Joint inspections of services for adults

Our approach

The Public Bodies (Joint Working) (Scotland) Act 2014 sets the legislative framework for integrating adult health and social care.

Integrating health and social care services is important to ensure that people have quick access to the range of services and support they need, that their care feels seamless to them and that they experience good outcomes and high standards of support. This is particularly vital for the increasing numbers of people with multiple, complex, long-term conditions in Scotland.

Since April 2017, the Care Inspectorate and Healthcare Improvement Scotland have had joint statutory responsibility to inspect and support improvement in the strategic planning and commissioning of integrated approaches.

In 2019, the Ministerial Strategic Group (MSG) for Health and Community Care asked us to further develop our joint inspections to focus on how integration impacts on people’s outcomes, to consider the performance of the whole health and social care partnership and to ensure a balanced focus across health and social care provision.

In response to the MSG recommendation, the Care Inspectorate and Healthcare Improvement Scotland have reviewed our joint inspection methodology to answer the following question:

“How effectively is the partnership working together, strategically and operationally, to deliver seamless services that achieve good health and wellbeing outcomes for adults?”

In order to address the question over the broad spectrum of adult health and social care services, we will conduct a rolling programme of themed inspections, looking at how integration of services positively supports people’s experiences and outcomes. It’s important to note that these thematic inspections are not considering the quality of specialist care for each care group but are simply a means of identifying groups of people with similar or shared experiences through which to understand if health and social care integration arrangements are resulting in good outcomes. In this way, we’re looking at integration through the lens of different care groups which, taken together, will in time build a picture of what is happening more broadly in health and social care integration and how this is experienced by people and the outcomes achieved.

How we do it

Our inspections last for a number of months. We work closely with the partnership to co-ordinate our inspection activities.

We have a range of ways to gather information that will help us to assess how integrated services in the area are helping to improve outcomes for people and their unpaid carers. These include:

• asking for information from the partnership
• speaking to people who use health and social care services and their unpaid carers
• speaking with staff, managers and leaders across the partnership
• reading people’s records.

We communicate regularly with the partnership and keep them up to date with our findings.

After the inspection, we publish a report about our findings on the Care Inspectorate’s and Healthcare Improvement Scotland’s websites. The report explains what we have found, identifies strengths and points out areas that could be improved. We agree an Improvement plan with the partnership to address those areas.

Getting involved

The voices of people who use health and social care services and of their unpaid carers are at the centre of our inspection. We will use as many opportunities as we can to get people involved and talk to them about their experiences of health and social care services.

We have developed an engagement framework to support all our engagement activity. The framework sets out 12 statements about positive outcomes and experiences that we will speak with people about.

More information

You can find full information about joint adult inspections:

• The Partnership guide sets out the inspection process step by step and provides all the information that partnerships need to manage their part in the inspection. 
• The Quality Indicator Framework (QIF) explains the criteria we use to evaluate quality in our inspections
• The Engagement framework provides a set of “I” statements to help us consider the experience of people who use health and social care services and their unpaid carers. It underpins all the engagement with people and unpaid carers that takes place during the inspection. 
• Our joint inspection reports can be found here.
• The record review template and record review guidance supports our reading of health, social work and social care records. The current version is used to read the records of people living with mental illness. 

Children and young people

Our role in children and young people’s services 

It is our job to make sure that every child and young person experiencing care in Scotland gets the best quality of care that meets their needs and choices and protects their rights. This is whether they live at home with their families, live in a children’s home, are fostered or adopted, stay in secure or school care accommodation or use respite services. We also inspect some services that provide care for families, such as women’s refuges, and housing support services that cater for young people.

Our strategic team assesses how well professionals from different disciplines and agencies work together. This is to make sure that children and young people who need care and protection are kept safe and their needs met. 

We assess how well services and partnerships self-evaluate and learn from adverse events to improve children’s experiences and outcomes.

Information about inspections for young people

Following some feedback we had from young people, we have created posters that explain what inspections are. You can download our poster for residential child care or our poster for foster care and display this in your service to help young people understand what inspections are and how they can get involved.

The Promise in action animation 

Our new animation co-designed with our young inspection volunteers demonstrates The Promise in action – by making sure that our young people’s voices authentically influence our work. 

Text to complain

Our young inspection volunteers

We work with 15 young inspection volunteers (aged between 18-26 years old) who visit children and young people’s services with us when we inspect.

Our young inspection volunteers talk with children and young people who use services and listen to their views. They meet managers to find out how well they involve children and young people to develop and improve services and they hear how well partnerships are fulfilling their responsibilities and duties as corporate parents.

If you would like to find out more about becoming a young inspection volunteer click here.

Click here to see some of the videos they have done for our joint inspections.

Our quality frameworks

Our quality frameworks support care services to self-evaluate. Our inspectors also use these when they inspect and look at the quality of care provided by services. 

Our children and young people’s inspection teams began using key question 7 in April 2022. As part of everyone's journey to meet the Promise, we reviewed key question 7 with inspectors, young people who experience or have experienced care and providers to evaluate the impact it was having and how well it was supporting the sector to self-evaluate its own performance. We made some changes as a result of this review and agreed that we will continue to use key question 7 for inspections from April 2024 onwards. We have also published new self-evaluation toolkits to support the sector. To support the launch we delivered webinars for care homes for children and young people and schoolcare accommodation and mainstream boarding schools and school hostels.

You can access the new KQ7 documents, full quality frameworks, and toolkits on The Hub here.

In April 2024 we held a live, online, briefing for providers, managers and external managers of registered services for children and young people. During the webinar we shared some overarching messages for the sector, on developments and practice themes identified throughout the previous inspection year; our methodology for the coming inspection year; and the increasing focus on young people’s voice and participation. You can watch the recording of the webinar here.

Care homes

• We have published Care Homes for Children and Young People - The Design Guide to support applicants and providers with design, planning and construction considerations for new or converted care homes for children and young people.
• We spoke to children about what was important to them in care home design, and included quotes from young people in the guidance.
• To support with emergency situations, we have published Guidance for providers of care homes for children and young people on the emergency relaxation of conditions of numbers.

Secure services

• The Secure Care Pathway and Standards Scotland were created to improve the experiences of children and young people who are in, or on the edges of, secure care, leading to better and brighter outcomes.
• We have published a Protocol and procedures for secure accommodation services on the use of registered emergency beds.

School care accommodation services

The Registrar of Independent Schools, the Care Inspectorate and Education Scotland have worked together to produce Guidance on effective safeguarding for boards of governors in independent schools, to assist with self-evaluation and monitoring of child protection and safeguarding practices.

To set out our approach to regulating guardianship arrangements in boarding schools we have published Guidance for the regulation of guardianship arrangements in boarding schools.

Supporting unaccompanied asylum seeking children (UASC)

We understand that meeting the needs of asylum-seeking and refugee children and young people across Scotland is very challenging and we believe that we all need to work together, to make any improvements that are needed. To help inform this work we hosted a webinar, with input from COSLA, Scottish Guardianship Service, and the Scottish Refugee Council. The webinar covered:

• the background to UASC policy and the National Transfer Scheme
• information about what support and services are available
• the context around why young people are arriving to Scotland, and what their lived experiences have been
• an opportunity to explore any queries or concerns, and share examples of best practice.

The content is relevant for local authorities, social workers, residential childcare staff, fostering services, and foster carers. You can watch the recording of the webinar here.

To better support how we engage with children and young people who have English as a second or foreign language, we have developed this poster for services to display. It’s designed to let young people know that we are happy to book an interpreter to chat with them.

Restrictive practices

• We understand that the use of restrictive practices in the promotion of rights, independence and choice for children and young people conflicts with promoting and maintaining a duty of care by taking protective action to keep young people safe.
• We are a member of Restraint Reduction Scotland, and have worked collaboratively with the Scottish Physical Restraint Action Group (SPRAG) to develop a Self-evaluation tool: The use of restrictive practices. It is designed to support services to evaluate how well they are doing in using restrictive practices and identify areas where they want to improve.
• To support the launch of the self-evaluation tool, we held two webinars; a recording of the webinars combined can be found here.

Depriving and restricting liberty for children and young people

We recognise that services are treading a delicate balance between taking necessary action to keep children and young people safe, whilst not unnecessarily restricting liberty.  Our new position paper aims to set out our attitude, expectation, and actions around the restriction and deprivation of liberty in care home, school care and secure accommodation services.  This includes circumstances where children and young people may be deprived of their liberty, where their liberty is restricted, or where this is a risk through environmental design and/or care practices. You can see the paper here.

Children and young people placed cross border and at a distance from home

Distance placements refer to any child who has been placed in a care setting outside of their home community. You can read our report on ‘Distance placements: exploration of practice, outcomes, and children’s rights’ here.

In January 2022 we carried out a short thematic review of children and young people placed cross border on Deprivation of Liberty Orders. We spoke to nine of the children face to face, and had a telephone interview with one young person. You can read the report about this here.

Admissions

In aspiring to make residential care a positive choice for all children in Scotland who require it, and to promote best practice in admissions and matching, we published Matching Looked After Children and Young People: Admissions Guidance for Residential Services.

Care planning

To support staff in services to develop personal plans for children and young people we developed a Guide for providers on personal planning: children and young people. We spoke with young people to gather their views, and included quotes from young people throughout the document.

Records and notification reporting

By law all services must keep certain records, and tell us if particular events take place. You can read our Records that all registered children and young people’s care services must keep and guidance on notification reporting here.

Staffing

To support providers to ensure they are appropriately assessing and providing staffing levels to meet the needs of young people in their care, we published Guidance for providers on the assessment of staffing levels.

Corporate parenting

As a corporate parent, we carry out many of the roles any parent should.

We work with other corporate parents to promote the wellbeing of all children and young people and keep them safe from harm. We work hard to enable children and young people to have as much of a say as possible.

Read our corporate parenting plan 2021-23.

We have developed Guidance for children and young people’s services on the inclusion of transgender including non-binary young people. This is in response to a number of services who approached us looking for advice on how best to support transgender including non-binary young people. The guidance is based on current good practice and includes real practice examples from the sector.

Stand Up For Siblings

We are a proud member of the Stand Up For Siblings partnership, a Scotland wide initiative to improve and change legislation, policy and practice.  It’s about making sure children and young people live with their brothers and sisters, where it is appropriate to do so, and sustain strong and positive lifelong relationships with them. Read the Staying together and connected: getting it right for sisters and brothers: national practice guidance.

Our young inspection volunteers made a big contribution to this award-winning work and made a film about promoting and supporting sibling relationships for children and young people who experience care. Watch the film here. 

The Promise

We continue to work to deliver our organisation's contribution to keeping The Promise for children and young people. The Promise is about providing more intensive, preventative support to families so they can stay together where it is safe to do so.

Scottish Child Abuse Inquiry

We work with the Scottish Child Abuse Inquiry to investigate the abuse of children in care in Scotland.

Continuing care

We have been supporting the Staying Put agenda since 2013 and our role as corporate parents under the Children and Young people (Scotland) Act 2014 includes supporting young people moving from care to adulthood and independence.

Read our Guidance for services on the provision of continuing care, the Continuing Care and the Welfare Assessment: Practice Note and watch the Continuing Care and the Welfare Assessment Webinar Recording.

We were involved in Continuing Care and Your Rights, a project co-created with care experienced young people, CELCIS, and Clan Childlaw. Continuing Care and Your Rights provides accessible information for young people on their right to continuing care.

Continuing improvement

We have created a video to help you learn how to run your own improvement projects using the Model for Improvement and ‘Plan Do Study Act’ (PDSA) cycles. This will also be helpful to both services and providers when progressing areas for improvement made as a result of inspection.

The video includes specific examples relating to children and young people. 

The Health and Social Care Standards

Under the Health and Social Care Standards, everyone is entitled to high-quality care and support tailored towards their needs and choices. That is why the Standards focus on the experience of people using services and supporting their outcomes.

The Standards apply to the NHS, as well as services registered with the Care Inspectorate and Healthcare Improvement Scotland. We use the Health and Social Care Standards to make sure services respect and meet people’s rights, needs and choices.

Download your copy of the Standards.

Equality and diversity

We believe that people in Scotland should experience a better quality of life as a result of accessible, excellent services that are designed and delivered to reflect their individual needs and promote their rights.

Our work focuses on people’s rights, choices and individual outcomes, the things that matter most to people. We continue to put equality and diversity at the heart of all we do. That’s why we made equality and diversity a key principle of our equality, diversity and inclusion strategy.