Interim National Care Service Advisory Board: Advice to Scottish Ministers and Council Leaders - Composition of the final National Care Service Advisory Board

Advice to Ministers and Council Leaders

The interim Board has discussed membership at 4 of the 5 meetings it has held since being set up. The interim Board agreed on a number of aspects of membership – set out below. It was not finally able to agree on how best to ensure the care provider perspective was included on the Board. All members were in agreement that this was a critical perspective, and one which must be in a position directly to contribute to discussions and decision making by the Board. No consensus was reached, however, on the number of care provider members which this required.

On the matter of care provider membership, the interim Board agreed that the best approach was to highlight the different options discussed by members, with the associated pros and cons of each option, and request that Scottish Ministers and Council Leaders take a final decision.

The interim Board recommends that core membership of the final Advisory Board should include:

Independent Chair

The independent chair should bring the twin perspectives of personal experience of engaging with health and social care services, and system leadership.

5 Individual members

These members should be recruited through a fair and open process – currently underway – and offered remuneration for their services in support of the Board.

Individual members should bring a range of personal experience of the health and social care system, including:

• Long term health condition
• Long term disability
• Unpaid carer
• Being care experienced as a child or young person
• Directly providing support as part of the workforce

7 Organisational members

These members should be nominated by their organisation on the basis that the nominee can contribute to Board activities as part of their contracted role for that organisation. No separate remuneration or expenses will be paid for their membership.

Organisational members should bring a range of professional experience of working within the health and social care system and will bring wider perspectives and expertise to the Board through discussing the Board’s work with their networks.

• Disabled people led organisation
• Independent Living Fund
• Scottish Independent Advocacy Alliance
• Carers organisation
• Local authority chief executive
• NHS health board chief executive
• Integration authority chief officer

To ensure the Board has a full understanding of the wider implications and feasibility of its advice, the interim Board recommends that the following people should be invited to attend all further meetings of the final Board, as advisers, rather than having core Board member status:

• Scottish Government director for Social Care and National Care Service
• COSLA Director of People Policy
• Chief Social Work Adviser

Other key advisers – including the Chief Nursing Officer and Chief Medical Officer – should be invited to meetings when appropriate.

The final Advisory Board should also ensure that wider interests – whether organisational or personal – have the opportunity to:

• feed expertise, experience and system leadership perspectives into the Board’s work
• contribute to the identification of priorities for the Board to explore

This can be done by drawing from existing groups and mechanisms for involving lived experience to contribute to specific Board priority work. Where the final Board considers it necessary, it should also be able to set up short life working groups or standing support structures for wider participation purposes. The aim of this is to include wider stakeholder opinions and thoughts on the development of the board’s advice to Ministers and Council Leaders.

To ensure resilience within the chairing arrangements for the final Board, the interim Board recommends that the final Board should have a deputy Chair.

This position should be selected from within and by the core Board membership.

Care provider membership

The recommendations above set out a core membership for the final NCS Advisory Board of 13 people, including the Chair.

It is agreed by all of the interim Board that it is essential that the non-public sector provider perspective is also included in the final membership. This would take the Board membership to at least 14. In the course of discussions about final Board composition, however, some concerns and observations were raised about the interim Board’s approach to membership for this group. This has meant that the interim Board was not able to reach a final recommendation on how the care provider perspective should be included on the final Board. Depending on Ministers’ and Council Leaders’ decisions in relation to this aspect of membership, this could take the Board membership up to 15 or 16:

• The interim Board included two members from care provider representative organisations and a member who was the chief executive of a care provider. It was noted that all other groups had been offered only one member position on the Board.
• The STUC had declined participation on the Board on that basis, as it felt the diverse perspectives of its members’ interests could not be covered by a single member.
• Disabled-people led organisations (DPOs) had also made representations for additional membership on the basis that:
  • disabled people of all ages are amongst the highest users of social care in Scotland
  • DPOs have highly participative mechanisms for involving and empowering thousands of disabled people.
• Currently the single DPO member on the interim Board is using her own network to reflect wider perspectives in Board discussions from both her own organisation, and the DPO ecosystem. There was additional DPO involvement in the priority group that led the development of the boards advice on self-directed support.
• The three interim Board care provider organisational members all covered social care support services, but none extended into community health.
• It was suggested that inviting the Health and Social Care ALLIANCE to join the Board would add to the breadth of Board expertise by representing a community health/specific conditions providers perspective.
• if ministers and council leaders agree to a principle of a single organisational member position for the non-public sector care provider perspective, this leaves the dilemma of seeking a nomination from four potential routes: CCPS, Scottish Care, the ALLIANCE or a care provider organisation.
• Inclusion of all would mean a different approach to other aspects of Board membership where only one system leader is involved. It would also exceed the numbers recommended by co-design by one seat.
• Extending membership to all 4 provider perspectives would ensure that expertise across the complex independent and third sector provider landscape for community health and social care was included on the Board.
• It is recognised that Board membership alone can never include all interests and perspectives. This was highlighted through co-design. Although the expertise and understanding of organisational Board members will be shaped and strengthened through their engagement with wider networks, they have been invited as individual system leaders, and not as representatives of a particular cohort.
• The Board will develop a wider participation approach through its supporting stakeholder groups to ensure that different and representative perspectives can inform its advice. Time will be built into the Advisory Board’s decision making process to allow for accessing these wider views.

Following extensive discussions by the interim Board, the following options for inclusion of care providers in the final Board have been identified. Interim members have shared their views on the pros and cons of these options, which are also provided below.

Option 1: Interim membership is carried over to final Board: CCPS and Scottish Care remain core Board members

Pros:

• Final Board membership numbers would be 15 - in line with co-design recommendations
• CCPS and Scottish Care represent the significant majority of care providers and have expertise in and access to distinct communities of provider (private/small business provision with significant focus on older people; and not-for-profit providers across a wide range of supported people respectively). They each have established and successful mechanisms for engaging with their wide memberships

Cons:

• DPOs, carers organisations, local authorities, NHS health boards, integration authorities and trades unions (who declined) have been offered only one member position. It is the collective responsibility of the Board to liaise with wider interests and ensure diverse perspectives and expertise can be fed into the Board’s discussions.
• The size of the 17 member interim Board has made it challenging to manage discussions within a time pressed agenda. While this Board composition would fall within the maximum membership advised by co-design, a still smaller Board would help to secure meaningful, inclusive discussions without having to limit its agenda or intended workplan.
• Representative provider organisation members would not bring direct, personal experience of service provision – but instead, would bring the views of the organisational members they represent. This would be less in keeping with the Board’s purpose of embedding lived experience in the Board’s decision making

Option 2: Interim membership plus is carried over to final Board: CCPS and Scottish Care remain core Board members and the ALLIANCE is given an additional member position

Pros:

• A community health provider perspective would be included on the Board, as well as very distinct elements of the social care sector
• In combination, the three membership organisations have significant reach into different communities of organisations with expertise

Cons:

• A Board of 16 would exceed the co-design recommendations that we limit membership to 12 – 15 and make discussions still harder to manage
• If it is accepted that CCPS and Scottish Care essentially bring the same perspective and expertise – that of non-public sector service providers – providers would still be being treated differently from other interest groups, by allowing multiple members to bring the same or similar perspective to Board discussions.
• Representative provider organisation members would not bring direct, personal experience of service provision – but instead, would bring the views of the organisational members they represent. This would be less in keeping with the Board’s purpose of embedding lived experience in the Board’s decision making

Option 3: One provider member is invited to join the Board – selected by Ministers and council leaders

Pros:

• This would bring Board membership to 14 – within the recommended co-production limit.
• If it is accepted that CCPS and Scottish Care essentially bring the same perspective and expertise – that of non-public sector service providers – the approach to provider membership would be consistent with that for all other groups
• A member could be identified in time to attend the first meeting of the final Board
• Appointment criteria for a single provider member could include:
• direct, personal experience of providing high quality, human rights driven care and support services
• knowledge and understanding of delivering frontline services within a complex system.

This would be in keeping with the Board’s purpose of embedding lived experience in the Board’s decision making

Cons:

• There could be concerns around a lack of transparency in the process of selecting the single member
• The expertise and understanding brought by the single provider member might be overly skewed towards a particular part of the sector.

Option 4: One provider member is invited to join the Board – selected through fair and open competition (as has been the case for lived experience members)

Pros:

• This would bring membership to 14 - within the recommended co-production limit
• If it is accepted that CCPS and Scottish Care essentially bring the same perspective – that of non-public sector service providers – the approach to provider membership would be consistent with that for all other groups
• An open competition approach would give a wider group of people the opportunity to apply and would be consistent to the approach to selecting individual members with personal experience
• Appointment criteria for a single provider member could include:
• direct, personal experience of providing high quality, human rights driven care and support services
• knowledge and understanding of delivering frontline services within a complex system.

This would be in keeping with the Board’s purpose of embedding lived experience in the Board’s decision making

Cons:

• A competitive recruitment would create a delay in identifying the member in time to join the final Board.
• A competitive recruitment could bring complications for the organisational nomination approach – which relies on organisations to support their nominee to attend meetings and undertake Board activities within their contracted time, and without remuneration from the NCS Board
• The expertise and understanding brought by the single provider member might be overly skewed towards a particular part of the sector.

Option 5: One provider member joins the Board and chairs a Providers Leadership Group – open to all providers from all parts of the sector (all services, whether third, independent or public sector)*

Pros:

• This would keep membership at 14 – within the recommended co-production limit
• It could establish a clear process for ensuring provider views and input from all parts of the sector to inform the Board’s work

Cons:

• This would create a different arrangement for providers than for other members – who are not currently supported to bring wider views to the Board
• The establishment of a separate group to feed into the Advisory Board could slow down decision making, duplicate current networks and place unnecessary participatory burden on an already pressured sector
• The chair of this group/Advisory Board member could be constrained from contributing to Board discussions as a system leader – requiring them to act as a delegate for the group, rather than bringing their own personal and professional insights as all other members are invited to do
• The three membership organisations and one care provider organisation involved in membership discussions have been consulted on this approach and none has supported it

The interim Board requests that Scottish Ministers and Council Leaders give consideration to these options, and agree on an approach for including the essential care provider perspective on the final Board, alongside the membership otherwise recommended above.