Nurse agencies have existed for many years to supply qualified nurses to private individuals and to healthcare establishments. In Scotland they have been licensed by health boards under the Nurses (Scotland) Act 1951. This Act made provision for agencies to be regulated in relation to:
- the qualifications of the person who runs the agency;
- storing and keeping records;
- paying nurses; and
- matching skills to positions.
Under this legislation, local health boards carried out annual inspections and collected the licence fee.
Over the years, nurse agencies have become an important staffing resource for all grades of qualified and unqualified staff for the NHS (Scotland) and independent sector healthcare providers, in both the acute and continuing care sectors.
The Nurses (Scotland) Act 1951 has been repealed by the Regulation of Care (Scotland) Act 2001 ('the Act'). Regulation of nurse agencies transferred to the Scottish Commission for the Regulation of Care ('the Care Commission') in April 2002.
The national care standards
Scottish Ministers set up the National Care Standards Committee ( NCSC) to develop national standards. The NCSC carried out this work with the help of a number of working groups. These groups included people who use services, their families and carers, along with staff, professional associations, regulators from health and social care, local authorities, health boards and independent providers. Many others were also involved in the consultation process.
As a result, the nurse agencies standards focus on outcomes for the person who receives nursing care. They describe what the service user (that is, the organisation who pays for the service or the individual who pays for the service) can expect from the nurse agency.
The standards are grouped under headings which follow the person's journey through the service. These are as follows.
Using the national care standards
Nurse agencies and their customers will use the standards to find out what is expected of them in offering support and care services.
National care standards have been developed for all care services. The focus of the standards is on the quality of experience of the people using the service. However, the position of nurse agencies in relation to these standards will differ from direct care providers, because a lot of their work will involve supplying staff to other care services that are registered by the Care Commission. The managers and staff of nurse agencies will need to be aware of the standards that are relevant to any service that is registered by the Care Commission to which they are supplying staff. For example, a nurse agency may be asked to provide nursing staff to a care home that is regulated by the Care Commission.
The quality of the communication and monitoring systems will be an important way of making sure that nurse agencies can provide a service that allows the organisation to meet the national care standards against which it is inspected.
Many nurse agencies combine their business with providing home nursing and home care to individuals living at home. Care home services have been regulated by the Care Commission since December 2003. Therefore, nurse agencies that offer nursing care and care at home will have to meet the standards for nurse agencies and the standards for care at home.
The principles behind the standards
The standards are based on a set of principles. The principles themselves are not standards but reflect the recognised rights people enjoy as citizens. These principles are the result of all the contributions made by the NCSC, its working groups and everyone else who responded to the consultations on the standards as they were being written. They recognise that services must be accessible and suitable for everyone who needs them, including people from black and ethnic minority communities. They reflect the strong agreement that your experience of receiving services is very important and should be positive, and that you have rights.
The main principles are dignity, privacy, choice, safety, realising potential and equality and diversity.
Your right to:
- be treated with dignity and respect at all times; and
- enjoy a full range of social relationships.
Your right to:
- have your privacy and property respected; and
- be free from unnecessary intrusion.
Your right to:
- make informed choices, while recognising the rights of other people to do the same; and
- know about the range of choices.
Your right to:
- feel safe and secure in all aspects of life, including health and wellbeing;
- enjoy safety but not be over-protected; and
- be free from exploitation and abuse.
Your right to have the opportunity to:
- achieve all you can;
- make full use of the resources that are available to you; and
- make the most of your life.
Equality and diversity
Your right to:
- live an independent life, rich in purpose, meaning and personal fulfilment;
- be valued for your ethnic background, language, culture and faith;
- be treated equally and to be cared for in an environment which is free from bullying, harassment and discrimination; and
- be able to complain effectively without fear of victimisation.
The Scottish Commission for the Regulation of Care
The Regulation of Care (Scotland) Act 2001 ('the Act') set up the Care Commission, which registers and inspects all the services regulated under the Act, taking account of the national care standards issued by Scottish Ministers. The Care Commission has its headquarters in Dundee, with regional offices across the country. It will assess applications from people who want to provide nurse agencies. It will inspect the services to make sure that they are meeting the regulations and, in doing so, will take account of the national care standards. You can find out more about the Care Commission and what it does from its website ( www.carecommission.com).
The Scottish Social Services Council
The Act created the Scottish Social Services Council ('the Council') which was established on 1 October 2001. It also has its headquarters in Dundee. The Council has the duty of promoting high standards of conduct and practice among social services workers, and in their education and training. To deliver its overall aims of protecting service users and carers and securing the confidence of the public in social services, the Council has been given five main tasks. These are: to establish registers of key groups of social services staff; to publish codes of practice for all social services staff and their employers; to regulate the conduct of registered workers; to regulate the training and education of the workforce; to undertake the functions of the National Training Organisation for the Personal Social Services. The Council has issued codes of practice for social service workers and employers of social service workers. These describe the standards of conduct and practice within which they should work. The codes are available from the Council website ( www.sssc.uk.com).
How standards and regulations work together
The Act gives Scottish Ministers the power to publish standards which the Care Commission must take into account when making its decisions. It also gives Scottish Ministers the power to make regulations imposing requirements in relation to nurse agencies.
The standards will be taken into account by the Care Commission in making any decision about applications for registration (including varying or removing a condition that may have been imposed on the registration of the service). All providers must provide a statement of function and purpose when they are applying to register their service. On the basis of that statement, the Care Commission will determine which standards will apply to the service that the provider is offering.
The standards will be used to monitor the quality of services and their compliance with the Act and the regulations. If, at inspection, or at other times, for example, as a result of the Care Commission looking into a complaint, there are concerns about the service, the Care Commission will take the standards into account in any decision on whether to take enforcement action and what action to take.
If the standards were not being fully met, the Care Commission would note this in the inspection report and require the service manager to address this. The Care Commission could impose an additional condition on the service'registration if the provider persistently, substantially or seriously failed to meet the standards or breached a regulation. If the provider does not then meet the condition, the Care Commission could issue an improvement notice detailing the required improvement to be made and the timescale for this. Alternatively, the Care Commission could move straight to an improvement notice. The Care Commission would move to cancel the registration of any service if the improvement notice does not achieve the desired result. In extreme cases ( i.e. where there is serious risk to a person'life, health or wellbeing) the Care Commission could take immediate steps to cancel the registration of any service without issuing an improvement notice.
Regulations are mandatory. In some cases not meeting a regulation will be an offence. This means a provider may be subject to prosecution. Not meeting or breaching any regulation is a serious matter.
Decisions by the Care Commission on what to do when standards or regulations are not met will take into account all the relevant circumstances and be proportionate.
You can get information on these regulations from the Regulation of Care (Scotland) Act 2001, which is available from the Stationery Office Bookshop. You can also see the Act on-line ( see Annex B for the address).
You can also see the Scottish Statutory Instruments for the Regulation of Care Regulations 2002 on-line ( see Annex B for the address).
If you would like to comment on these standards you can visit our website and send a message through our mailbox:
You can also contact us at:Care Standards and Sponsorship Branch
Community Care Division
Primary and Community Care Directorate
St Andrew's House
Tel: 0131 244 5387
Fax: 0131 244 4005