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Publication - Research Publication

National health and care standards: consultation analysis

Published: 28 Apr 2017
Part of:
Health and social care, Research
ISBN:
9781786529206

Full analysis of responses to the consultation on new national care standards.

116 page PDF

997.4kB

116 page PDF

997.4kB

Contents
National health and care standards: consultation analysis
Annex 2: Detailed comments relating to each Standard

116 page PDF

997.4kB

Annex 2: Detailed comments relating to each Standard

Where respondents submitted clear and substantive comments relating to individual descriptive statements, these were extracted and have been summarised in the tables below. There has been no attempt to weight or judge these comments, which may be views shared by many respondents, or the view of just one individual, but nevertheless are useful for consideration in the final editing of the Standards.

Table 1

Detailed comments relating to individual descriptive statements supporting Standard 1

Statement

Detailed comments

Dignity and respect

1.1 I am accepted and valued whatever my needs, disability, gender, age, faith, spirituality, mental health status, background or sexual orientation.

  • Adopt the protected characteristics list from the Equality Act 2010.
  • Insert "beliefs" before "spirituality".
  • Omit the list altogether here and elsewhere. Not needed.

1.2 I am not discriminated against in any aspect of my care and support.

  • Prefer to see the statement presented in active terms and referring to human rights, rather than individuals passively being discriminated against.

1.3 I am supported and cared for using a positive and understanding approach, even if my behaviour is challenging to others.

  • The term "even if my behaviour is challenging to others" was viewed as subjective and value-laden. Alternatives which were suggested included replacing it with "behaviour that challenges"; or taking out the reference to behaviour - "I am supported and cared for using a positive and understanding approach at all times".

1.4 If I require intimate personal care this is carried out in a dignified way, with my personal preferences respected.

  • All care should be carried out in such a way.
  • Will this allow for preferences for a male or female carer to be respected?

1.5 If I need support managing my money and my personal affairs, I am able to have as much control as possible and my interests are safeguarded.

This statement attracted no substantive comment.

1.6 If I am being supported and cared for in the community, this is done discreetly and with respect.

  • This should apply if the person is cared for in residential/care settings too.
  • This is a welcome element of this Standard.

Compassion

1.7 I experience encouragement and warmth and my strengths and achievements are celebrated.

  • "and warmth" considered to be subjective.
  • How can "celebrated" be measured? Change to "recognised".

1.8 I get the most out of life because the people and organisation who support and care for me have an enabling attitude and believe in my potential.

  • Suggestion made that 1.8 is merged with 1.7.
  • Suggestion made that 1.8 could usefully be moved to come under Standard 4.
  • "enabling attitude" is open to interpretation.

1.9 I am supported to discuss changes in my life, including death or dying, this is handled sensitively and my wishes and choices are respected.

  • Perhaps better under Standard 2?
  • Need to mention Anticipatory Care Plan.
  • Not appropriate for early years' children. Add "where appropriate".
  • Replace "handled" with "approached".
  • What would happen if the wishes and choices included assisted suicide?

1.10 If I experience care and support in a group, the overall size of that group is right for me.

This statement attracted more comment than others.

  • Group size that is right for me was considered to be subjective.
  • Some settings may not have provision for meeting the needs of all service users regarding group size.
  • Size of group is not the only factor of importance. Composition of group is also significant.

Be included

1.11 I am recognised by people who support and care for me as an expert in my own experiences, needs and wishes.

  • The word "expert" is not appropriate for early years' children.
  • The statement needs to take account of the mental capacity of the service user.
  • Could go further with reference to self-directed support in which personal plans are composed collaboratively between service user and others.
  • Should be reference to the need for the service user to have access to information, on which to base choices.
  • Should be mention of recognition of advocate/nominated representative of service user.

1.12 I am encouraged to take part in everyday tasks to help the running of the service if I choose to.

  • This will apply in some settings more than others.
  • Not likely to apply in hospital settings; A&E; mental health; secure settings.
  • Could be health and safety issues in applying this.
  • Expected rather than encouraged in settings such as school care accommodation.
  • If service users are paying for services, they may consider this inappropriate.
  • Replace "tasks" with "activities".

Responsive care and support: Assessing my care and support needs

1.13 My emotional, psychological and physical needs are assessed by a qualified professional at an early stage, regularly and when my needs change.

  • "Qualified professional" needs further definition.
  • Perhaps replace with "suitably qualified" or "appropriately qualified".
  • Local support agencies may not have access to "qualified professionals".
  • The statement generally needs to reflect that needs change and response should be flexible to accommodate this.
  • Add "spiritual needs" to the list.
  • Add "cognitive, social and vocational" needs to the list.
  • Add "educational needs" to the list.
  • Define "regularly".

1.14 My care and support is right for me because I am fully involved in my assessment.

  • This does not take into consideration the capacity or age of the service user. Add, "where appropriate".
  • "because" is perhaps misleading. This incorrectly assumes that because I am fully involved, my care and support will be right for me.
  • What will happen if there is a difference in view over what care and support is right for me?

1.15 If I have a carer, their needs are assessed and support provided.

  • Clarity required on whether this refers to a formal or informal carer assessment, that is, a compulsory or voluntary arrangement.
  • Carers may choose not to have their needs assessed and this should be acknowledged.
  • Not all services providing care can offer carer assessments.

1.16 If the care and support that I need or choose is not available or delayed, the reasons for this are explained to me and I can get help to use a suitable alternative.

  • This has significant implications - what if there is no alternative?
  • Clarity is required in order to manage levels of expectation. Add "if available"?
  • Who defines "suitable alternative"?

Responsive care and support: Experiencing care

1.17 I am supported to live in my own home if this is possible for me.

  • The concept of "home" may not be clear-cut, e.g. foster home; birth home; care home.
  • The emphasis on living at home may be misplaced. Whilst it may be possible and appropriate in some cases, this may not be the preferred choice for others. The choice to live somewhere else can be positive, not negative. Could add, "and if this is where I want to be".
  • Needs greater realism - a person cannot stay at home regardless of risk or cost ( e.g. some people with dementia).
  • Replace "my own home" with "place of my choice".
  • Not relevant for very young children.

1.18 I am supported to manage my own care and support if this is what I want.

  • Add "and if it is safe to do so".

1.19 I can access technology and other specialist equipment so I can be independent, including to call assistance and manage my own health and wellbeing.

  • Add "my own specialist technology where required" to recognise the increased uptake of smart devices.
  • This could be very costly. Example given of blind and partially sighted people, for whom assistive technology can be expensive.
  • Could raise expectations which cannot be fulfilled.
  • Could be misinterpreted by sectors such as young people whose use of some forms of technology may be inappropriate.
  • Access to technology may not be appropriate to service users in prisons.

1.20 I fully participate in developing and regularly reviewing my personal plan.

  • Need to define a personal plan.
  • Change to "I am supported to participate in…"
  • Add "where possible".
  • Should recognise that other significant people such as family members will be involved in this.
  • The timeframe for reviewing should be more closely defined.
  • Replace "fully" with "meaningfully".

1.21 If I have particular needs, due to a health condition, age or circumstance, I am informed about the care and support I should experience, (or care plan) that clearly sets out my needs and wishes and how these will be met.

  • The wording is clumsy and could be rephrased to make the meaning clearer.
  • People should have access to the care plan and this should be acknowledged in the statement.
  • Is a care plan different from a personal plan?
  • "Wishes" may not be practical or safe.

1.22 If I, or others, have concerns about my health and wellbeing, these are acted on and appropriate assessments and referrals are made.

  • Qualify "others". These should be appropriate others.
  • Who decides what is "appropriate"?

1.23 My needs, as agreed in my personal plan, are fully met, and my wishes are respected.

  • This may not be met due to circumstances outwith providers' control.
  • "Fully" met may be overly ambitious.

1.24 I know how organisations can support my wellbeing and I am helped to contact them if I wish.

This statement attracted no substantive comment.

1.25 I experience proper planning and am helped when using a new service, or when I move between services.

  • What is meant by "proper planning"?
  • Add a sentence to emphasise that all relevant information about me accompanies me promptly when I move between services.
  • Suggestion made that a new section is devoted to transitions between services.

Wellbeing: general

1.26 I am in the right place to experience the care and support I need and want.

  • What does "right place" mean? What if the person is sleeping rough; in prison?
  • Replace "right place" with "appropriate place".
  • Remove "and want".

1.27 I am helped to access the health care that I need and any other public services.

  • Change to "I am supported to…"
  • Could this be combined with 1.24?
  • Why does this mention other public services without explanation?
  • Need to acknowledge that other significant people, such as relatives, may have input on what is needed.

1.28 I am supported to make healthy lifestyle choices that are right for me.

  • Viewed as patronising. People should be allowed to make unhealthy lifestyle choices if they wish.

1.29 If I need help with medication, this is done safely and effectively.

  • Should be more rigorous.
  • Needs to refer to regulated/prescribed medication.
  • Some medication regimes are very complex and this should be acknowledged.
  • Should refer to maintaining privacy as medication can be a confidential issue ( e.g. HIV patients).

Wellbeing: eating and drinking

  • General views about this section were that it referred more to care home settings than others, such as home settings.
  • It appears to assume that people can eat without assistance.
  • The statements were perceived to be relatively vague overall.
  • The section needs to make explicit mention of home environment and support with food shopping.
  • An extra statement is required along the lines of, "I can have meals and snacks at an appropriate time that is acceptable to me".

1.30 I can choose suitably presented, healthy and nutritious meals and snacks, including fresh fruit and vegetables if this is right for me.

  • "healthy" as a concept is not clear-cut with its meaning dependent on a variety of factors and circumstances.
  • When would nutritious meals and snacks not be "right for me"?
  • Does this statement fit with 1.33?
  • Depends on age and stage. Perhaps the emphasis here should be on educating on nutrition for some people.
  • People should be permitted to choose whatever diet they wish.
  • What is the relevance and meaning of "suitably presented"?

1.31 I can enjoy unhurried snack and meal times in a relaxed an atmosphere as possible.

  • This may not be practical in some settings.
  • May run contrary to food hygiene and health and safety requirements, if food is left out for lengths of time in temperatures which may render it unsafe to consume.

1.32 I can enjoy snacks and meals alongside other people using and working in the service if appropriate and I want this.

  • Drafting considered clumsy.
  • Remove, "if I want this".

1.33 I enjoy meals and snacks which meet my cultural and dietary needs.

  • This should aim to reflect a proportionate approach.
  • Vegetarian diets should have explicit mention.

1.34 If I experience care and support in a group, I can choose to make my own meals, snacks and drinks, with support if I need it.

  • Some care homes may not have their own food preparation facilities.
  • This should refer to contexts outwith groups too.
  • Some care home residents would not be safe to do this.

1.35 I can drink fresh water at all times.

  • Too specific. Why not refer to unlimited fluids instead, to encompass the range of fluids which the person may prefer.
  • Some people will be "nil by mouth" and this should be acknowledged, perhaps adding, "if this is right for me".
  • Some people need assistance drinking, e.g. drink through a tube.

Wellbeing: Activities

1.36 I can have an active life and fulfil my aspirations by being supported to take part in activities that are important to me, in the way I like.

  • This should be set within the context of managing risk.
  • May not be possible due to staffing levels.

1.37 I am supported to participate in a range of recreational, social, physical and learning activities.

  • Add "vocational" and "spiritual".
  • Add access to outdoor space.
  • Add "if I wish" or "opportunities are there for me to be supported…"
  • Add reference to participation in social media activities.

1.38 If I experience care and support in a group, or in my own home, I can choose to do creative and artistic activities every day, such as art, crafts, music, drama, and dance.

  • Too specific regarding activities. By including these, others are excluded.
  • Might be impractical to offer such choice every day.
  • This is already covered by 1.36.
  • May have financial implications.

1.39 I am supported to participate fully as a citizen in my local community.

  • "Community" needs further explanation - this might be a geographical community, or a community of interest.
  • Could include encouragement to participate in employment community.

Wellbeing: Protection

  • Generally missing from this section is reference to the human rights requirement to take practical steps to address situations where there is real and immediate risk to life (Article 2, ECHR).
  • Need something on staff training.

1.40 I am listened to and taken seriously if I have a concern about the safety and wellbeing of myself or others.

This statement attracted no substantive comment.

1.41 I am protected from all forms of abuse and exploitation.

  • Use the word "harm" rather than "abuse". This fits with the Adult Support and Protection (Scotland) Act 2007.
  • Needs to reflect that people do not always make choices which are in their own best interests in this context.

1.42 I am helped to develop personal resilience and ways to keep myself safe.

  • "Personal resilience" is not a term which most people will understand.

1.43 If I might harm myself or others, I know that people have a duty to protect me and others, which may involve contacting relevant agencies.

  • This is information rather than being part of a Standard. Perhaps it should be rephrased to state that people will be informed if other agencies are contacted.
  • Not sure if needed.
  • Perhaps need to mention that minimum restraint may be used in circumstances where people are in danger of hurting themselves or others.

1.44 The people who support and care for me are alert and responsive to any signs that I may be unhappy or at risk of harm.

  • Should this go further to state that the people who support and care for me will know how to respond to these signs and take action?
  • "Unhappy" is vague and too generic for this context.

Wellbeing: for children in their early years

  • Some service users and participants in engagement events considered that these statements would be better mainstreamed across the other statements rather than meriting their own section.

1.45 I have fun as I develop my skills in understanding, thinking, language, literacy, numeracy, investigation and problem solving.

  • Whether someone has "fun" depends on their personal preferences. The statement implies that all education is fun.
  • These should be tailored to different ages and stages.

1.46 I can take part in pretend play and storytelling.

  • Already covered in Curriculum for Excellence and not needed here.
  • Replace "pretend play" with "imaginative play".

1.47 I spend time outdoors every day and this is a significant part of my day if I attend full-time, where appropriate.

  • Wording is cumbersome.
  • Should not apply just to those attending full-time.
  • Could apply equally to other settings, e.g. for people with dementia.

1.48 I can regularly explore, and be creative in, a natural environment.

  • What does "natural environment" mean?

1.49 If I attend all day and I am under school age, I can if needed have a sleep on a sleeping mat or bed with my own bed linen.

  • May not be realistic.
  • Add "where appropriate".

1.50 I can choose to grow, cook and eat my own food, if possible.

  • Depends on many variables, including age and stage.
  • Too specific.
  • Not realistic.

Table 2

Detailed comments relating to individual descriptive statements supporting Standard 2

Statement

Detailed comments

Dignity and respect

  • Another statement was suggested, "I can decide who takes part in planning and reviewing my care and support".

2.1 I am empowered and enabled to be as independent, and as in control of my life as I want and can be.

  • Replace "want" with "choose".
  • Insert "supported" after "empowered".
  • Who decides what I can be?
  • Not always applicable in some settings, for example some young people are in care because they have not respected boundaries.
  • Why not state simply, "I am empowered to be as independent as I want to be".
  • Add "…and I receive appropriate support, rehabilitation and training needed to enable me to achieve/sustain independence".

2.2 I receive and understand information and advice in a format or language that is right for me, including using independent advocacy if I want or need this.

  • This could usefully be divided into two separate statements or sentences, one about receiving information and the other about using advocacy.
  • More specificity required on "information and advice".
  • Need something on access to translation services.
  • Add, "or another representative" after "advocacy".

2.3 I am as involved as I can be in agreeing any restrictions to my independence, control and choice and these are justified, uphold my human rights and are kept to a minimum.

  • Insert another few words to say that restrictions will be reviewed regularly.
  • Tensions may emerge between what is agreed for an individual and what is best for the community within which they are receiving care.
  • Need to be explicit that the least restrictive option will be adopted.
  • Change "uphold" to "respect".
  • Need to clarify that restrictions will be in line with Mental Welfare Commission guidance.
  • Reference should be made to the particular circumstances of young people in secure care.

Compassion

2.4 I am supported to communicate in a way that is right for me, at my own pace, by people who are sensitive to me and my needs.

  • Communication is a key aspect of high quality care and merits a Standard in its own right.
  • Include reference to professionals having to demonstrate that they have communicated in a way which is appropriate for the person and that the message has been understood.
  • Need something on staff training to use equipment aimed at addressing sensory loss.
  • The wording is confusing. Change to, "I am supported to communicate in a way that is right for me".

Be included

  • An overarching statement is required referring to checking understanding and not simply conveying information.
  • The role of the corporate parent should be included across this section.
  • This generally appears more for the parents/carers than the service users.

2.5 I can access translation services and communication tools where necessary and I am supported to use these.

  • This should cross-cut all Standards.
  • Expand to include reference to specific information formats such as Braille, easy-read, and so on.
  • Could be merged with 2.4
  • Add "Communication support is explored with me to identify tools or aids that are appropriate for me".
  • Add that services interacting with me may also need to access translation services.
  • Need to refer to sustained access to such tools.

2.6 I have time and help to understand the planned care, support, therapy and intervention I will receive, including any cost, before deciding what is right for me.

  • Not specifically relevant to children under age 16.
  • Not relevant to those in secure care.
  • Transparency of costs merits its own Standard.
  • If this refers to service user agreements, then this needs to be stated.
  • This should be moved to "Responsive Care and Support".

2.7 If possible I can choose who will provide my care and support and how this will be provided. If possible, I can visit the service before deciding and/or meet the people who

  • Statement incomplete due to typo.
  • Likely to raise unrealistic expectations.
  • Not always possible to arrange visit beforehand, e.g. in context of hospital admission for a procedure.
  • "If possible" allows wriggle room.
  • For whom is it "possible"?

2.8 If there is limited choice, this is explained to me so I understand the reasons for this.

  • How will this be enacted?
  • Limited choice cannot be resolved by providing reasons. Not viewed as helpful unless accompanied with something about what is going to happen to address the limited choice.

2.9 If I need or want to move on and start using another service, I will be fully involved in this decision and helped to find a suitable alternative. If I am moving from a service for children to one for adults, I am helped with this transition.

  • This is worded as if this applies largely to children, but it applies more generally to adults too.
  • The person may not be able to be fully involved - e.g. if anaesthetised during the transition to another care setting.
  • This is often influenced by capacity of the person which should be acknowledged.
  • Use the word "supported" through the transition as this is more respectful and empowering.
  • Add "…and am provided with a choice of services".
  • Add, "If I move on from a service I should be able to continue relationships with those who provided my care and support, if this is safe and I decide I want to do this".
  • Omit "need or want to".

2.10 If I am unable to make my own decisions, the views of those who know my wishes, my carer, advocate or representative will be sought and taken into account to establish what my wishes would be.

  • Insert "legal" before "representative".
  • Give examples of who "representatives" can be.
  • Mention Anticipatory Care Plan.
  • Needs to mention specifically parents' and carers' involvement.
  • What does "taken into account" mean?

2.11 If I have expressed my own views and choices, these will be respected if I lose capacity.

  • This raises ethical issues as people's preferences may change even amongst those who have lost capacity and have an advanced statement in place.
  • Need to explain the term, "lose capacity".
  • Should this be under the "Dignity and respect" principle?
  • Add a record of my views need to be "… easily accessible and kept up-to-date".

2.12 I am able to resolve conflict, negotiate boundaries, agree rules and build positive relationships with other people as much as I can.

  • Does "all relationships" include staff?
  • Replace "able to" with "supported to" or "enabled to".
  • Could usefully be split into two separate statements, one on conflict and rules and the other on building relationships.

Responsive care and support

2.13 I am supported to manage my relationships with my family, friends and/or partner in a way that suits my wellbeing.

  • Too vague and ambiguous. Could be open to interpretation.
  • Add "carer" to the list.
  • Need to set firm parameters to ensure the inclusiveness of this statement to encompass LGBT and others.

2.14 If I am living in a care home, I can receive visitors in private and have a friend, family member or partner to sometimes stay over in the home.

  • Could be difficult to implement in all settings, e.g. childcare; criminal justice.
  • Could include children and young people by mentioning them specifically and adding, "…if this is assessed as being safe for me and for the other people who live with me".
  • Not just relevant for care homes, but also for other settings such as hospices, private psychiatric hospitals.
  • This could come under Standard 5 as it relates to premises.
  • Raises costs and safeguarding issues. Who will be charged for this?
  • Will depend on availability of accommodation in settings.
  • Could pose risk to others, e.g. exceeding numbers for fire regulations.
  • Appears aspirational rather than achievable.
  • Add "… my family and friends are made as welcome as possible, while they recognise that this is a community and other people live here".

Wellbeing

  • Each of the statements in this section should have caveat, "If I am able".

2.15 I make choices and decisions about all day to day aspects of my life, including managing my own money, how I dress, what I eat and how I spend my time.

  • The list should be left out as it is limiting.
  • Add "what I drink".
  • This is open to interpretation and does not acknowledge that people make choices sometimes not in their best interests.
  • Replace "choices" with "preferences".
  • Overlaps with 2.1.
  • Needs to be combined with 2.16.
  • Not generally applicable in secure care settings.
  • Insert "informed" before "choices".
  • This does not recognise capacity issues. Add, "supported to".

2.16 I make informed choices and decisions about risks I take in my daily life and am encouraged to take positive risks which enhance the quality of my life.

  • What is "positive risk" taking?
  • Who will determine what acceptable risks are?
  • This could place professionals in breach of their Code of Professional Conduct.
  • Professionals are likely to err on the side of caution - staff would need the support of their organisation to implement this.
  • Risks taken should be documented and the documentation made accessible.
  • Replace "encouraged to" with "able to" to reflect self-directed support.
  • Need to balance individual risks with the impact on others in the setting.
  • Not suitable for all settings - e.g. school care accommodation.

2.17 I am helped to understand the impact and consequences of risky and unsafe behaviour and decisions.

  • Subjective. What professionals regard as risky and unsafe may not chime with those which the individual regards as such.
  • Replace the statement with, "I am able to discuss the benefits and drawbacks of things I would like to do, and reach a decision about whether or not I will do it. If I am able to do it, I am supported to do so as far as it is possible".
  • Replace statement with, "I am helped to understand the impact and consequences of behaviour and decisions that are considered to be risky and unsafe".

Wellbeing: For children in their early years

  • Section is unnecessary. Could be mainstreamed into the general Standards.
  • Agree with this section.
  • Appears more for younger children than older.

2.18 I have the right to control my own play in the way that I choose.

  • This appears contradictory to 2.21.
  • Too absolute - need to consider the rights and wellbeing of other children in the same setting.
  • Younger children need more direction and guidance - this statement is too open.
  • Does not reflect best practice where a balance is expected between child-led and adult-led organisation and activity.
  • Replace "play" with "activities" and incorporate with 2.15.

2.19 I can freely access a wide range of experiences and resources suitable for my age and stage, which stimulate my natural curiosity, learning and creativity.

This statement attracted no substantive comment.

2.20 I enjoy extended play and activities that develop my confidence, self-esteem and imagination.

This statement attracted no substantive comment.

2.21 I can play flexibly and creatively using open-ended and natural play materials and I experience a balance of organised and freely chosen activities.

  • Insert, "and learn" before "flexibly". Concern that there is a lack of focus on learning in the early years' sections of the Standards.
  • There is an implication of choices of activity at all times, which is clearly not what is intended.
  • Could be adapted for broader range of service users, such as people with dementia ( e.g. by replacing references to "play" with references to "recreation").

Table 3

Detailed comments relating to individual descriptive statements supporting Standard 3

Statement

Detailed comments

Dignity and respect

  • Needs some reference to individual beliefs and culture.
  • Needs reference to safe and effective care.

3.1 I experience people speaking and listening to me in a way that is courteous and respectful, with my care and support being the main focus of people's attention.

  • Add something about people communicating in a way that the service user understands the message.
  • People have different values and understanding of what is courteous and respectful, for example someone with autism may perceive this differently to others.
  • Simplify this, "People speak and listen to me in a way that…."
  • Replace with, "Workers listen to me and make sure I am involved in making changes".

3.2 If I experience care and support at home, people are respectful when they visit my home.

  • Simplify this, "People providing care and support are respectful if they visit me at home".
  • This should be the case whether at home or elsewhere.
  • Should be expanded to include respect for my family, friend and other carers.
  • Should expanded to cover my possessions within my home.

3.3 I am supported and cared for by people who challenge discrimination and bullying and stand up for me and my rights if I need this.

  • As currently phrased, this puts the service user in a passive light. Could be more empowering if drafted to say that the person will be supported to stand up for themselves where appropriate.
  • Could be split in two to reflect standing up for oneself and someone else doing this on your behalf.
  • Add that if I behave in this way I expect to be challenged.
  • Could be combined with 3.21.

3.4 I am treated as an individual by people who get to know me and understand me, my lifestyle and choices.

  • Insert "and respect" after "know me".
  • Does not fit well with primary care.

Compassion

3.5 I am greeted warmly by people, and, if I do not know them, they introduce themselves.

  • "Warmly" is vague and will be difficult to measure.
  • Replace "warmly" by "positively".
  • Who are "people"?
  • Replace statement with, "People who do not know me will introduce themselves".
  • People will need to introduce themselves every time for people with dementia.
  • Need to review this to make it appropriate for people with autism.

3.6 I experience a warm atmosphere because people who support and care for me have good working relationships.

  • Are these relationships with me or with others in their organisation, or across organisations?
  • What is meant by "warm atmosphere"?
  • Could be removed.
  • Good relationships may not necessarily result in my experiencing a warm atmosphere.

3.7 I can build relationships with the people who support and care for me in a way that we all feel comfortable with.

  • This raises issues about professional boundaries and Codes of Conduct.
  • May blur boundaries as open to interpretation.
  • Insert "appropriate" before "relationships".
  • For homecare workers, this may not be realistic.
  • Delete "in a way that we all feel comfortable with".

3.8 I experience warmth, kindness and compassion in how I am supported and cared for, including physical comfort when appropriate for me and the person supporting and caring for me.

  • Mixed views on including physical comfort - some respondents welcomed the explicit inclusion of this, others considered it open to interpretation and possible abuse.
  • Would need to be supported by clear guidance for workers.
  • Why not spiritual or emotional comfort too?
  • Finish sentence at, "cared for".

3.9 I am helped to feel content and at ease by the people who support and care for me.

  • May be inappropriate for people with dementia.
  • Already covered by 3.8.
  • Perceptions of "feeling content" cannot be controlled by workers.
  • Replace by, "I should be encouraged to discuss the things that may make me content".

Be included

  • Need reference to common aids which help inclusive communication.

3.10 I know who provides my care and support on a day to day basis and what they should do. If possible, I can have a say on who provides my care and support.

  • This does not reflect the realities of provision of care which will involve shift workers, emergency workers and rotation in workforce.
  • Add that I know how to make contact with them.
  • Not relevant for short-stay hospital settings.
  • Does this refer to knowing individual staff or knowing the provider organisation?
  • Delete "if possible".
  • What does "knowing" constitute?

3.11 I can understand that the people who support and care for me when they communicate with me.

  • Could have implications for recruitment of people who speak/do not speak English as first language.
  • Service users will represent a range of ethnicity and language which may not be able to be matched by workers.
  • There could be profound communication impairments and difficulties for the worker to overcome.

3.12 I am supported to be part of the local community, to enjoy family life and to develop interests if this is what I want.

  • Difficult to achieve in certain settings such as prisons, short term transitional arrangements and emergency-based services.
  • Change "local" to "my".
  • Challenging if scheduled worker visits do not coincide with local community activity.
  • Could require additional resourcing.

3.13 I experience appropriate and consistent boundaries, guidance, and care.

  • What does this mean?
  • Include that I have an input in setting these.
  • Add that these are mutually agreed.
  • "Boundaries" is concerning. Need guidance on what is age appropriate.
  • Some adults living at home have full capacity to make their own boundaries.
  • Should this not refer to consistent approaches to boundaries rather than consistent boundaries?

Responsive care and support

  • This section raises issues about relevance for sessional staff and high turnovers of staff.

3.14 My needs are met by people who are trained, competent and skilled to support me, and able to reflect on how they do that, and follow their professional codes.

  • Service users are not likely to be aware of the professional codes.
  • Will all workers be reflective practitioners? How will this be assessed?
  • Would the professional codes apply to all settings? What about foster parents/unqualified and unpaid carers/interpreters?
  • Add, "where available" at the end.
  • Instead of "trained" state "appropriately qualified".
  • Delete the statement - covered by 4.19.
  • People providing care also need to be knowledgeable ( e.g. about dementia; HIV).

3.15 I am supported by people who understand my needs, choices and wishes.

  • Typo in "understand".
  • Covered by 3.14 and 3.4.
  • Insert, "and respect" after "understand".
  • Add, "and my religious or personal beliefs".

3.16 I am supported sensitively by people who anticipate issues and are aware of and plan for any known vulnerability or frailty.

  • Rather than "anticipate issues" state that people "take circumstances into account".
  • There may be vulnerability and frailty which cannot be planned for.
  • Covered by 3.14.

3.17 My needs, wishes and choices are met because I am supported by the right number of people with the right skills and experience.

  • What is the "right number"? Who decides this?
  • The previous Standards set out clear expectations on ratios and this is felt lacking here.
  • Important that people have the right attitude as well as the right skills and experience.
  • Providers address needs but can only take account of wishes and choices.
  • Replace "right" with "relevant and appropriate".
  • Add, "….and which fits with the support provided by my carer".
  • Need illustrations of how this will be assessed.
  • Add, "at the right time".

3.18 People have enough time to support and care for me and to speak with me.

This statement attracted more comment than others.

  • Viewed as aspirational but not relevant in context of limited resources, short length of scheduled visits, limited staff, work pressures.
  • Could lead to challenges and complaints.
  • Dependent on resources.
  • "Enough" is vague.
  • Add "and listen to me".

3.19 I am supported by people who respond promptly when I ask for help.

  • What does "promptly" mean? There will be different perceptions.
  • Replace "promptly" with "in a timely manner".
  • Dependent on resources.

3.20 My care and support is consistent and stable because people work together well.

  • Statement is not necessary.
  • Remove "stable".
  • What does "people" refer to? Unpaid carers? Multi-disciplinary teams?
  • Needs reference to record-keeping and sharing information.
  • Replace "work" with "communicate".

Wellbeing

3.21 I am supported and cared for by people who have a clear understanding of their responsibilities to protect me from discrimination, neglect, abuse and avoidable harm.

  • Replace "abuse" with "harm".
  • Remove "avoidable harm".
  • Entire workforce will need training in adult support and protection.
  • Duplicates 1.41.
  • How will this be evaluated?

3.22 I am helped to feel safe and secure in the area where I live.

  • Care services cannot be responsible for determining whether an area is safe.
  • Does this mean community/neighbourhood or home/care setting?
  • Implies geographical area. Replace with "environment".
  • Delete statement.
  • Should encompass an environment that enables active travel.

3.23 The people who care for me stimulate my interests and spontaneity.

  • "Spontaneity" considered an odd word requiring clarification.
  • Achieving this is likely to require one-to-one care which may not be available in some settings.
  • Outings require planning and cannot usually be conducted without planning.
  • How would this be measured?
  • Replace with, "I am provided with opportunities that encourage spontaneity and support me to develop interests".

3.24 People help me to extend my learning and development, and they ask open questions and involve me in genuine dialogue.

  • Appear to be two different aspects to this statement, which could be separated.
  • "Open questions" is too specific.
  • Raises expectations which may not be fulfilled, for example, home care workers in a 15-minute scheduled visit.
  • Finish statement at "development".
  • Should reference wide value of learning and development and involvement in dialogue (Convention on the Rights of Persons with Disabilities (Article 25(1)).

Table 4

Detailed comments relating to individual descriptive statements supporting Standard 4

Statement

Detailed comments

Dignity and respect

4.1 I am confident and experience that my human rights are central to the organisation that supports and cares for me, and that it helps to tackle inequalities.

  • The statement would be better split into two parts dealing with human rights and tackling inequalities, respectively.
  • How will people know what their human rights are?
  • Add another statement: "I am helped to understand what my rights are and how I can get help and support to realise them, including independent advocacy".
  • Add reference to empowering people to understand their human rights.
  • Take out "and experience".
  • Jargonistic; clumsy; unclear.
  • Needs to be more specific about which inequalities are to be tackled.
  • "Challenge" inequalities rather than "tackle" them?
  • Should make mention of workforce human rights being central too.
  • Suggest rewording, "I believe that the organisation that supports and cares for me always puts my human rights and best interests first. I also believe that the organisation does all it can to challenge inequalities".
  • Add that I am confident that the care and support I receive is in line with Scottish legislation.
  • Appears to refer to a service rather than a group of services which make up care in a care setting.

Compassion

  • These statements may sit better under Dignity and Respect.
  • Need reference to attending to and recognising emotional and psychological needs.

4.2 I receive an apology if things go wrong with my care and support or my human rights are not respected and the organisation takes responsibility for its actions.

  • Simplify this to, "I receive an apology if things go wrong", or end the sentence at "not respected".
  • Insert "prompt" before "apology".
  • 4.3 should come before 4.2.
  • An apology in itself does not right wrongs. Ineffective if no action taken to put things right.
  • Unrealistic to expect an apology in a culture of liability and there may be valid reasons why things have gone wrong, for example, the service user may be the cause.
  • May be better to focus on achieving transparency and candour rather than seeking apology.
  • Also need to recognise that service users have responsibilities.

4.3 I use a service where all people are respected and valued.

  • Remove "all" to simplify.
  • How would the user know if this is being achieved?
  • Remove this. Not needed as it repeats the overarching principle of dignity and respect.
  • Perhaps add another statement, "I know what the organisation is called and what it does and the responsibilities of senior staff and who to contact for compassionate support".

Be included

  • This should recognise that some people do not wish to be included.
  • 4.4 - 4.7 unrealistic.
  • Needs reference to circumstances where person does not have capacity.
  • Needs to recognise that families, friends and other advocates may be involved too

4.4 I am informed of the organisation's aims and I can be involved in decisions about how it works and develops.

  • Change emphasis to encouragement, or given the opportunity, to be involved, if this is desired.
  • May not be workable in all settings, such as emergency and drop-in services.
  • Insert "meaningfully" before "involved".
  • Insert, "in a way I understand" after "aims".

4.5 I am actively encouraged to be involved in improving the service I use, in a spirit of genuine partnership.

  • Change "encouraged" to "empowered".
  • "..in a spirit of genuine partnership" appears an unnecessary add-on.
  • 4.5 overlaps with 4.6 and 4.10.

4.6 I give feedback on how I experience my care and support and the organisation uses learning from this to improve.

  • Amend to make this the providers' duty to be proactive in seeking feedback.
  • Add that the person needs to know what happened to the feedback after it was given. For example, "I am notified of all the changes which affect me as a result of the feedback I provided".
  • There may be an element of fear of retribution for those giving negative feedback.
  • Person may need to be supported to give feedback, and this should be added.

4.7 I can take part in recruiting and training people who provide my care and support if possible.

  • Not practical nor desirable in all settings. For example, would not work for short break respite; hospitals; clinics.
  • Children should not be involved in recruitment.
  • Businesses have business issues to consider when recruiting.
  • Does this refer to formal training or could informal training, ad hoc learning from each other about needs, be included?
  • Too ambiguous - what is meant by "if possible"?

4.8 I am supported to make use of relevant screening and healthcare programmes.

  • Add, "if I wish".
  • Seems out of place here. Perhaps better to include in Standard 1?
  • Almost a repeat of 1.27.

Responsive care and support

  • Some of the statements are not achievable and could lead to complaints.

4.9 I experience high quality care and support based on relevant evidence, guidance and best practice.

  • Add "… and legal requirements".

4.10 I am involved in shaping how my service can continually improve to meet everybody's needs, choices and wishes.

  • How does this differ from 4.5 and 4.6?
  • Perhaps examples would help.

4.11 I receive appropriate notice and I am involved in finding an alternative if the service I use plans to close.

  • There are two separate issues covered in this statement and it could be divided accordingly.
  • "Appropriate notice" is ambiguous. Replace with "sufficient" notice.
  • Replace with, "I am involved in finding an alternative if the service I use plans to close or my placement ends".
  • This could be moved to Standard 5.
  • Refer to the service no longer able to support my needs; or changing the type of service provided.

4.12 I am looked after in a planned and safe way, including if there is an emergency or unexpected event affecting the premises.

  • Replace "looked after" with "supported/assisted".
  • Change the end of the statement to, "..or if a change in my condition there is an appropriate anticipatory care plan with the equipment required to enact this. This plan is accessible by professionals who may be involved in my case".

4.13 I continue to experience stability in my care and support from people who know my needs, choices and wishes, if there are changes in the service or organisation.

  • Could be difficult to deliver if the service closes.
  • Insert "will" before "continue".
  • Add "or changes in location".
  • Similar to 4.14 - do not need both.

4.14 I am supported and cared for by people I know so that I experience consistency and continuity.

  • Not achievable due to nature of care provision with high turnovers of staff and use of agency staff.
  • People's needs change and they may need different forms of care provided by different people.
  • Person may not know the people providing care although they are providing consistency and continuity.
  • Add "where possible".

4.15 If I am supported and cared for by a team or more than one organisation, this is well co-ordinated so that I can experience consistency and continuity.

  • Need to refer to good anticipatory care planning and information that can be readily shared.
  • Who performs the "co-ordinating" role?

4.16 I know how to make a complaint or raise a concern about my care and support.

  • Could be strengthened by mentioning that some people may need help to do this.
  • Refer to access to independent advocacy or the help of a representative if required.
  • Should make explicit that there should be an explanation about the action taken in response to the complaint or concern raised.
  • Add, "I will be written to in a format I can understand telling me the outcome of my complaint".
  • Should refer to making compliments and positive feedback as well as complaints.

4.17 If I have a concern or complaint, I know this will be acted on without negative consequences.

  • Add that if the complaint is not upheld, "I will be provided with an explanation and if still not happy I can approach the Care Inspectorate".
  • Add "to me".
  • There could well be negative consequences arising, for example, if the person makes numerous complaints which impact on efficient service delivery.
  • Replace the statement with, "I can be confident that I can raise a concern or complaint about my service and this will be investigated without any negative consequences for me about raising the concern". Or, "If I have a concern or complaint, I know this will be taken seriously and dealt with in a fair and impartial manner without negative consequences for me. I will be supported to participate in this process and the result will be explained to me".
  • How will the service user know whether there were negative consequences arising from the concern/complaint?

Wellbeing

  • How will these statements be evidenced?
  • Need a statement on quality assurance and leadership.

4.18 I am confident that the service I use and the organisation providing it are well led.

  • Too vague. What does "well led" mean?

4.19 I am supported and cared for by people who have been appropriately recruited.

  • What does "appropriately" mean?
  • Add that people have been trained and supervised and supported.
  • Could replace 3.14.
  • Replace with, "I am supported by people who have received the necessary training to meet and respond to my needs".

4.20 I am supported to reach my full potential by people who are encouraged to be innovative in the way they support and care for me.

  • How would a service user know that people had been encouraged to be innovative?
  • Replace "by people who" with "an organisation which".
  • Need to refer to positive risk taking and proportionate risk management.

Table 5

Detailed comments relating to individual descriptive statements supporting Standard 5

Statement

Detailed comments

Dignity and respect

5.1 I experience an environment that is well looked after and attractive, with clean, tidy and well-maintained premises, furnishings and equipment.

  • Too broad and subjective.
  • Remove the word "attractive".
  • Add, "…where my particular needs are taken into account".

5.2 I can use an appropriate mix of private and communal areas, including an accessible outdoor space.

  • Outdoor space should be qualified with: well maintained; safe; secure (particularly for people with dementia).
  • Add "…and facilities to worship, meditate or reflect according to my belief or faith".
  • Insert, "safe and supported" before "private and communal.
  • May not always be achievable in some settings, such as hospitals with limited outdoor space.
  • Important to have this included as people need to be able to get away from the television.
  • Mixed views over specifying "private" areas with respect to children.

5.3 I can easily access a toilet from the rooms I use and I can use a toilet when I need to.

  • This needs to reflect the requirement for privacy of those who require incontinence products changed.

5.4 If I live in a care home, I have ensuite facilities with a shower and can choose to have a bath if I want.

This statement attracted much criticism.

  • Not universally achievable depending on age and design of building.
  • May raise unrealistic expectations.
  • Could have significant financial implications for providers.
  • Not desirable nor safe in some circumstances.

5.5 I have a secure place to keep my belongings.

  • Add "…in my room".
  • Add "…which I can access whenever I need to".
  • Add that I should be able to lock my room.
  • Add a reference to keeping medicines in a secure place in order to protect privacy.

5.6 If CCTV is used, I know about this and how my privacy is protected.

This statement attracted more comment than others.

  • CCTV is only one form of monitoring device, and the statement should be broadened to reflect this, e.g. "surveillance and monitoring devices".
  • Use of such equipment should be proportionate and based on legitimate reason. The statement should reflect this.
  • The impact on other staff and visiting friends and relatives should be taken into account.
  • Data protection and privacy regulations should be consulted prior to implementation.
  • The presence of CCTV appears incongruous with homeliness.

5.7 For children in their early years: if I wear nappies, there is a suitable area with a sink and some privacy for me to be changed.

This statement attracted more comment than others.

  • Too specific to children. This statement should apply to people of all ages who have incontinence-wear or nappies.
  • The word "nappies" can be embarrassing, even to small children who would prefer another term.
  • Not needed as covered by 5.19.
  • Replace with a more general statement, "I will be treated with respect and my dignity will be preserved at all times".
  • "Some privacy" is not sufficient; must be total privacy.
  • This must cater for LGBT needs too.

Compassion

5.8 I experience care and support in a homely environment.

  • "Homely" is a subjective and has different meanings depending on the context.
  • Better to express this in terms of an environment which is in-keeping with the preferences and needs of the person.
  • Not needed as 5.10 covers this.

5.9 I experience homely care and support in a service that is the right size for me.

  • Who determines what is the right size?
  • Vague.
  • Delete.

5.10 If I live in a care home, the premises are designed and organised so that I can experience small group living and an environment that is right for me.

  • May be difficult to achieve according to the definition in the glossary.
  • Depends on what space is available.
  • People may not want to experience small group living. Should focus more on what people prefer.

5.11 If I experience care and support in a group, I can use a cosy area with soft furnishings to relax.

  • What is meant by "cosy"? Replace this with, "informal"; "an area that feels comfortable".
  • There could be financial implications for providers.
  • Some people may want bland and neutral furnishings (people with autism were given as an example).
  • Combine this with 5.8.
  • Language could be perceived as condescending.

Be included

5.12 I experience a service as near as possible to people who are important to me and my home area if I want this and if it is safe.

  • Providers may not be able to influence this if they are not involved in decision-making over who is placed in their setting.
  • Specialist services may be centralised and not local.
  • Challenging in some rural areas.
  • Replace with, "I am able to choose the service that is best for me even if it is some distance from my current home".

5.13 The location and type of premises enable me to experience care and support free from isolation and for me to be an active member of the local community if this is appropriate.

  • What is "community"? There are different types of community, such as the community of people with autism.
  • Not all care homes are in residential areas with local communities.
  • Perhaps this needs to be split into two different issues: one relating to location; and the second relating to feeling valued as part of a community.

5.14 If I experience 24-hour care, I have access to a telephone, radio, TV and the internet so that I am connected.

This statement attracted more comment than others

  • Very important for some people to have access to the internet.
  • Not all of Scotland has access to the internet.
  • There may be some parts of the building without internet access depending on the position of the router.
  • Unsupervised access to the internet for young people is a safety issue. There would need to be restrictions.
  • It would need to be made clear that access may not be on an individual basis, but may be shared.
  • Too specific, for example, radios may be of no use to deaf people. Better to make a more general statement about access to technology that supports inclusion.
  • Need to add access to current printed media.

5.15 I can independently access all parts of the premises I use and the environment has been designed to promote this.

This statement attracted more comment than others.

  • It may not be appropriate or safe for people to access all parts of the premises. Areas off limits were identified as staff areas; laundry/sluice; office areas; other people's bedrooms.
  • If the kitchen is to be accessed, then this should be stated explicitly.
  • Some people may not be able to access areas independently and may need support. This should be stated.

5.16 If people who support and care for me have separate facilities, these do not take away from the homeliness of the service and my feeling of being at home.

No specific comments made.

5.17 If I live in a care home, I can control the lighting, ventilation, heating and security of my bedroom.

  • Add, "if this is safe" or "when safe to do so".
  • This is vital for some people, such as those with motor neurone disease.
  • Providers cannot facilitate this in all cases.

5.18 If I live in a care home, I can decide on the decoration, furnishing and layout of my bedroom, including bringing my own furniture where possible.

  • Not practical nor realistic.
  • Could this be changed to say I can customise or personalise my bedroom?
  • Cleaning and safety standards could restrict choices of décor, furnishing and layout.

Responsive care and support

5.19 The premises I use are designed, adapted, equipped and furnished with my care and support needs in mind.

  • This will not be true for many settings, particularly older ones.
  • This focuses on physical infrastructure rather than responsive care.
  • Insert, "in advance" before "furnished.
  • Insert, "and equipment" after "premises".
  • Add something about timescales. Particularly important in relation to those nearing the end of life.

Wellbeing

5.20 I experience a secure and safe environment that is suitable for me.

  • Not needed.
  • Already covered by 5.21 and by other statements.

5.21 My environment is relaxed, welcoming, peaceful and free from avoidable and intrusive noise and smells.

  • Replace "smells" with "odours".
  • Important statement in view of the TV noise and smell of other residents which can be unpleasant.

5.22 I can enjoy a pleasant environment, with plenty of natural light, fresh air, space and a comfortable temperature for me.

  • What does, "plenty of natural light" mean?
  • What is a "comfortable temperature for me"?
  • Add something about accessing indoor and outdoor environments.

5.23 I have enough physical space to meet my needs and wishes.

  • What comprises "enough"? Too subjective.
  • In some settings all the rooms are exactly the same size.

5.24 I am able to access a range of good quality equipment and furnishings to meet my assessed needs, wishes and choices.

  • What does "good quality" mean in this context?
  • Perhaps need to add, "appropriate for my particular needs".

5.25 I am able to participate in a variety of creative and physical activities, including exercise both indoors and outdoors.

  • Add "regular" before "exercise".
  • Need to add something about easy access.
  • Perhaps change to, "there should be sufficient outdoor and indoor space that meets my needs".
  • Should not be confined to creative and physical activities, but broadened to activity/occupation of choice.
  • This should apply only if relevant to the person.

5.26 If I am an adult living in a care home, I have my own bedroom that meets my needs.

  • Could this be combined with 5.4?

5.27 If I am an adult living in a care home, I can choose to live with and share a bedroom with my partner, relative or close friend.

  • It could be very beneficial for some people to be with someone they know well.
  • Could be challenging for care homes which single room occupancy only.
  • Needs clarity on whether the additional person is a paying resident; living in the setting on a short-term or longer-term basis; needing care themselves.

5.28 As a child or young person, I might need or want to share my bedroom with someone else and I am involved in deciding this.

  • Concerns about young people being allowed visitors in their own bedrooms unsupervised.
  • This needs to be reviewed in the context of safeguarding individuals.
  • Perhaps add, "where assessed as appropriate".
  • Perhaps add, "where there is sufficient space to do so".

5.29 If I experience 24-hour are, I have a bedside cabinet and light and there is enough space for me to sit comfortably with a visitor in my bedroom.

  • This suggests that the person experiencing 24-hour care is bed-bound, which may not be the case.
  • 5.26 covers this already.
  • Not always appropriate for children and young people in care.
  • May not be best to have such furnishing beside beds for people with visual impairments.

5.30 If I live in a care home and I want to keep a pet, the service will try to accommodate this request.

  • Specific mention should be made of "assistance dogs" as opposed to pets.
  • Young people often request this and if not permitted, then there should be an explanation given and the decision reviewed on a regular basis.
  • The therapeutic role of pets should be acknowledged and requests for pets accommodated as far as possible.
  • Drawbacks to keeping pets in care homes include: adding to falls risk; staff may end up caring for the pets; some people may be allergic to pet hair; some people may be frightened of pets; staff may not wish to work in an environment with animals.

Table 6

Detailed comments relating to individual descriptive statements supporting Standard 6

Statement

Detailed comments

Dignity and respect

6.1 I experience my human rights being protected when my liberty is restricted and this complies with the relevant legislation.

  • People need to know what their human rights are for this to be effective. Perhaps this should include an intention to educate on human rights?
  • Replace "liberty" with "independence, choice and control"

6.2 I am helped to understand how and why my behaviour affects my rights, including the use of any physical intervention, sanctions or incentives.

  • Change the focus from decisions being made about me, to supporting me to understand. Could do this by replacing "helped" with "supported".
  • It reads as though "behaviour" justifies being deprived of rights, and meriting "sanctions". Behaviour may not be a choice, but part of a condition. Inappropriate to link "behaviour" with sanctions in this way.
  • Perhaps insert "people's interpretation of" before "my behaviour.

6.3 I only experience restraint as a last resort and for the minimum time necessary by people who are properly trained.

This statement attracted more comment than others.

  • What is meant by "last resort"?
  • Should be supported by a statement about the need to review actions taken and assess them for appropriateness.
  • "Properly trained" should encompass regular reviews of training to ensure it is up-to-date and relevant.
  • Clarity is needed on the scope of "restraint". Physical restraint is only one aspect, but other forms could include medication, curfews, inclusion/exclusion zones, alcohol bans, restorative practices, and so on.
  • Need to be clear that actions (such as giving medication without consent) will comply with current legislation.
  • A child-friendly term such as "safe hold" should be considered as an alternative to "restraint".

6.4 I will only be searched if there are clearly identified concerns and I am told what these are.

  • Clarify that an individual and their room may be searched.
  • Add that if a search takes place, the reasons will be clearly recorded with detail of how human rights were upheld.
  • Add, "…and appropriate legislative processes have been followed".

6.5 If I am restrained or searched, this will be carried out sensitively.

  • "Sensitively" is vague and needs to be clarified.
  • Needs to make clear that action will be carried out "in the least restrictive way and in line with relevant legislation and guidance".
  • Add "safely" after "carried out".

Compassion

6.6 I am supported by people who anticipate challenges with my or others' behaviour and they work creatively to help manage this.

  • Language considered patronising and assumptive.
  • Needs reference to wider family and carers, social contacts and recreational activity as a broader, supportive network.
  • Emphasise that actions will be legal and safe.
  • How can challenges by "anticipated"?
  • Needs some recognition that behaviour may change depending on the right support being given.
  • Rephrase to, "When my behaviour can be difficult for people to handle, they think of creative and compassionate ways to deal with it".

Be included

6.7 I can be with my peers, including other people who use the service, except where this has been properly assessed as unsafe.

  • Replace "properly" with a more suitable word.
  • Expand this beyond "peers" to family, community, professional support services, and so on.
  • Add "if I wish" as not everyone will want this.
  • Ensure authorised, legal and human rights compliant.
  • Add that if request to spend time with peers is denied, the reasons for this are recorded and subject to regular review.
  • What is "unsafe"?
  • The statement should reflect more of an emphasis on enabling the individual to work towards inclusion and independence.

Wellbeing

6.8 The environment is specially designed and managed to minimise the risk of me harming myself or others.

  • Not all settings in which liberty can be restricted will be purpose-built, although they will comply with relevant standards.
  • Include reference to minimising the risk of harm from others.
  • Wording was perceived as relatively negative rather than presenting a positive promotion of wellbeing activity, albeit risk-assessed.

Table 7

Detailed comments relating to individual descriptive statements supporting Standard 7

Statement

Detailed comments

Dignity and respect

7.1 I am cared for by people who are ambitious for me, champion my needs and enhance my life chances.

  • What is meant by "ambitious"?
  • How would this be measured?
  • Need to change focus from others having ambitions for me, to my being supported in my ambitions.
  • Could this be changed to, "I am cared for by people who want the best for me, support me and make sure I achieve whatever I want in life".
  • Perhaps an additional descriptor is needed, "The choices I make in order to express my identity are treated with respect".

Compassion

7.2 I live in a place that feels like a home and I am supported and cared for by people who make me feel valued, special, loved and safe.

  • Language open to interpretation and subjective.
  • Change "feels like a home" to "feels like home".
  • How would this relate to prison settings?
  • What is meant by "special"? This has connotations of abuse.

7.3 I am supported to develop a positive view of myself and to form and sustain trusted and secure relationships.

There were no specific comments about this statement.

7.4 I am supported and cared for by people who are fully informed about my history and understand what I am communicating.

  • Concerns about people knowing my personal details which may not be relevant and without my permission.
  • Data sharing will need to be thought out.
  • "History" is an odd word to use, and could be replaced with "life".
  • Is the statement about communication challenges too and young people expressing their needs?

7.5 I am helped to overcome any previous experiences of trauma and neglect so I am emotionally resilient and have a strong sense of my own identity and belonging.

  • Appears to presume that experiences of trauma and neglect can be overcome by children and young people, which may not be the case.
  • Change "so I am emotionally resilient" to "supported to build resilience".
  • Not all trauma is caused by neglect, so this should read, "trauma and/or neglect".

7.6 I am responded to with sensitivity and the people who support and care for me anticipate and reduce any conflict, with difficulties sorted out in a low-key way.

  • "Low key" perceived to be subjective and difficult to measure.

7.7 I am helped by the people who support and care for me to understand the consequences of any difficult or unsafe behaviour and I am supported to take responsibility to change this.

There were no specific comments about this statement.

7.8 I have as normal an upbringing as possible and I am helped by the people who support and care for me to achieve this.

  • Replace "normal" with "positive" or "secure" or "healthy and nurtured" (a GIRFEC term).

Be included

7.9 I am encouraged and supported to make friends with people my own age.

  • Too prescriptive. Friends can be different ages and across generations.
  • Change to: "I am encouraged and supported to make friends."

7.10 I am helped to understand decisions taken in my best interests and why sometimes it might not be possible to act on my wishes.

  • Needs to be more explicit about ensuring children and young people have an input to decisions about them. For example, "I am included and supported to make decisions".
  • To be UNCRC compliant the statement could read, "I am always supported and encouraged to be included in decisions about my care and support and if a decision is taken against my wishes I am supported to understand the reasons for this".

7.11 I am fully included in all aspects of family life if I am fostered.

  • Why is this specific to fostering? All looked-after children should be included in this statement ( e.g. kinship care).
  • "Family life" may need further definition - is this foster or birth family life?
  • There are other settings such as small group living which should be reflected here.

Responsive care and support

7.12 My needs and wishes are assessed in good time and an assessment for a permanent placement is done within 12 weeks.

  • Could this be combined with 7.13?
  • The timescale of 12 weeks is unrealistic in all cases, e.g. adoption. This does not recognize the complexities of issues which can arise.
  • Clarity is required on when the timescale begins.
  • Clarity is required on what a "permanent placement" comprises.
  • Another statement may be required relating to inter-agency working and communication where there are siblings under the care of different providers.
  • Is this in line with GIRFEC?

7.13 My need for permanent care and support is assessed and met.

  • Could this be combined with 7.12?

7.14 I experience stable care and support with minimum disruption, from people who can nurture and form strong attachments with me.

  • Replace "attachments" with "bonds" to reflect attachment thinking.
  • Young people talk of "relationships" rather than "attachments".
  • A similar statement should also appear under Standard 1 and Standard 2 under Responsive Care and Support.

7.15 If I need and want this, I am placed with wider family members (kinship care) alongside my brothers and sisters where possible and where it is safe.

There were no specific comments about this statement.

7.16 People making decisions about me, including fostering and adoption panel chairs and advisers, know me and have the right skills, training and experience to decide what's best for me.

  • Chairs of panels will be independent and are unlikely to know the child.

7.17 I am supported to have safe contact and continuity of relationships with family and people who are important to me by people who understand the importance of maintaining attachments.

  • Although there may be instances where it might be better, on balance, for the contact to cease.
  • Include, "and opportunity to remain in current schools if I choose to".
  • Attachment is wider than maintaining contact and continuity of relationships, and there should be a separate statement dedicated to this.

7.18 I continue to be supported and cared for into adulthood.

  • Add "…if I choose".
  • What level of support and for how long will this continue?

7.19 I experience different organisations working together for my benefit.

  • Difficult to evidence.
  • There may be only one organisation involved. Reword to, "When different organisations are involved in my case, they……."
  • Better to refer to one clear point of contact.

Wellbeing

7.20 I am supported to achieve my potential in education and employment.

  • Add "fully" before "supported".
  • Add sentence, "This will include advocacy from the people that care for me."
  • Insert "training" before "and employment".
  • Add "and meaningful activity/occupation".
  • Add "and other life activities".

7.21 I am supported to develop my independence while protecting myself from unsafe situations.

There were no specific comments about this statement.

7.22 I am supported to become increasingly safe from neglect, abuse, grooming and sexual exploitation, self-harm, bullying, misuse of drugs or alcohol and going missing.

  • The list appears to be negative and stereotyped.
  • Should not be a list as it cannot be exhaustive or future-proofed.
  • Instead, insert "from risks such as" before "neglect…"
  • Replace with, "I am supported to become increasingly safe from all forms of neglect and abuse".
  • "Increasingly safe" is odd. Remove the word "increasingly".

7.23 I am supported by people who seek to understand why I have been missing and work with me to minimise future risks.

  • This should come after 7.24.
  • Could merge 7.23 and 7.24.
  • It could be unrealistic for carers/staff to go searching if they have other people to look after.
  • Delete "work with me to minimise future risks". Instead, this could read, "If I go missing, people will take urgent action to find and protect me".
  • Replace "work with me to minimise future risks" with "take action to address the reasons why I became missing".

7.24 If I go missing, people take urgent action to protect me, including looking for me and liaising with the police and other agencies, and my family.

  • This should come before 7.23.
  • Could merge 7.24 and 7.23.
  • Add another statement, "If I go missing, I am offered choices about where I return to once I am found".

Contact

Email: Chris Taylor

Phone: 0300 244 4000 – Central Enquiry Unit

The Scottish Government
St Andrew's House
Regent Road
Edinburgh
EH1 3DG