• Staffing level tools are designed to provide numerical information based on people’s needs.
• The tool must include information based on the professional judgement of staff. This information may be numerical or based on conversations and observations. The tool should be designed to include an assessment of people’s needs and wishes in order to accurately identify the level of staffing required at a particular time.
• Quality assurance systems are used to monitor staffing, dependency assessments and outcomes for people who experience care.
• Services are confident the staffing level tool demonstrates the right skill mix of staff to support and care for people in a person-centred way.
• Staff schedules and rotas provide evidence that staff skills and experience ensure the choices and needs of people are met.

Most adult care homes use a staffing level or dependency tool to determine baseline staffing numbers. We collect information from care homes about the tools they use. However, we do not, currently, recommend any specific staffing level or dependency tool for use in the social care sector. 

Services must have sufficient numbers and availability of staff, forward planned over a minimum of a four-week period. Providers should consider overall numbers of staff in addition to the knowledge, skills, values, and experiences of staff that enable them to deliver high quality care. Staffing levels should include a mix of staff roles, experience, mentors, and keyworkers to meet people’s needs and wishes.

This part of the staffing method will complement the data generated by the staffing tool.  Any current staffing tool is unlikely to reflect much of the ‘soft’ data described in the paragraph above.  The assessment of staffing therefore needs to include the professional judgement of managers or senior staff who know their staff team, the people experiencing care in the service and daily changing tasks or circumstances.

For example, managers may adapt the staffing assessment to reflect staff who may be undertaking restricted duties due to health or wellbeing factors, or those who should not lone work.

An important consideration in this part of the staffing method will also be the number of staff required to meet the needs and preferences of people using the service, which takes account of the importance of relationships. This would include planning for staff resources required to enable people to connect to their local community and to maintain interests and activities that are important to them.

This part of the staffing method will also assess the staff resources needed to carry out non-direct care tasks, administrative care tasks, meetings, training, and supervision. It will also consider staff availability due to vacancies/staff absence/annual leave or outbreaks of infectious disease and the impact of this on people and staffing for instance. Services should also consider how working with volunteers could enhance outcomes for people experiencing care.

This part of the staffing method may highlight challenges and actions required to achieve high quality care and outcomes for people. It may also highlight difficulties with maintaining staff wellbeing, work-life balance, or staff retention. The Health and Care (Staffing) (Scotland) Act 2019 Act aims to promote transparency in staffing and support an open and honest culture throughout health and social care. The HCSA also seeks to support local decision-making, flexibility, and the ability to redesign and innovate across multi-disciplinary and multi-agency settings. It will therefore be important that every service provider uses the local and national reporting and communication pathways to highlight acute or persisting difficulties.

This part of the staffing method considers the impact of the physical environment and of the local context on the assessment of staffing.

Examples of important factors to consider for the assessment of staffing include the size and layout of the building/s, range of private and communal spaces, accessibility of different areas of the service, access to a safe outdoor space. Other factors that impact on staffing will be the setting. Has the service designed or adapted for high quality care and support taking account of good practice guidance such as the King’s Fund tool for people with dementia, ‘Living in the community’ and ‘Building Better Care Homes’.

All of the examples listed above have an effect on staff’s ability to observe and spend time with people using different areas, communicate well with colleagues and support housekeeping and care of the environment. Many of these factors will also affect the ability of people experiencing care to do things independently.

Evacuation procedures in the event of fire or other emergency situations must be considered in the staffing assessment.

The local environment and impact of geographical location can be important factors in decisions about staffing. Examples include the local travel infrastructure, availability of bank or agency staff and access to community resources and connections.

Consideration of the local context also includes the availability of volunteering opportunities for those visiting the service and those in the local community.

The guiding principles of The Health and Care (Staffing) (Scotland) Act 2019 are to provide safe and high-quality services, and to ensure the best care outcomes for service users. This part of the staffing method therefore requires services to regularly evaluate the quality of people’s outcomes and to link these evaluations to the assessment of staffing.

To achieve this, and to make it a meaningful process, it will be important to ensure that people’s personal plans are focussed on people’s personal outcomes and that the personal plans are regularly and meaningfully evaluated. People should be supported to fully to express their wishes and preferences with relevant individuals important to them involved in the care planning and review process. For further information please refer to the Guide for providers on personal planning (Adults) in the appendix.

An important part of the regular evaluation of people’s care, and a valuable opportunity to gain information about the link between people’s outcomes and staffing, are well conducted care reviews. Regular care reviews should therefore include conversations about staffing with people experiencing care, families, representatives and, at times, external professionals.

The initial outcomes described in each person's personal plan should be consistent with any outcomes or goals that were specified when the service was assessed and agreed for them. Approaches to risk enablement should take into account any risks identified by the commissioner of the service/placing authority. Significant and substantial changes in support needs that may require adjustments should be communicated to the commissioner/placing authority to ensure that the service remains aligned with the person's needs. 

Providers may use quality assurance processes, regular clinical governance meetings or other, new, and innovative ways to regularly assess and evaluate people’s needs and outcomes.

Self-evaluation is a core part of assuring quality and supporting improvement. Self-evaluation and quality assurance processes will cover most areas of practice in one way or another. Providers should consider how others, (staff, people using the service and their families) are supported to be involved in how a service assures quality including through self-evaluation. A range of regular audits, observations of practice, checks and measurements will produce important information about staffing, either directly or indirectly.

An example of quality assurance showing a clear link to staffing could be a mealtime observation where the observer may see if the number, deployment, and skills of staff support good outcomes for people. Audits for medication, care plans or cleaning may be examples of indirect links to staffing.

Poor records and poor evaluations, with high levels of incident reporting can be symptomatic of problems related to staffing levels, deployment, and skills. The staffing method should therefore always ensure that these possible links are visible, assessed and acted on.

It is important that the staffing method also acknowledges the time required by managers and staff to carry out quality assurance tasks and to evaluate the findings. Sufficient time will also be required to share quality assurance outcomes and to develop, plan and manage necessary changes or improvement ideas.

Our quality frameworks ask three questions for the regular quality assurance and self-assessment cycle:

• How are we doing? This is the key to knowing whether you are doing the right things and that, as result, people are experiencing high quality, safe and compassionate care and support that meets their needs, rights, and choices.
• How do we know? Answering the question ‘how we are doing?’ must be done based on robust evidence. The quality indicators in this document, along with the views of people experiencing care and support, and their carers, can help you to evaluate how you are doing. You should also take into account performance data collected nationally or by your service.
• What are we going to do now? Understanding how well your service is performing should help you see what is working well and what needs to be improved. From that, you should be able to develop plans for improvement based on effective practice, guidance, research, testing, and available improvement support.

People’s views and preferences regarding staffing should be actively sought when planning and delivering care and support, to ensure that the needs and wishes of people experiencing care are understood and valued.

The views of relatives and family carers about staffing arrangements should be collected in a range of ways: surveys, meetings, focus groups, care reviews and conversations. It will be important that there is a meaningful, open, and transparent process of gathering and sharing views and information. The staffing method and the outcomes of staffing assessments should be shared with people in an accessible way and genuine involvement should be encouraged.

Seeking the views of staff is a crucial part of the staffing method. Listening to staff views, concerns or ideas is important to ensure the dignity and rights of people experiencing care are respected and standards and outcomes are high.

Providers should have processes in place to ensure the views of staff have been gathered and how they have informed decision-making. Staff feedback can be collected formally or informally in a range of ways: suggestion boxes, individual and group meetings, focus and peer groups and supervision meetings.

Providers should be mindful of the link between the outcomes of people experiencing care and the wellbeing of staff. Increased staff wellbeing can reduce sickness absence, burnout, and work-related stress, meaning that staff are available to care for service users. Healthy, engaged staff are also better able to provide safe and high-quality services. In some situations, staff will be working in challenging environments which may increase risks to their wellbeing. The regular processes to exchange views mentioned above should also be used as opportunities to discuss and check on staff wellbeing.

The Health and Care (Staffing) (Scotland) Act 2019 promotes appropriate multidisciplinary working within the context of ensuring that people experience the highest quality of care.

The Scottish Government Healthcare Framework for adults living in care homes collaboration and partnership working with professionals from health and other disciplines as vital for the quality of people’s care. Multidisciplinary professional input supports positive outcomes for people. The observations of professionals visiting the home and their advice on the implementation of good practice interventions can offer valuable insight in staffing strengths or weaknesses.

This part of the staffing method asks providers to ensure that feedback from professionals is heard, captured, and used to inform the assessment of staffing. There should be proactive processes to seek feedback about staffing, which could be done in various formal and informal ways.

Positive risks, based on human-rights, enables person-centred support as outlined in the Health and Social Care Standards. An enablement approach should be used to ensure a level of risk is understood and managed by both people using the service and staff who support people to achieve their outcomes. It is about making it possible for people to make choices about risks that they choose to take and make sure that staffing levels and skill mix do not restrict people unnecessarily. For example, enabling people to make a cup of tea or spend time in the garden.

Providers should consider the ways in which people are supported with managing risks and the potential impact on staff numbers, deployment, and skill mix.

This will include risks to the health and wellbeing of staff, staff resources and deployment to support people and minimise the occurrence of adverse events. For example, the service should ensure they have sufficient staff to follow any arrangements, policies or procedures relating to health and safety.

It is important that providers are aware of current guidance and standards relevant to providing safe and high-quality services, and to ensuring the best health care or care outcomes for service users. Following evidence-based good practice guidance may have an impact on the assessment of staffing.

A current example of this would be the approach to stress and distress experienced by people living with dementia. A person-centred approach may be more time and staff intensive than outdated, reductionist and medication reliant approaches. This is because staff time will be required to carry out meaningful assessments, work with relatives and professionals on implementing and frequently revaluating person-centred plans and on implementing them consistently.