Interim National Care Service Advisory Board: Advice to Scottish Ministers and Council Leaders - Coming Home

Introduction

1. The 2018 Coming Home report and the 2022 Coming Home Implementation Plan aimed to reduce out-of-area residential placements and inappropriate hospital stays. The intention is that out-of-area residential placements are only made through individual, or family choices, and people are only in hospital for as long as they need assessment and treatment.

The Coming Home agenda is jointly owned by the Scottish Government and COSLA, and much work has been undertaken to progress this aim since 2018 – including the establishment of a Dynamic Support Register (DSR). The DSR brings together local and national data to track progress, identify national issues and themes, and support local planning and support.

The latest quarterly data from September 2025 showed that around 1,490 people were recorded on the Dynamic Support Register. Of these, 385 of these were in the urgent category. This is a reduction from 486 people in September 2024. Within this group:

• 66 people were delayed in hospital, down from 85 in September 2024
• 31 people had been in hospital for at least 10 years, down from 44 in September 2024
• 34 people were recorded as being placed inappropriately out of area, compared to 57 in September 2024.
• 180 people were recorded as being at risk of support breakdown, compared to 234 in September 2024

2. Over the same period, the number of people identified for enhanced monitoring increased from 188 to 257.

3. The interim NCS Advisory Board considers it wholly unacceptable for any individual to be delayed in hospital or placed inappropriately out of area. It supports Audit Scotland’s findings, in its report of 8 January 2026 Delayed discharges: A symptom of the challenges facing health and social care that any delay in being discharged from hospital harms a person’s physical and mental wellbeing. The interim Board notes that real harms are being done to those who are delayed in hospital or in inappropriate placements and human rights are not being met.

4. The Scottish Human Rights Commission’s January 2025 publication Tick Tock highlights a gap between the stated commitment to a human rights based approach and what happens in practice. It identifies, “a clear gulf between the rhetoric of taking a human rights based approach and the reality of putting that into practice.”

5. Living in an inappropriate environment can cause stress and uncertainty. This can lead to increased distress and changes in behaviour, which may result in people being assessed as needing more intensive care. This can make it more difficult to find a care package in the community that meets their needs. This situation is not acceptable, either morally or financially, and has to change.

6. Although the Dynamic Support Register shows some recent progress, the interim Board believes overall progress under Coming Home has been inadequate, and the variance across different parts of Scotland is unjustifiable. There is a critical and urgent need for Scottish Ministers and COSLA to work together with local areas, to ensure that all those identified on the Dynamic Support Register can be supported into community based support.

7. In identifying Coming Home as a priority, the interim Board notes the critical links with its other priorities, and with recent national improvement and reform work:

• Getting it right for everyone (GIRFE)

The interim Board is providing separate advice on embedding a GIRFE approach at national and local level, across all health and social care services. GIRFE Principles highlight the importance of making it easier for people to get the support they need, in the way which works best for their whole life and wider wellbeing. They emphasise the importance of services working together to develop a joined-up understanding of people’s needs, and how they can best be met. GIRFE ensures that people:

• have the information they need to make decisions
• are supported to understand the options available to them
• are trusted to know what is right for them.

These principles must apply to everyone on the Dynamic Support Register. Different services - including housing and workforce – must work together to ensure that needs and choices are understood, and can be supported.

• Self-directed support (SDS)

Under self-directed support legislation, local authorities must give people choice and control over their social care support. Self-directed support should be person led, and support people’s human rights to choice, dignity and being able to take part in the life of their communities. The interim Board is providing separate advice on how a more flexible approach to self-directed support can ensure that people’s choices are honoured and needs met.

• Rights to breaks for carers

Providing people and their unpaid carers with the support they need from the start can prevent the breakdown of placements which results in people going into unsuitable, out of area placements in the first place. The provision of short breaks for carers plays a key part in ensuring those carers have the resilience they require to continue to provide support. The interim Board is providing separate advice on what is needed to ensure that the new legal rights to breaks for carers can be successfully implemented.

• Scotland’s Population Health Framework

This framework sets out the long-term shared approach of the Scottish Government and COSLA to improving Scotland’s health and reducing health inequalities over the next 10 years.

• Independent Review of Adult Social Care (IRASC)

Derek Feeley’s review set out an ambition that, “Everyone in Scotland will get the social care support they need to live their lives as they choose and to be active citizens. We will all work together to promote and ensure human rights, wellbeing, independent living and equity.” It also highlighted the need for social care support to “help people achieve their goals and desired outcomes; to live their best lives and maximise their wellbeing, as equal citizens.”

• Health and Social Care Service Renewal Framework (SRF)

This framework sets out a vision focused on prevention and person-led services. It aims for services that respond to people’s needs, respect individuals, and deliver outcomes that matter to them.