NATIONAL CARE STANDARDS COMMITTEE (NCSC) MEETING
Conference Room 12, Victoria Quay, Edinburgh,
10.30am, Monday 27 November 2006
Present: Adam Rennie (Chair), Marjory Barquist, Leigh Edwardson, Robert Houtman, Tom Lamplugh (attending for Paper 3 only), Jacquie Roberts, Steven Wilson (attending for Michael Bews).1. Welcome and apologies
1.1 Adam Rennie welcomed everyone to the 20th meeting of the NCSC.
1.2 Apologies had been received from Janie Allen, Irene Audain, Jackie Hughes, Jim Macdonald, Janis Pelosi, Carole Wilkinson.
1.3 The Committee was advised that Margaret Ann Davidson had resigned from the NCSC as the representative for childcare agency service providers. Adam had written to Margaret thanking her for her work on the Committee. There were no plans to replace Margaret as the Committee was nearing the end of its remit.2. Note of last meeting and matters arising
2.1 Matters arising from the last meeting were:
· National Standards for Dental Services. The Committee had been advised at the last meeting that the National Standards for Dental Services would be published toward the end of July. Unfortunately, this timescale had again slipped as it had taken the Executive and NHS QIS longer than expected to finalise publication due to this being a joint document. The intention was to now to publish and distribute the document by end December. A press release would be issued but there would be no formal event to launch the document.
· Revision to the NCS for Adult Placement Services. At the last meeting the Committee had agreed proposals to amend the NCS for adult placement services to restrict the number of individuals that could be placed per adult placement carer at any one time. The Committee had then signed off the final wording for the revision in correspondence in September. The next step would normally be for the proposal to go forward to Ministers. However, having attended a recent National Association of Adult Placement Services (NAAPS) conference, Marjory Barquist advised that further consideration would need to be given to the amendment. She explained that adult placement services are a developing sector and the Executive needed to be careful that the proposed revision would not restrict innovative service provision. Policy colleagues would be consulted on this issue before it was decided whether the revision should be recommended to Ministers.
· Changes to the NCS in relation to OFT recommendations. The Executive was currently drafting a consultation paper setting out proposed amendments to the NCS for Care Homes for Older People in response to the Office of Fair Trading Report on Care Homes for Older People. Revisions were being proposed in respect of price transparency and complaints. The Executive hoped to be in a position to consult on the proposals early next year.3. Paper 1: Revision to the National Care Standards for Independent Healthcare Services
3.1 Marjory introduced Paper 1, which asked the Committee to reconsider the wording of the proposed amendment to the NCS for Independent Healthcare Services.
3.2 The Committee had agreed the wording of the amendment in correspondence in September. Robert Houtman subsequently raised some concerns about the impact of the amendment on the sector, particularly in relation to obesity management. The Executive had taken further advice from professional colleagues, who suggested a revised form of words taking account of Robert's concerns. The revised wording was set out in Paper 1 for consideration.
3.3 Robert explained that he was concerned that the proposed amendment, as currently drafted, could restrict a doctor's ability to prescribe particular medicines. In relation to obesity management in particular, the drugs that were most widely used were not those recommended by the British National Formulary (BNF) and Royal College of Physicians (RCP). However, he advised that these drugs were considered by many clinicians in this field to be a proven and cost effective way to treat obesity. The drugs recommended by the BNF and RCP were effective but much more expensive However, if drug selection was to be solely based on good practice, such as that issued by the BNF, then the ability to prescribe older medicines would be limited.
3.4 Robert was further concerned that if these older, less expensive drugs were not available in private clinics then patients would seek to buy the medication online without the advice and support of a doctor.
3.5 Jacquie Roberts advised that, in relation to the regulation of independent clinics, this amendment would not prevent a doctor from prescribing older medicines so long as the decision to do so was evidence-based and reflected recognised good practice. She highlighted that the GMC, for example, issued guidance for doctors on prescribing unlicensed medicines and the use of anti-obesity medication. She made it clear, however, that the Care Commission was unable to make any judgements in relation to prescribing practices in independent clinics.
3.6 The Committee recognised that this amendment could not be considered solely on the basis of regulating obesity management clinics given that it would apply to all independent healthcare services. It was agreed that if the amendment was likely to have an unfair impact on obesity clinics then the Care Commission would need to discuss separately with service providers how it would regulate against this standard.
3.7 The Committee considered the proposed wording set out in Paper 1 and, following discussion, agreed that the amendment should read as follows:
'The care and treatment you receive from [the service] takes account of all relevant NHS Quality Improvement Scotland standards and reflects good practice based on evidence based treatments, relevant research studies, audit reports, standards and guidelines'.
3.8 Adam advised that the revision would now go forward to Ministers and, once signed off, would be incorporated into the relevant standards at the earliest opportunity. Action: Scottish Executive4. Paper 2: National Care Standards for Independent Medical Consultant and GP Services
4.1 Adam introduced Paper 2, which set out the feedback from the Working Group and Independent Healthcare Panel on the draft National Care Standards for Independent Medical Consultant and GP Services. The Committee was asked to consider the feedback with a view toward finalising the draft standards.
4.2 The main points of discussion were as follows:
4.3 The Committee agreed with the suggestion that, in relation to what services these standards cover, it would be helpful to clarify that the standards do not apply to private consultations carried out in NHS facilities. The Executive would consider this further and, if appropriate, draft a sentence.
4.4 The Committee agreed that it would be helpful if a reference to clinical governance was included in the standards but were unsure whether Standard 2.3 was the most appropriate place. It was agreed that the Executive would look at the standards in relation to clinical governance and consider whether there were any gaps. Steven Wilson thought that the standards covered most issues in relation to clinical governance. He also pointed out that, under Standard 12.4, providers should be providing care and treatment which takes account of NHS QIS standards - this would include clinical governance.
4.5 Following discussion, it was agreed that it would be helpful to make reference to clinical governance in the introduction, under the 'Links with NHS QIS' heading, and also add a definition of clinical governance to the glossary.
4.6 The Committee agreed that individuals should be able to raise concerns not only post treatment, but also at any point before or during their treatment. It was agreed that the Executive would draft a form of words and include it at an appropriate point in the standards.
4.7 Colleagues in Pharmacy Division in the Health Department had advised that, as currently worded, 11.4 was not clear and would probably not be understood by service users, particularly the term 'specialist pharmaceutical treatment'. In view of this, it was suggested that standard 11.4 be reworded or removed.
4.8 Both the working group and the independent healthcare panel had also been asked for their views but could not explain the intent of this standard or why it had been included. Furthermore, the user representative on the working group did not think that this standard would be readily understood by service users and suggested that it be removed.
4.9 Following discussion, the Committee agreed that Standard 11.4 should be deleted as Standard 9 adequately covered the issue of staff being appropriately trained to administer medication.
4.10 This standard sets out what is expected in terms of the safe recruitment of staff who have access to children and young people. In view of the feedback on this standard, the Committee considered whether more was needed in respect of ongoing staff checks.
4.11 Following discussion, the Committee agreed that Standard 9: Staffing adequately sets out what is expected in terms of safe recruitment, including in relation to Disclosure Checks. However, it was noted that this did not cover the issue of ongoing checks. It was, therefore, agreed that the Executive would look at previous standards and consider whether any revision was required. The Committee further agreed that this was an issue for all service users, not just children, and that any amendment should apply to everyone using the service.
4.12 Following consideration of all the feedback received, it was agreed that the Executive would make the necessary revisions to the standards, informed by the Committee's discussions. A revised draft of the standards would then be circulated to the Committee for consideration and sign off in correspondence. Once agreed, the standards would be submitted to Ministers to be signed off for publication. The final version of the standards would also be circulated to the Working Group and Independent Healthcare Panel for information. Action: Scottish Executive5. Paper 3: Review of the National Care Standards
5.1 Tom Lamplugh introduced Paper 3 which invited the Committee to agree the selection of National Care Standards which would form the focus of the review.
5.2 At its meeting in June, the Committee had considered options for a review of the National Care Standards. The Committee had agreed on a focussed approach involving a 360 degree review of the standards, taking account of the views of all relevant stakeholders including services users, providers, regulators and the general public. The review would examine issues such as content, presentation, accessibility, awareness and availability of the standards with a view toward making practical recommendations relating to the future development of the National Care Standards.
5.3 The original proposal was for the 5 sets of standards for adult care homes to form the focus of the review. Members had expressed concern that the scope was too narrow and suggested that it should be revised to comprise a more diverse range of standards.
5.4 With this in mind, and following discussion with the Care Standards and Sponsorship Branch, Tom had put together a revised selection of standards, set out in Paper 3, for consideration. Following discussion, the Committee were content that the revised selection would sufficiently broaden the scope of the review.
5.5 Adam advised that the next step would be to make policy colleagues aware of the proposals to review the standards before submitting the Committee's recommendations to Ministers. He could not give an indication as to when the review might take place but reassured the Committee that the Executive was committed to taking it forward.
Action: Scottish Executive6. Future meetings and remaining work
6.1 Adam advised that once the Committee signed off the doctors standards it would have effectively completed its remit. It was hoped that any outstanding work could be completed in correspondence and, therefore, there were no plans to schedule any further meetings.
6.2 Adam thanked the Committee for all their hard work and advised that he would be writing to them in due course. The Committee would need to be reconvened in some form in respect of the review of the National Care Standards, but with a revised, more broadly representative membership.7. AOCB
7.1 There was no other business.
National Care Standards Committee Secretariat