Scotland

The regulations focus on the quality and safety of care in ways that have implications in relation to staffing levels. There must be, as detailed below, adequate staff to cover for workers who may be off sick, to ensure that there is sufficient time for a proper handover when shifts change. Similarly, the focus in the Regulations on the independence and choice of ‘service users’ implies that there are adequate staff available to offer flexibility and individually tailored care and support.

Under new legislation in Scotland, the quality and safety of care is linked directly to the interests of care workers. The Health and Care (Staffing) (Scotland) Act 2019 (not yet in force) will establish new duties on service providers in relation to staffing. The Act creates new guiding principles for staffing in care settings, which are that:

·      the main purposes of staffing in care services are to provide safe and high-quality services, and ensure the best care outcomes for service users;

·      staffing for care services is to be arranged while taking account of various matters, including: improving standards and outcomes for service users, taking account of the particular needs, abilities, characteristics and circumstances of different service users, respecting the dignity and rights of service users, allocating staff efficiently and effectively, ensuring the wellbeing of staff, taking account of the views of staff and service users, and being open with staff and service users about decisions on staffing, (insofar as any of these matters is consistent with the main purposes).

The provisions set out in this new Act follow the example of the existing regulations in establishing care quality indicators that have direct implications for staffing levels.

Under the Regulations currently in force, service providers must 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’. The Regulation therefore contains an emphasis on both the numbers of staff and their competence.

Breach of this regulation is not an offence and is therefore enforced through the inspection regime.

Once it is in force, the 2019 Act will amplify these duties. The Act will require service providers to ensure that at all times ‘suitably qualified and competent individuals are working in the care service in such numbers as are appropriate for:

·      the health, wellbeing and safety of service users,

·      the provision of safe and high-quality care, and

·      the wellbeing of staff – insofar as it affects either of the above matters.

The Health and Care (Staffing) (Scotland) Act 2019, section 7(1) (not yet in force).

Under the current Regulations, in deciding on the number, type and competence of staff, service providers are required to have regard to the size and nature of the care service, its statement of aims and objectives, and the number and needs of service users.  The 2019 Act will also contain these requirements, placing them into primary legislation.

Breach of the current regulation is not an offence and is therefore enforced through the inspection regime.

The Health and Care (Staffing) (Scotland) Act 2019, section 7(2) (not yet in force).

Under Regulation 15, a provider must ensure that employees receive training appropriate for their role and suitable assistance, including time off work, in order to obtain further qualifications. The requirement to enable employees to take ‘time off work’ has implications for staffing levels, implying that there must be an adequate number of staff to cover for staff who are training.  Similarly, [care workers who are registered with the Scottish Social Services Council] are [required to undertake a certain amount of ‘post-registration training and learning’ (PRTL)]. The amount of PRTL required varies with the role undertaken. At the time of writing, support workers in domiciliary care services were required to do ten days (60 hours) of training over a five-year registration period. This has implications for staffing levels, as employers – who are required to support registered care workers to meet their requirements of continuing registration – must have adequate staffing levels in place to enable care workers to undertake their PRTL.

SSSC, ‘Post registration training and learning (PRTL)’ 

The Scottish Government has published a series of ‘Standards’ which set out its expectations of health and social care services. These Standards have implications for staffing levels, as they cannot be met without adequate numbers of appropriate staff, without consistency in staffing, and they require sufficient staff time to deliver. For example, the Standards contain expectations that:

·      A person’s needs are fully met, and their wishes and choices are respected;

·      Individuals using care or support can have an active life and participate in ‘a range of recreational, social, creative, physical and learning activities every day, both indoors and outdoors’;

·      Individuals ‘can enjoy unhurried snack and meal times in as relaxed an atmosphere as possible’;

·      Individuals are spoken and listened to ‘in a way that is courteous and respectful, with [their] care and support being the main focus of people’s attention’;

·      I feel at ease because I am greeted warmly by people and they introduce themselves.

·      There is time for individuals to be supported and cared for;

·      Care workers respond promptly to an individual’s needs, including when they ask for help.

The Standards are taken into account by the Care Inspectorate in relation to inspections, and registration.

The Standards are published under section 50 of the Public Services Reform (Scotland) Act 2010 and section 10H of the National Health Service (Scotland) Act 1978.