5. Monitoring of the Statutory Requirement
5.1 The intended aims of the legislation can only be met where there is compliance with any duty. We propose that organisations' progress in meeting requirements be monitored in the following ways:
- Monitored locally through local reporting arrangements.
- Monitored nationally through existing reporting and regulatory mechanisms, including the workforce planning aspects of the Local Delivery Plans ( LDPs); Staff Governance monitoring; reporting arrangements for national workload and workforce planning programmes; and through existing performance monitoring, scrutiny and inspection processes, where appropriate.
- Excellence in Care will support the triangulation approach to safe and effective staffing through the national quality measure source. NHS Boards will use the Care Assurance Information Resource ( CAIR) to support quality assurance and improvement both locally and nationally. The CAIR contains workforce, and a range of other indicators, that will be used to demonstrate safe, effective and person-centred care.
5.2 The intention is to consider the extent to which requirements can be monitored using the existing reporting and regulatory mechanisms in Scotland, to embed organisational requirements within systems that are already established and familiar to providers of health and social care services. Examples of these are outlined below in respect of Scottish Government, Healthcare Improvement Scotland and Care Inspectorate reporting and follow up. The consequences that will be applied to those who do not demonstrate that they are implementing the duty will vary depending on the organisation concerned.
5.3 NHS Boards are publicly accountable for the delivery of key aspects of financial and service performance. A number of mechanisms are in place nationally and locally to support them. Some examples of relevant monitoring and reporting arrangements are provided below.
5.4 NHS board accountability is monitored and maintained through a process of Annual Reviews, which are conducted in public during the summer. Scottish Government Ministers, supported by Health and Social Care Directors, meet with all NHS Board Chairs, Chief Executives and their teams in a publically accessible venue, to discuss progress made on key priorities, performance against LDP Standards and the contribution that the Board has made towards delivery of the Scottish Government's National Outcomes.
5.5 NHS Board Chief Executive and senior management teams also undertake mid-year stock-takes where they meet with Scottish Government Health and Social Care Directors to take stock of in-year performance and also to look ahead to the forthcoming year.
5.6 Statistics indicating progress against Local Delivery Plans ( LDP) Standards are reported publicly throughout the year and a summary of overall annual performance is provided through the NHSScotland Chief Executive's Annual Report. Regular progress against LDP Standards are also publicly reported through the Scottish Government's performance website Scotland Performs .
5.7 NHS Boards are required to include in their Local Delivery Plans, an outline of their local Everyone Matters: 2020 Workforce Vision Implementation plans for 2017-18. This will include a brief summary of the local actions they are taking to ensure workforce capacity and capability. Local Delivery Plan Guidance for 2017/18, available at http://www.sehd.scot.nhs.uk/dl/DL(2017)01.pdf reaffirmed that the application of the Nursing and Midwifery Workload and Workforce Planning Tools should be documented in the development of Workforce Plans and workforce projections.
5.8 NHS Boards' progress against the actions set out in the Everyone Matters Workforce Vision Annual Implementation Plan is measured in the following ways:
- Monitored locally through local reporting arrangements.
- Monitored nationally through the Workforce Planning and HEAT Targets aspects of the Local Delivery Plans ( LDPs).
- Taking into account Annual Reviews, Staff Governance Monitoring, Employee Experience Measures and iMatter.
5.9 Each element of the Staff Governance Standard Framework is assessed annually to seek assurance from Boards that each of the five elements of the Standard are being carried out locally and that all staff are: well informed; appropriately trained and developed; involved in decisions; treated fairly and consistently, with dignity and respect, in an environment where diversity is valued; and provided with a continuously improving and safe working environment, promoting health and wellbeing of staff, patients and the wider community. This includes ensuring that local policies which are compliant with PIN Policies are implemented.
5.10 Each NHS Board's Staff Governance Committee should make sure that arrangements are in place to ensure continuous delivery of the Staff Governance Standard. Responsibilities include overseeing the commissioning of structures and processes which ensure that delivery against the Standard is being achieved; monitoring and evaluating strategies and implementation plans relating to people management, and, providing the Scottish Government with staff governance information to enable national monitoring arrangements.
5.11 Organisational performance against the Staff Governance Framework is also reviewed by the Scottish Workforce and Staff Governance Committee (SWAG) as guardians of the Staff Governance Standard, on behalf of the Scottish Partnership Forum (SPF).
5.12 Local Partnership Forums are also directly involved in assessing the performance of NHS Boards as employers through the use of the nationally agreed staff experience and staff governance monitoring arrangements. The assessment does not rely on a single form of measurement, and local health systems will have the flexibility to agree and set their own priorities.
5.13 NHS Boards' application of available nursing and midwifery workload and workforce planning tools is monitored through Nursing and Midwifery Workload and Workforce Planning Programme monitoring and reporting arrangements, which currently include:
- Reviewing available analytical data regarding application of available tools across ward areas, units and departments within and across NHS Boards, covering hospital and community settings.
- Reviewing how NHS Boards' application and analysis of the nursing and midwifery workload and workforce planning tools is reflected in the development of Workforce Plans and workforce projections.
5.14 Although IJBs are not employers themselves, they are accountable for planning staffing needs for the services delegated to them by local authorities and NHS Boards. They play a key role in shaping workforce demand and in supporting 'intelligent forecasting'. A legislative requirement operates on IJBs to produce workforce development and organisational development plans.
5.15 IJBs must also publish strategic commissioning plans which identify local need and set out a vision and plan for how these needs will be met, working in partnership with local staff, communities and partners. The Integration Planning Principles which underpin the Public Bodies (Joint Working) (Scotland) Act 2014 state that that the main purpose of services which are provided in pursuance of integration functions is to improve the wellbeing of service-users, and that strategic commissioning plans which are developed to deliver integration functions must also protect and improve the safety of service users. Within this context the views of Integration Authorities must be taken into account.
5.16 Related methods of scrutiny also contribute to a wider set of resources and continuous processes where evidence is used to drive improvement in quality.
5.17 Healthcare Improvement Scotland ( HIS) was created through the Public Services Reform (Scotland) Act 2010, which amended the National Health Service (Scotland) Act 1978 ("the 1978 Act"), on 1 April 2011. HIS' stated purpose is to drive improvements that support the highest possible quality of care for the people of Scotland.
5.18 The 1978 Act places a number of statutory duties upon HIS, including:
- A general duty of furthering improvement in the quality of healthcare.
- A duty to provide information to the public about the availability and quality of services provided under the health service.
- When requested by the Scottish Ministers, a duty to provide to the Scottish Ministers advice about any matter relevant to the health service functions of HIS.
5.19 The 1978 Act sets out the functions of Scottish Ministers that HIS is to exercise:
- Functions in relation to supporting, ensuring and monitoring the quality of healthcare provided or secured by the health service including providing quality assurance and accreditation.
- Functions in relation to supporting, ensuring and monitoring the discharge of the duty to encourage public involvement of each NHS Board.
- Functions in relation to supporting, ensuring and monitoring the discharge of the duty to encourage equal opportunities of each NHS board (insofar as that duty is relevant to the quality of health care and the duty of public involvement described above).
- Functions in relation to the evaluation and provision of advice to the health service on the clinical and cost effectiveness of new and existing health technologies including drugs.
5.20 The 1978 Act also sets out the general principles in accordance with which HIS must exercise its functions, which includes that:
- The safety and well-being of all persons who use services provided under the national health service and independent health care services are to be protected and enhanced.
- Good practice in the provision of those services is to be identified, promulgated and promoted.
- Provision of those services taking account of guidance and information published or endorsed by HIS should be promoted and encouraged.
5.21 The 1978 Act section 10I provides HIS with powers to inspect any service provided by the National Health Service. Section 10J of the Act sets out the powers HIS has to inspect independent health care services, in pursuance of its general duty of furthering improvement in the quality of health in Scotland.
5.22 HIS is introducing new comprehensive assessments of the quality of healthcare - Quality of Care Reviews. This is part of a programme of work to implement a new framework-based approach to comprehensive assessment and external quality assurance of the care provided in NHSScotland.
5.23 The aim is to deliver an operational review methodology that is proportionate, sustainable and focused on quality improvement. The proposed methodology is currently being tested with the service and is due for phased implementation across Scotland from Autumn 2017. It will include tools and guidance which have been co-produced with stakeholders to support internal self-assessment and external validation of the quality of care.
5.24 HIS are working closely with other programmes of work where there are overlaps and interfaces to the quality of care reviews programme, such as the National Health and Social Care Standards and Excellence in Care.
5.25 The Care Inspectorate (formal name Social Care and Social Work Improvement Scotland ( SCSWIS)) was established on 1 April 2011 under the Public Services Reform (Scotland) 2010 Act as the new single improvement and scrutiny regulator in Scotland for social work and social care (taking over the functions of its predecessors, the Care Commission, the Social Work Inspection Agency and some of the functions of HMIE).
5.26 The Care Inspectorate's statutory duties include:
- Furthering improvement in the quality of social services.
- Undertaking joint inspections of services for adults and children.
- Providing information to the public about the availability and quality of social services.
- Providing advice to Ministers about any matter relevant to the functions of the Care Inspectorate.
- Taking into account standards and outcomes relating to care services and social work services and the Scottish Social Services Council's codes of practice in the performance of its functions.
5.27 The Care Inspectorate regulate around 14,000 individual care services. This includes registering/deregistering and inspecting services, supporting services to improve, investigating complaints and undertaking enforcement action. The Care Inspectorate also scrutinise the delivery of local authority social work functions.
5.28 The Care Inspectorate assess workforce planning/experience at the point of registration to see if this is appropriate for the service.
5.29 Sections 54 to 56 of the Public Bodies (Joint Working) (Scotland) Act 2014 amend the Public Services Reform (Scotland) Act 2010 and The National Health Services (Scotland) Act 1978 to extend the remit of the Social Care and Social Work Improvement Scotland and Healthcare Improvement Scotland ( HIS) to inspect the planning, organisation or co-ordination of the services that Health Boards and Local Authorities delegate, as set out within their Integration Schemes, to Integration Authorities.
5.30 We will discuss with HIS how compliance with proposed requirements under the legislation fits with Quality of Care reviews.
14. Do you agree with the proposals to use existing performance and monitoring processes to ensure compliance with the legislative duty and associated requirements?
15. In what other ways could organisations' progress in meeting requirements be monitored?
16. What should the consequences be if organisations do not comply with requirements?
Email: Dawn Sungu
Phone: 0300 244 4000 – Central Enquiry Unit
The Scottish Government
St Andrew's House