Creation of a National Care Service

Creation of a National Care Service

The Scottish Government is proposing a new law to create a National Care Service. Currently, social care and social work services are funded and delivered by local authorities through Integration Joint Boards, which are a partnership between local authorities and NHS health boards. The new law proposes to reorganise how these services are funded and delivered by creating new care boards that are directly accountable to and funded by Scottish Ministers. These new care boards will replace the existing Integration Joint Boards. The proposals would allow Scottish Ministers to have overarching responsibility for the National Care Service and give them powers to transfer social care functions from local authorities, to include aspects of healthcare in the National Care Service, and to transfer staff, property and liabilities If you agree with these proposals in the National Care Service Bill click the thumbs up button (👍) below. If you disagree with these proposals click the thumbs down button (👎) below. If you are unsure about the proposals and feel you need to know more about them click the question mark button (❓) below. If you have any additional comments about this proposal please provide them in the comment section below.

Points

Carer representatives have expressed concern that the Bill does not explicitly mention the role that unpaid carers will play in the design and delivery of the National Care Service. While we understand that this is a framework bill and there will be more details provided in regulations and guidance, the role of statutory stakeholders is mentioned throughout the Bill, leading unpaid carers to the conclusion that they will still not be viewed as equal partners in the new structures

We understand that the process for the appointment of members to Care Boards may take a public appointment approach. This is concerning as our report Equal, Expert and Valued shows that Integrated Joint Boards (IJBs) already struggle to appoint unpaid carers, so making this a more challenging process will have an impact on unpaid carer involvement. ‘We presently lack proper representation of member of the public on boards. This may result in further problems as people won’t want to go through the process’.

It is does not explicitly state that Care Boards will replace IJBs, although this is clearly the intention and there is no information on the transition period, including timescales, transfer of functions and membership. For example, will the carer representatives on IJBs transfer to become members of the Care Boards? This uncertainty and anticipated additional workload has added further pressure to the role and, as a result, some unpaid carers are considering stepping down.

We as a group are concerned that services needed in rural areas with less population will not be looked at favourably, possibly the differing needs may be overlooked and be economically driven. Most of Scotland is rural and only the central belt is highly populated where services are more cost effective. It is important that integration between health and social care continues to develop ensuring an holistic approach to looking after those in need.

Many IJBs are failing and health boards do not pay their fair share of funding. Care boards need representatives from those that currently manage funding under type 1 arrangements on behalf of those in receipt of social care funding. Where good arrangements are made by family members responsible for financial and legal matters this should continue and will relieve the pressure on the new boards.

I think this would centralise services and remove many anomalies in the current provision of services across the country

If properly funded and monitored there is no reason why local boards - IJB's - cannot continue. But they must be funded properly, and some members given more powers rather than be present as observers (i.e. a vote)

This should allow for equality of service. At the moment the support provided varies considerably between local authorities.

The partnership between local authorities and the NHS has not been particularly successful, with adult social services in our region in what seems to us as service users, to be in a state of chaos .Too many gate keepers and not enough experienced Social Workers in the community.

I work for Edinburgh council care home service it is an excellent service and staff are treated fairly for our hard work and professionalism.. I would be against being transferred to a private care provider as my terms and conditions of employment would be much worse. I have more than 32 years experience in health and social care this is unfair. It is would also give a much worse standard of care to our residents I have worked in the private sector as a nurse and can wholeheartedly evidence

Our local Authority provided good care facilities until about 10 years ago and it has deteriorated since then. I am 79 and have cared for severely disabled daughter for 51 years. If this proposal improved our lot I would welcome it despite preferring local accountability. There are lots of questions. where are the staff and the buildings? My daughter requires medical and leaning difficulty care and we have nowhere to turn to here. Crisis management seems to be all that is on offer.

How will Scottish Ministers be trained so they know what standard good person centred care looks like ? Will they have the time to oversee training and employment standards?

Good arrangements need to continue

Hopefully this would provide a more equal approach, preventing the provision of care being at the political whim of individual councils.

In principle, the creation of a National Care Service could be of benefit, the IJB’s are not effective. However, Scotland does not have a good record of organising funding at a national level, and this is too important an area to get wrong. Social work and care services are the ‘poor cousins’ to the health service, and the value of carer services is not recognised. There is a fundamental reliance on unpaid or family carers, which is not recognised and extremely undervalued.

Many discontents argue this will deny local accountable, via locally elected councillors. I welcome this as it will provide a Nationwide Service which guarantees people's human rights, incl. freedom of movement. it will also ensure equality of service quality. However, discussions still need to be had on how the Minister will choose board members

I agree since with Scottish Ministers having overarching responsibility this in turn comes with direct accountability too.

Creating bureaucracy with said costs when we should be improving the current system we have

Comment from Young People, Thistle Foundation visit to Parliament, 26/7/22: We need more information, but the creation of the NCS is potentially a good thing, as it will provide the same policies and care to everyone. Think it is good, being fixed, not varying from Council to Council, streamlined, centralised system. More consistency from one service to another. Takes away a postcode lottery. More inclusive. Support varies from one part of Scotland to another. This might provide equal opportunities. All areas should be equal. Been tested, end result is accessible to all, regardless of background. Centralisation might give the government too much control. Would the NCS be pitched at the good support level? What would minimum level of care look like?

It will take away the postcode lottery of the level of care your council provides

NCS Bill will create c £ 25 billion extra cost in a decade The Financial Memorandum is incorrect. Realistic estimates of additional costs of the NCS and its impact are per year - (i) Disruption and friction, effort, risk and cost of NCS £ 550 million (ii) Additional costs borne by unpaid Carers £ 650 million (iii) Social infrastructure damage to employers, employees £ 400 million (iv) Direct costs of changes and additional staff £ 300 million The NCS Bill will create c £ 25 billion extra cost in a decade

Services are on their knees and we do need radical change. I do worry we will spend the next decade and a shedload of money on a restructure that will result in lots of experienced people leaving the service (no doubt on packages) and wont result in an extra penny going to the frontline of care where it’s really needed. I am also concerned it will result in more privatisation which in my experience has not benefitted people who need social care support at all. But if it’s going ahead, please concentrate all your energies on the frontline and getting the basics right and ensure we retain capacity in the public and voluntary sectors too - otherwise the private sector companies registered offshore and using every financial trick in the book have you over a barrel.

I have noticed that I can’t read longer comments here. Can you check with the IT people to ensure we can expand the comments or limit the length to what is seen?

I welcome this proposal. However, more discussion has to address the relative power dynamics between the various members. There needs to be further discussion/ input to enable true co-production take place; i.e. help to non-professional people to gain the same meaningful influence as professionals; incl. providing additional support to unpaid carers and those with lived experience, and holding meetings in different formats.

I fundamentally oppose removing these services from local authorities. Many of the problems with delivering quality services has been due to chronic underfunding for many years. No system is perfect but doing a total redesign is time consuming, wasteful and with no guarantee that adequate funding ensues. Accountability will be lost to locally elected councils. Whilst I support many of the principles outlined in the bill, delivering their outcomes is likely to be hugely problematic. Undermining local authority social services is the issue here. Most councils know their health and education colleagues well and can deliver quality services if funded properly.

Personally speaking as one who for many years have taken a keen interest in health matters, having been part of many patient groups, a public member of the base commission, later the base inspectorate and currently a public partner in local group and attended or local IJB. Also, I was for a number of years carers for a neighbour and then my late husband when his health broke down. I do hope the new service will be properly funded. I would like to enquire how many boards there will be and where they’ll be located?

Still not 100% convinced this is the correct way to go! I can see good-ish points but also areas where things could go downhill quickly

IJB's don't seem to have worked, and I cant remember what came before those in an attempt to get Health and Social Care to work together. Social Care needs investment, which would hopefully prevent people having to access Health services. However Health Boards, I presume, are loathed to divert funds, to truly invest in Social Care.

Group discussions with 10 unpaid carers, 6 Carers Centre staff and 4 health and social care professionals: 7 for, 2 against and the rest undecided. Although many liked the idea of having consistency across Scotland, and giving equal respect to care services as to health services, there was real concern about implementation. Health & social care partnerships were supposed to solve many issues but have added a layer of bureaucracy without service users seeing improvements. Many also mentioned other big reforms like Curriculum for Excellence and the centralisation of police services to demonstrate how big ideas can be difficult to implement in practice. Questions were also raised about funding.

It is not clear to me from the proposed bill how the expense associated with reorganising operations, integration with the NHS, funding, delivery and the centralisation of control and accountability by government ( far removed from delivery) will improve outcomes for people who need services in the short or medium term. Underfunding has hampered true integration between health and social care - what will change under the proposed NCS? Far more evidence is required on how practically this shall be implemented, the risks assessed and mitigations required, detailed overall costs and benefits and ultimate benefit to people who need care demonstrated before decisions can be made.

@Cathie Russell: Thank you for raising the issue of shortened comments. I can confirm that we receive all comments in full and these will be analysed at the end of the engagement exercise. The service providers for the site are looking into a solution. Thank you for engaging with the Scottish Parliament.

The Carers Collaborate is a forum for carer representatives on IJBs. It is facilitated by the Coalition of Carers in Scotland. The forum met in August to discuss the Bill and had the following questions about plans for a National Care Service • Will Care Boards be subject to independent monitoring instead of self-assessments? Will the responsibility for monitoring sit with Ministers? And will the codesign process have an ongoing role to play in independent monitoring? • How will the new NCS help improve the integration agenda e.g. integration of digital records and moving towards shared assessments (involving statutory and voluntary sector).

The Carers Collaborate is a forum for carer representatives on IJBs. It is facilitated by the Coalition of Carers in Scotland. The forum met in August to discuss the Bill and made the following points about the National Care Service Bill The key criticism of the Bill is that the proposals lack detail, and it is impossible to articulate an informed response on their merits or deficits while they are in an amorphous state. Given the importance of the parliamentary process in scrutinising draft legislation and mitigating against unintended consequences, there are real concerns that the legislation may not deliver its stated aims. This lack of detail is also hampering local discussion. Many carer representatives on Integrated Joint Boards (IJBs) are reporting that discussions at a local level are being hindered by the lack of detail in the Bill. This is concerning, as there will be a lack of preparation for involvement at local level if IJBs are waiting until regulations are produced. This is creating a catch-22 situation at local level – local areas are waiting for more detail to be able to have discussions, but the detail might not come until regulations are developed. This lack of discussion and preparation is concerning ‘it feels like being on the Titanic with the iceberg approaching but no-one engaging’.

The Carers Collaborate is a forum for carer representatives on IJBs. It is facilitated by the Coalition of Carers in Scotland. The forum met in August to discuss the Bill and made the following points about the creation of a National Care Service A balance must be struck between centralisation and localism. While national standards and accountability can drive improvements, decisions must be made as close to people and communities as possible. This is particularly the case for rural and island communities who must have representation within the structures of the National Care Service. Carer representatives were concerned that the government’s proposals are too focused on structures and processes and not human rights and enabling people to live their best lives. The involvement of unpaid carers, including young carers, and people with lived experience as equal partners in the new structures and processes, both nationally and locally is a prerequisite to improving social care. The development of a National Care Service will require considerable investment. Carer representatives were clear that they wished to see the majority of additional resources made available for the reform of social care being directed to frontline services.

Many unpaid carers have expressed the view that unpaid carers must be full members of the local Care Boards and the National Care Service Board, with voting rights. This should be included on the face of the Bill.

The Bill allows for Care Board members to receive recompense for their involvement. We welcome this development. Many unpaid carer representatives on IJBs undertake the equivalent of a full-time job, with no financial payment. In fact, many have to subsidise this role as they don’t receive full expenses such as replacement care, or they lose out on earned income when they attend meetings

The Bill does not mention how housing will fit into the National Care Service plans. Will local care boards include representation from housing services? The lack of suitable housing is a huge barrier to independent living for many older and disabled people. If local care boards don’t work in partnership with housing, these issues will not be addressed

For the proposed system to work, it will require strong monitoring and intervention from SG when things go wrong, strong user and carer involvement, a localised approach and easy remedies for those who use the system. Many of the principles eg human rights compliance should be reflected currently - so something needs to change if these principles are to be translated into practice. In particular the Care Service charter needs to have teeth. New rights need to be created. The chair of each care board should be appointed by board members. Similarly, consultation on strategic plan should involve carers and users as well as community planning partners before public consultation. Stronger obligations to reflect views of users and carers in policy development is essential. The number of boards should equate to current local authority boundaries to ensure a local approach. Care must be taken to ensure that no barriers to support arise from care board boundaries - assessments may be standard but provision in different areas may not be. Boundaries should not be a bar to accessing the most appropriate care provision. Finally my preference would be for the Boards to be called "Social Care" Boards to emphasise the distinction from health. The Boards will need to address all social care needs - not just those that impact on health and delayed discharge.

I have serious concerns about setting up a National Care Service. Your track record on centralising services is abysmal. Services should remain with the local authority and with the local community, they are best placed to provide what is required. Our local HSCP is very good, use that as a template as best practice for others, there is no need to nationalise. I can only foresee inefficiencies and poor judgement (because you are so far removed) from this proposal. The problems during Covid in care homes was not caused by local HSCPs, it was caused by top down, poor and confusing messages from Government. Please don’t make a further mess. If you have to do this, listen to others and their expertise instead of your usual minds made up beforehand and political point scoring. Finally implement Anne’s Law immediately and make sure it’s unambiguous. Thank you.

The group felt that overall, the National Service could be a good development if as a result of its inception there is more consistency and improvement of provision and experiences particularly those experienced by Kinship families where there is no or little consistency at the moment.

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