How do we put the Health and Social Care Standards into practice?

What are the Health and Social Care Standards, in plain terms?

The introduction to the Standards says they set out what we should expect when using health, social care or social work services in Scotland. There are five headline outcomes, starting with: I experience high quality care and support that is right for me. Under each one sits a list of descriptive statements, which the Scottish Government says explain what achieving the outcome looks like in practice. It also says not every descriptor will apply to every service.

The Standards rest on five principles: dignity and respect, compassion, be included, responsive care and support, and wellbeing. The principles are not standards in themselves. They describe the way everyone should expect to be treated.

The thing I would notice first is the voice. Almost every statement is written as I. Each one describes something a person should be able to say about their own life, rather than a task for staff.

How does the Care Inspectorate use them?

From 1 April 2018, the Standards have been taken into account by the Care Inspectorate in its inspections and in registration. Its quality framework for care homes for adults and older people says the quality illustrations under each quality indicator are the link to the Standards and are drawn from the expectations set out in them. That framework is for care homes, so if you run a different type of service, check the framework for your service type.

That shapes what inspectors look for. The Care Inspectorate's guidance on how it inspects regulated services says inspectors will always triangulate evidence, through observation, talking with people and sampling documentation. Where improvement is needed, the inspector may use requirements or areas for improvement linked to the Standards.

So the Standards sit inside inspection rather than beside it. The quality illustrations inspectors use are drawn from them, so they shape how your service is evaluated, seen through the person's eyes.

Why do staff know the Standards but struggle to show them?

In my view, knowing the Standards exist is rarely the problem. The gap usually sits between knowing the words and recognising them in the work.

One common reason is that the Standards get taught as a document to remember. Staff learn that they exist, sign to say they have read them, and go back to the rota. Nobody shows them what 3.16 looks like at half past seven on a Tuesday evening.

Another is that records are written about tasks. A daily note that says personal care given, ate well, settled is accurate, and it tells an inspector nothing about whether the person felt respected or had a choice.

A third is treating the Standards as if they replace the rules. The introduction is clear that they do not replace or remove the need to comply with legislation. You still need your policies, your training and your legal duties. The Standards describe what all of that should feel like from the other side.

The cost of getting this wrong is quiet. A service can have sound systems and kind staff and still struggle to evidence it, because nobody has joined the practice to the language the framework uses.

What does an I statement look like on a real shift?

This is where I would start with a team. Take a handful of statements and ask what each one looks and sounds like on the floor. The wording in the first column is the Standard. The other two columns are my own illustrations, not the Care Inspectorate's, and they are the kind of test I would use rather than a list of what an inspector will check.

The Standard says	What it might look like on a shift	A question to ask your team
1.35 I can enjoy unhurried snack and meal times in as relaxed an atmosphere as possible	Nobody is cleared away while still eating, and staff sit down rather than hover	Who decides when lunch is over?
1.26 I can choose to spend time alone	A person who prefers their room is not recorded as refusing activities	How do we write it down when someone says no?
2.17 I am fully involved in developing and reviewing my personal plan, which is always available to me	The person knows what their plan says and can see it	When did they last see their own plan?
3.6 I feel at ease because I am greeted warmly by people and they introduce themselves	Agency and new staff say who they are, every time	Would a new starter do this without being told?
3.16 People have time to support and care for me and to speak with me	Conversation happens during care, not only when the work is done	Where in the shift is there time to talk?

The statements under outcome 3 are a good place to begin, because they are about the people who support and care for someone. Staff can see themselves in them straight away. The statements under outcome 2, about being fully involved in decisions, are a good second step.

How do we build the Standards into supervision?

Supervision is where the Standards can stop being a document and start being a habit. One statement is enough for one conversation.

Ask the member of staff to describe a time this week when the statement was true for someone they support, and a time when it was not. Then ask what got in the way. The answers are often practical: a short staffed morning, a task list that crowds out conversation, a handover that misses something the person cares about.

Standard 3.14 helps frame this. It says I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow their professional and organisational codes. Reflection is written into the Standard itself, so a supervision built around it is part of meeting it.

Write down what was agreed, in plain words. Over a few months that record shows how practice is changing, which is far more useful than a signature saying the Standards were discussed.

How do we make records sound like the person?

The statements under outcome 1 include this one: 1.15 My personal plan (sometimes referred to as a care plan) is right for me because it sets out how my needs will be met, as well as my wishes and choices. Another, 1.9, says I am recognised as an expert in my own experiences, needs and wishes.

Together, those two lines set the test for any plan or daily note. Here is a short example I wrote myself to show the difference.

Thin: Assisted with breakfast. Ate well.

Stronger: Chose porridge today and asked for it thinner than usual. Wanted to eat in her room with the radio on, so breakfast was taken through and a carer went back to chat once she had finished.

The second note takes a few seconds longer. It shows choice, a preference respected and time spent together, all in the person's own terms. When a team writes like that, the evidence for the Standards builds up in the ordinary course of the day.

When is this not the answer?

If your last report included requirements, start there. They are based on regulations and always include a timescale, so in my view they come first. My post on improvement plans after low grades goes through that order of work.

If people are at risk today, because of staffing you cannot cover safely or a protection concern, deal with that before any work on practice and language.

And if your team can already describe their work in the words of the Standards, your plans read like the people they belong to and your supervision records show practice changing, you may not need outside help at all. Keep doing what you are doing.

Where should I start?

Pick one statement this week. Read it aloud at handover, ask each shift what it looked like for one person, and write down what they say.

If you would like help, my training and development work helps teams turn the Standards into daily practice, and I work with services in Scotland on plans and records that sound like the people they describe. When you are ready, book some time with me and we can look at where your team is now.