Variations around the skills mix in care homes
Care homes for older people
The Care Inspectorate is aware of the challenges faced by some care providers on the recruitment and retention of nurses in the care sector. Some care providers have approached us about reconfiguring their staffing model, to develop the role of their senior care workers so that they can deploy their nurses more effectively and in some cases reduce reliance on agency nursing in order to promote more stable staff teams.
The Care Inspectorate recognises and strongly supports the role that nurses play in many care homes, particularly in providing clinical leadership and planning care for residents. We are also keen to support innovation in care that reflects changing needs and demands, where this improves outcomes for service users.
Where care homes for older people are proposing to vary the skills mix in a care home, and this would require a change to staffing schedules, we will consider proposals through our registration variations process. We expect such proposals to improve the quality of care for residents. We will ask care homes to provide us with specific information to support the variation request.
If agreed, we may place specific time-limited conditions on the registration of the service. We will expect any such initiative to be evaluated by the care home provider, before consideration is given to confirming these arrangements as permanent. Where a variation is agreed, the next inspection of the care home is likely to look at all quality themes, even if the home has been performing at a high level for some time.
Prior to submitting your variation, the registration team will be able to advise on what actions you should be taking to support your application. This should include engagement with local commissioners, as well as with residents and relatives and the development of a plan to evaluate the impact and effectiveness of your initiative. Please note, cost saving will not be an acceptable reason for application.
National Preventive Mechanism
The Care Inspectorate is a member of the National Preventive Mechanism (NPM), a group of organisations designated to monitor the treatment and conditions of those people who have been deprived of their liberty.
The NPM’s Eighth Annual Report was published on 20 February 2018. It gives an overview of members’ work monitoring detention across the UK from 1 April 2016 to 31 March 2017 and the NPM’s joint, thematic work on transitions and pathways between different detention settings.
The NPM was established pursuant to the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). OPCAT is an international human rights treaty designed to strengthen the protection of people deprived of their liberty, including requiring each state party to set up a national level body (known as a National Preventive Mechanism) that can support efforts to prevent their ill treatment. The aim of an NPM is to prevent torture and other cruel, inhuman or degrading treatment or punishment from taking place.
Central to OPCAT is the idea that a system of regular, independent visits to places of detention can serve as an important safeguard against abuses, and prevent torture and ill-treatment in places that by their very nature fall outside the public gaze.
Specific requirements of an NPM
To comply with OPCAT, members of the National Preventive Mechanism, such as the Care Inspectorate, must have certain powers. These include the power to:
- inspect all places of detention
- access all information relating to detainees
- interview detainees in private
- choose where to visit and who to speak to
- make recommendations based on human rights norms to relevant authorities
- make proposals and observations on existing or draft legislation.
The Care Inspectorate has these powers in respect of secure care for children. We also work closely with HM Inspectorate of Prisons in Scotland and support some of their inspections.
They recently published Isolation in Detention guidance. The guidance provides a framework that NPM members will apply when examining the issue and making recommendations, and aims to improve consistency of approach. It allows NPM members to identify and promote good and improved practice.
The UK’s National Preventive Mechanism
The UK ratified OPCAT in 2003, expressing its commitment to prevent torture and ill-treatment in places of detention.
The UK’s National Preventive Mechanism was formally designated in 2009 and is now made up of 21 member organisations whose official functions include monitoring and inspecting places of detention.
Across the UK, different detention settings are visited or inspected by different NPM members. The UK NPM is coordinated by HM Inspectorate of Prisons and decision-making is guided by a steering group, which is made up of representatives from NPM members in the four nations.
Each NPM member has a different mandate, powers and geographical remit, and sets its own priorities for detention monitoring as well as contributing to joint NPM priorities.
The Care Inspectorate is actively involved in the UK NPM work, including involvement in three of its four sub-groups:
- Mental Health Network
- Children and Young People’s sub-group
- Scottish sub-group.
Scotland
The Scottish members of NPM are:
- Care Inspectorate
- Her Majesty’s Inspectorate of Constabulary in Scotland
- Her Majesty’s Inspectorate of Prisons for Scotland
- Independent Custody Visitors Scotland
- Mental Welfare Commission for Scotland
- Scottish Human Rights Commission
The Scottish sub-group coordinates NPM activities in Scotland, provides support to NPM members, raises the profile of the work of the NPM and improves liaison with the Scottish Government. It is chaired by the Scottish member of the Steering Group, currently the Mental Welfare Commission for Scotland.
Why your annual returns are so important
Why your annual returns are so important
Every year in January and February, we ask care service providers to complete an annual return. It asks for a great deal of information about your service and the people who use it. It is important to know why you are asked for this information, and what we do with it.
First and foremost, the information you provide in the annual return helps us understand your service. This means inspectors are able to plan and prepare for effective inspections that are focused appropriately.
Not only is the annual return important for planning and focusing inspections, but the information you also give provides a national picture, which can help the us and other partner organisations in a number of ways.
Annual returns will be available between 6 January and 2 March 2025 and should be completed online through our eForms system. Services can log in to their Care Inspectorate eForms account from any computer connected to the internet. The closing date includes an extension of two weeks on our usual six-week deadline.
Even inactive services must submit an annual return.
If a service was registered on or after 1 October 2024, it should try to complete an annual return this year. Although it is not mandatory for these services, any information supplied will be used by the Care Inspectorate and Scottish Government. The information entered this year will automatically appear in the December 2025 annual return and only information that has changed will need to be entered.
Benchmarks and comparisons for inspectors
Inspectors can compare a service they are looking at with national averages to identify potential issues. For example, if the inspector is preparing to inspect a service with higher staff turnover than average, when they inspect, the inspector might look at the impact this could have had on the quality of care and outcomes for people using that service.
Publishing statistics
We also publish statistical reports of some of the annual returns data. We also use the annual return data to inform many of our other publications such as:
National policy makers (the Scottish Government) can use these summaries and publications to shape and evaluate national policies and providers can see how their service compares with other services.
Supporting improvement
The intelligence we gather through annual returns helps us target our improvement activity and support within social care. It is a great source of baseline data across a variety of health and wellbeing indicators which we use to identify, drive and track improvement, for example infection control, nutrition and the recruitment and retention of staff. The data also helps us to identify trends and topics by both geographical area or service type, so that we can see where best to focus our improvement support work, for example, improvement workshops or new resources and guidance for care services across the sector.
Reducing duplication and sharing information
We also share information with other public bodies to reduce duplication and the costs of data collection for both the taxpayer and the people providing data. For example, anonymised staffing information is shared with the Scottish Social Services Council, so they can develop intelligence about the workforce without having to collect additional data from care services.
If you need help accessing the annual return, you can call our contact centre on 0345 600 9527 or read our frequently asked questions (to follow).
About us
How we are organised
We work in four teams: adults, children, justice and protection.
Each team is led by a service manager and we report through two chief inspectors to the Executive Director of Scrutiny and Assurance.
We are supported by a team of strategic support officers who provide support and co-ordination to all our scrutiny activities.
What we do
These are the core functions of the strategic inspection team.
- Carrying out strategic inspection work.
- Quality assurance functions – monitoring the completion and quality of:
- Learning reviews (significant case reviews) in relation to children and adults.
- Serious incident reviews (SIRs) in relation to people on community payback orders, drug treatment and testing orders and people supervised on release from prison.
- Investigations into the deaths of looked after children.
3. Providing support to local authorities and partnerships through our link inspector role.
Who we work with
We know that outcomes for children and adults are affected by many factors.
Different services and organisations are involved in providing care and support to vulnerable children and adults and in most cases, social work services are planned and delivered in collaboration with partners.
We also understand that children and adults are all different, with a wide range of life circumstances and experiences.
For this reason, we do not carry out our scrutiny work in isolation but in partnership with children, adults and other organisations. This helps us to be confident that we are taking all relevant factors into account in our scrutiny work.
Inspection volunteers and people with lived experience
Wherever possible, we involve people with lived experience of using services, or of caring for someone who does, in our scrutiny work. We know that this keeps us grounded and often makes it easier for children and adults to share their experiences with us.
The Care Inspectorate has an involvement team that recruits and supports volunteers to work on inspections across our organisation, including strategic inspections. There is a specific team to support young people with experience of care services, between the ages of 18 and 26.
If you have lived experience of social work and social care services, or care for someone who does, and would like to know more about becoming involved in strategic inspections, please email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Associate assessors
Associate assessors are professionals from statutory and third sector organisations who work at a strategic level and have significant practice or management experience in services for children, adults or justice. They work as part of an inspection team for one inspection.
We believe that including associate assessors brings current practice perspectives to our strategic inspections. They can help ensure we are partnership-orientated and contribute to our understanding of the contemporary picture of service planning and delivery. At the same time, this involvement provides an ideal opportunity to help build capacity for joint self-evaluation and improvement in local partnerships.
Please check our frequently asked questions for more information.
We are not currently recruiting associate assessors. However, if you are interested in becoming an associate assessor, please check our website which we will update when we are next recruiting.
Our scrutiny partners
Many of the functions of planning, delivering and monitoring services for children and young people and adults and older people are carried out by more than one agency or organisation. For example, through community justice partnerships, children’s services partnerships and health and social care partnerships. So, we often collaborate with these other scrutiny bodies.
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Education Scotland
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Healthcare Improvement Scotland
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Her Majesty’s Inspectorate of Constabulary in Scotland
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Her Majesty’s Inspectorate of Prisons for Scotland
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Inspectorate of Prosecution in Scotland
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Audit Scotland
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Mental Welfare Commission
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Scottish Housing Regulator
MAPPA review
The Care Inspectorate and HMICS gave a commitment to work collaboratively with other scrutiny bodies to undertake a proportionate, risk-based and intelligence led review of the multi-agency public protection arrangements (MAPPA) in Scotland. The joint review foccused on Category 1 offenders subject to the Sex Offender Notification Requirements.
The review was published on Thursday 26 November 2015.
The purpose of the joint thematic review was be to assess the state, efficiency and effectiveness of the MAPPA in Scotland, in terms of keeping people safe and reducing the potential risk of serious harm by registered sex offenders in our communities.
The review objectives were to:
- assess how effective the responsible authorities are in the discharge of their statutory duties, under terms of the Management of Offenders etc. (Scotland) Act 2005, including adherence to national guidance and good practice.
- assess how effective the processes are in relation to MAPPA Significant Case Reviews AND the arrangements that are in place to promote organisational learning and development across the responsible authorities.
While the report notes that the number of registered sex offenders in Scotland continues to rise, it also highlights key strengths in the way they are managed by organisations including the police, social work services and the prison service
You can download a copy of the report here and read the press release in our news archive.
A progress review was published in June 2017. You can find the report here.
Medicine waste in care homes
The Care Inspectorate worked with colleagues in NHS Tayside, Scottish Care, Community Pharmacy Tayside and other Pharmacy organisations to reduce inappropriate medicine waste in care homes. Co-production between these organisations resulted in all agreeing a new protocol to ensure only appropriate waste was collected. The project has been successful and we have received positive qualitative feedback from care home managers and pharmacy staff.
Letter sent to care homes in September 2016
Watch our clip below to find out more.
If you need any help or advice in relation to this project please feel free to contact either your community pharmacist or any one of the following individuals:
Staffing schedules
The Care Inspectorate has traditionally issued a staffing schedule to relevant service types at the point of registration. This is a historical practice that has continued from previous regulatory bodies. The issuing of staffing schedules has been reviewed over the years, but the practice of some service types having a staffing schedule remains. We have recognised that the majority of staffing schedules in place do not reflect the changing needs of people who currently use the service. In a time of great change across the care sector, we want to promote innovation and also ensure people experiencs high-quality care and support that is tailored to their needs, rights and choices. High-quality staffing that responds dynamically to people’s needs is essential for this.
We recognise that staffing schedules are prescriptive and that they merely set a minimum standard based on numbers and general assumptions around the needs of the residents at the point of registration, which may have changed significantly since then. The staffing schedules are based on the assumption that services operating at full occupancy. They do not take account of changes in residents’ dependency and capabilities, either among long-standing residents or new people coming to live in the home.
Consequently, we have taken the decision to move away from issuing staffing schedules to enable providers to apply judgement and flexibility in demonstrating how they meet the requirements of the relevant regulation (SSI 210 (15) Staffing) which states that:
‘A provider must, having regard to the size and nature of the care services, the statement of aims and objectives and the number and needs of service users…ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users.’
We will however retain the discretion to impose conditions about staffing, or any other matter, on any individual care service where that is necessary to ensure people experience high quality care.
The legal framework under which services operate is quite clear that the responsibility for assessing staffing according to need lies with the provider of a care service. The Scottish Regulators’ Strategic Code of Practice requires us to be proportionate in our approach and we believe that the safety, health and wellbeing of people who experience care can be enhanced without the issuing of fixed staffing notices at the point of registration.
The removal of staffing schedules will also remove reference to the management arrangements, however Scottish Statutory Instrument (SSI) 210: Regulation 17 (1) (c) – Appointment of Manager states: “A provider who is not, or does not intend to be, in full time day-to-day charge of the care service must appoint an individual to manage the service”. We expect this regulation to be complied with and to see the management arrangements detailed in the aims and objectives for each individual service.
With the removal of staffing schedules, our scrutiny methodology will help provide assurance that the provider has systems in place to assess people’s dependency, regularly and as their needs change. Providers will be required to maintain a daily record of the staffing level and skill mix which results from a dynamic process in relation to the assessment of need and capability.
Quality Indicator 3.3 in the new quality framework for care homes for older people states: ‘Staffing levels are right and staff work well together’. Inspectors can and will evaluate providers systems and processes against this indicator to ensure that there are positive outcomes for people who receive services. We strongly encourage providers to ensure this is part of their self-evaluation and quality assurance systems also.
This approach reflects the Care Inspectorate’s broader shift towards outcomes-focused regulation which seeks to ensure that care and support is responsive to people’s individual needs. Providers of care and support have a clear responsibility to provide effective staffing, and we will continue to ensure through our scrutiny work that this is happening.
From 1 September 2018 we will no longer issue staffing schedules for new registrations. A letter and variation template will be sent to all existing providers for services who have staffing schedules. Between January and 31 March 2019 we will process variations for all providers who return a completed variation template.
It may take some time to complete variations for all relevant registered services. We are therefore unable to give a timescale for completion of individual applications; however, we will endeavour to complete variations as quickly as possible.
Early learning and childcare profiles
Early learning and childcare profiles, by local authority
We have created early learning and childcare local profiles to assist local authority planning for the expansion of early learning and childcare in Scotland.
These profiles are a valuable source of information about daycare of children services in local authority areas. They include information about: number of services and capacity; funded places; trends in children registered; registered children by age; service quality; sessions and opening times; SIMD and urban/rural classification; staffing and vacancies; population estimates and projections; and an early learning and childcare service list of the area.
The profiles focus on those services that provide early learning and childcare (children and family centres, nurseries and playgroups) while our early learning and childcare statistics publication also provides information about out of school care, holiday playschemes and creches.
We welcome any feedback, queries and ideas for improvement for these profiles; please email This email address is being protected from spambots. You need JavaScript enabled to view it.
Early Learning and Childcare Profiles, as at 31 December 2016
Early Learning and Childcare Profiles, as at 31 December 2017
Early Learning and Childcare Profiles, as at 31 December 2018