New health and social care standards 'not sufficient' to improve conditions, says Scottish Care CEO

The National Health and Social Care Standards are not sufficient to improve conditions for health and social care service users, according to Scottish Care’s chief executive Dr Donald Macaskill.

Although Macaskill lauded the introduction of human rights-based standards for health and social care as “profoundly significant”, he argued that the new standards will not make much difference to service users unless extensive changes are made to the way in which social care contracts are awarded.

Speaking at Holyrood’s event on the subject on Wednesday, Macaskill expressed particular concern over the continued use of competitive tendering and fifteen minute appointments, both of which he alleged undermined the commitment to human rights in social care.

He said: “Is it a human rights-based system that we allocate the care and support of some of our most vulnerable citizens by a mechanism which is competitive tendering, where we calculate the weight of rights by the seconds and the minutes?

“You cannot claim to a human rights-based system of standards if the way you commission social care is in itself deceptively acting against those human rights.”

Discussing the emphasis on compassion in the new guidelines, Dr Fiona Wardell, Standards and Indicators Lead at Healthcare Improvement Scotland, told delegates that staff are under pressure and often “pushed for time”.

In these situations, she said, “compassion unfortunately sometimes is a widow of time”.

Macaskill also criticised the “perversity” of the standards being more deeply embedded in social care than they are in health.

He said: “I spend a lot of my time in clinical settings, and you talk about the human rights-based national health and care standards and get blank faces.

“I experience far too many clinicians, far too many general practitioners, far too many AHPs [allied health professionals] who know nothing about these rights.

“There’s a perversity that if we’re wanting to create a whole-system approach to human rights, that we’ve addressed the low-lying fruit, which is the social care sector.

“Unless we start to, in this coming year, embed human rights into the heart of the NHS then we will have failed.”

He noted that better communication and training for front line staff was needed if this was to be achieved.

Macaskill stated that the rhetoric around human rights needed to undergo a fundamental change if the new health and social care standards were to have any significant effect.

He said: “We need to bring human rights home. We need to start talking about human rights and not being apologetic about using that language, because unless they are rooted in ordinary living and discourse, they will become the interest of a minority group, whereas they should be the lifeblood of all civic society.”

Macaskill also argued that in order for the new standards to make a significant difference to health and social care service users, similar standards had to be implemented in every area of Scottish political life, including education, criminal justice and taxation.

He said: “There’s absolutely no point in coming up with a human rights set of standards after you have made primary decisions around how as a society you are going to spend your money or you are going to raise taxes, etc.

“So human rights have to speak to education, they have to speak to our reform of the criminal justice system, and they have to speak to the way in which police are organised in Scotland, as much as they have to speak to social care and health.”

In spite of his multiple criticisms, Macaskill was optimistic about the progress that has been made so far in implementing the new standards, and urged delegates to be “evangelical and passionate” about changing the health and social care system to benefit service users.