employment processes and of the imperative of timely action and intervention, (e.g. legal response following a disciplinary procedure) which are tight and must be adhered to (otherwise the process could be deemed procedurally unfair).  When you consider that dismissing on the grounds of medical capability is one of the most complex, lengthy and difficult of all HR activities, will ‘fitness to practise’ compromise a safe and fair decision being made?

 

We are very concerned about how current employment practice and legal requirements will relate to the fitness to practise model, especially in relation to employment law procedural fairness requirements. An employer is clearly and unequivocally responsible for employees and has to make decisions and are legally responsible for them.  Where does liability sit, with SSSC or with the employer in a ‘fitness to practise’ challenge? Our members are extremely uneasy about situations where their actions, whilst in accordance with Fitness to Practise procedures would be deemed to have acted against procedural fairness in employment terms. We need clarity on this as a matter of urgency.

 

 

In conclusion therefore, Scottish Care warmly welcomes the changes made to the vast majority of the Codes of Practice. We do, however, wish to convey our very real concerns about elements of the move to a ‘fitness to practise’ approach. These concerns have been detailed throughout the document. Moving forward we will be happy to work with colleagues to ensure the requirements of the Regulator are addressed in a manner which meets the concerns of employers and workers alike. The key consideration is to have in place Codes of Conduct that are fit for purpose, add protection to those who use services and can be readily understood and applied by those who have to use them.

 

 

January 2016.