Private Care Sector Workforce Initiative
Care and Support Planning in Health and Social Care Services
Key national stakeholders are meeting to consider ways to develop the capacity of service providers to ensure high quality care and support planning
1. Introduction
Feedback from service providers suggests there is need to provide clear and up to date guidance on care planning in registered adult social services in Scotland, focussing initially on services for older people. The guidance needs to cover both the content of care plans and the process of care planning.
Arising from this, key national stakeholders are now meeting to consider ways to develop the capacity of service providers to ensure high quality care and support planning. It includes health and social care providers, Scottish Government and the regulatory agencies.
2. Background
It is acknowledged there is a lack of consistency in personal care planning in registered adult social care services for older people in Scotland. In part this is due to there being a range of models, formats or systems currently in place, across different agencies and subject to different scrutiny.
Based on the National Care Standards, the Care Commission has an expectation that each person’s personal plan and its review will detail needs and preferences and set out how they will be met. However, the standards do not detail content or structure, with the onus being on providers to appropriately care plan.
Local authorities, in commissioning social services, may (or may not) require care planning to comprise specific areas of need, and the level of information and support provided by social work staff to care services varies considerably.
The NHS in providing health services make use of a range of planning models and tools to assess and plan for/with individuals. Individuals may have new and different care plans created if they move between health and social care provision and despite the emphasis on integration there remains a significant difference in what is meant by a care plan within social care and health settings.
In addition, there are other parts of the process which impact on the planning of care but are not always fully integrated with it, for example the single shared assessment and the life history of a person. Also, there are potentially several partial care plans to manage various conditions and needs e.g. pharmaceutical, advanced/anticipatory care plans. The list of additional expectations regarding care plans and care planning has grown as new areas of concern have been highlighted in relation to areas such as tissue viability, nutrition, dementia, palliative care etc.
There has also been the development of models of assessment and care planning consistent with the personalisation agenda. For example, of significance is the move to combine user and carer involvement with an outcomes approach to planning, delivery, evaluating and improving services. This is shown in the work to develop ‘Talking Points’, an approach based on user and carer defined outcomes. This approach aims to shift engagement with people who use services away from service-led approaches.
In our view, achieving a greater level of clarity and consistency in relation to current expectations as to how care plans are designed, developed and carried out, would go a long way to assist the delivery of improved outcomes.
3. Policy Context
Key Scottish Government policy drivers relevant to the planning of care services for older people include Reshaping Care for Older People; Shifting the Balance of Care; Living and Dying Well: A national action plan for palliative and end of life care in Scotland; the NHS Quality Strategy; and the Dementia Strategy.
As indicated above, an important feature currently and in the future will be how services are personalised, that is working with people, their families and carers to develop support and services providing choice and control. This includes self-directed support, through shifting the balance of care towards sustaining and improving health and preventing longer term conditions through an emphasis on self-help.
Policy developments address and imply significant change across health and social care systems. It means new models of service delivery; clinical and care pathways that may involve shifting location, shifting responsibility; and identifying individuals earlier who might benefit from support that might sustain their independence and avoid adverse events or illness. It demands care planning which crosses health and social care services and incorporates the various components of support and care which comprise the whole plan.
From April 2011, the new social care regulatory body in combining the functions of SWIA and the Care Commission will also be able to look at the process of care planning and review from initial referral and assessment in the community, through the commissioning and placement phases, to the delivery of the appropriate care package.
4. Proposal
As has been suggested, social care providers would welcome guidance on the issue of care planning, taking account of the evolving regulatory and policy framework. This would not be intended as prescriptive or mandatory, but rather serve to bring some greater consistency for all concerned in the process. In keeping with the emphasis on self-evaluation, it might also assist those in supervisory and management roles to audit their service’s care plans and care planning activity against current expectations.
In order to discuss the matter more fully and to scope what work, if any, should be carried forward, Scottish Care proposed and has now convened a meeting of key stakeholders. This includes representation from:
• Providers across adult social care settings
• Scottish Government
• Joint Improvement Team
• Care Commission
• Cosla
• Association of Directors of Social Work
• NHS Education Scotland
• Institute of Research and Innovation in Social Services (IRISS)
• Royal College of Nursing
• Dementia Services Development Centre
• Scottish Social Services Council
• Alzheimer Scotland
• NHS Greater Glasgow and Clyde.
There may be other organisations which will contribute to the discussion in the future.
An initial meeting was held in Glasgow on 25 June and another is scheduled for 1 September. Minutes from the first meeting and a set of objectives/actions will be published here when available.
If you wish to know more, please contact David Rennie at or on 07946 607532.
