National Care Service: Access and eligibility criteria co-design report

What we learned about access to and eligibility for social care

There needs to be clearer information about the services available and how people can access them.

We learned from people it is very important to them that they can easily understand how and where to access social care services.

They told us good, open conversations helped build trust and understanding.

Other points around this included:

• people do not know what services might be available, or really understand what social care is and how it can help
• people are not told about the services they will receive, or why they are getting them

Here are some of the things people said during our discussions:

“When you are in crisis, you don’t know what you need (referring to when being asked to pick what support you need). If you have complex issues, having to pick one – you don’t know which one you have to pick.”

“If it wasn’t for the community navigator [from GDA] I wouldn’t have a social worker. It feels like routes to support are secret.”

“Sometimes when you are deemed eligible it isn't explained what you will be getting or why it is being put in place. No information available”

How we will use this

We have been working to improve information and access to the Care Information Scotland service. This provides national care support information as well as signposting to local services for people.

This means making sure:

• the most up to date and correct information is available
• people can access the service in different ways such as telephone, website and webchat
• the information on the website is accessible and easy to understand

People can send feedback in different ways about areas of the service to help improve the information too.

Getting it Right for Everyone (GIRFE) aims to make health and social care more joined-up and person-centred. It’s designed to support people from young adulthood through to the end of life by making the help they need:

• easy to access
• consistent
• tailored to their individual needs

One of the key principles of GIRFE is: I have the information I need to make decisions about my life, in a way that works for me, and I am supported to understand what options are available to me, and trusted to know what is right for me.

We are also developing a Health and Social Care Service Renewal Framework. Which will show how services across Scotland will renew and improve. One of the most important things is making sure everyone can access services fairly, with a focus on what each person needs. We plan to publish the Framework before the end of June 2025.

The system is not flexible enough, people are waiting too long to access support and worry it will not be available if they move area.

We learned that people can wait a long time for an assessment and service. Which can have a negative impact on their mental health, as well as their physical condition. People need more clarity about how long they will wait, and what services they can access.

People were also concerned about the variation in services, not only across local councils areas, but within cities too.

Other points around this included:

• difficulty accessing a GP appointment can create a barrier to accessing services where a referral is needed
• self-referral was also challenging, with people having to constantly ask, and explain their stories
• the process for accessing support can feel daunting to some people and some need more time to feel ready. At the same time there is always a long queue of people waiting for support so services are not able to hold places open for people until they feel able to engage

Here are some of the things people said during our discussions:

“Why do people have to wait years to become critical? [I’ve] given up going to my GP. My consultant told me my family should look after me.”

“Taking that step [to self-refer / ask for care] just to be told you have to wait, and telling your story again and again. You shouldn’t have to explain it every time you phone up.”

“Adult mental health is completely different in this side of the city from the other side. Might get rejected when you move to the other side”

How we will use this

In the Joint Statement of Intent and Next Steps for Adult Social Care, Ministers and local government body COSLA have committed to an:

“Overhaul of the current mechanism of eligibility criteria to ensure an approach to adult social care support that is based on human rights and needs”.

We have established the Access to Social Care Support Services External Working Group. This group will help to develop a range of options for change. With the aim of creating a system that provides consistent access to support across the country, based on people’s individual outcomes and needs.

We will also work with others in the Scottish Government to help us deliver real change. Putting the lived experience of people at the heart of decision making.

A focus on eligibility criteria is outdated and does not treat people with dignity and respect

We learned that people do not feel that professionals fully understood their needs or condition. Often making assumptions about the care someone needed without asking them.

People felt focusing on criteria that were risk based did not meet a person’s right to dignity and respect. Sometimes, people deemed a high risk had support ‘forced on them’. Whereas, those at lower risk did not get any support, despite wanting it.

Other points around this included:

• having your rights respected comes down to the relationship you have with the person in the supporting role
• If you don’t feel you can open up to the person in the supporting role, you are not going to trust them
• assessments do not take into account how people’s needs can change day to day – just because they can do something on the day of assessment does not mean they can do it every day

Here are some of the things people said during our discussions:

“The system isn’t dignified or respectful – you’re already at the end of your tether before you ask for help then you’re told your needs aren’t high enough. You can feel like you’re in crisis but a professional will just say no.”

“One size doesn’t fit all. You can’t use the same package for everyone. We need national criteria but with individual flex which takes account what is critical / important to me.”

“People with disabilities are treated as if pariahs or paupers instead of people with rights and needs. Can’t be treated as a pariah of society – we are people. I’m disabled but a human being. Disabled people are not asking for millionaire lifestyles.”

How we will use this

We have established the Access to Social Care Support Services External Working Group. This group will help to develop a range of options for change. With the aim of creating a system that provides consistent access to support across the country, based on people’s individual outcomes and needs while upholding their human rights.

We will build on the successful reopening of the Independent Living Fund in April 2024 by continuing to work in partnership with:

• ILF Scotland
• DPOs
• other stakeholders

We plan to:

• improve access
• remove barriers

to the funds for organisations that are more aligned to a human rights-based approach.

There needs to be better understanding and acknowledgement of family and culture

We learned that when offering support professionals sometimes did not take into account a person’s faith or culture. It was often assumed that families would be willing and able to support the person. Even without any consultation with the individual or family.

Other points around this included:

• professionals sometimes make judgements about a person and their circumstances before they meet
• doctors are sometimes too quick to medicate when a ‘softer’ community intervention might be more appropriate, such as a community garden
• people can feel ‘pushed into’ services they might not want, for a fear of getting nothing
• there are language barriers, staff need proper support and training to be able to communicate

Here are some of the things people said during our discussions:

“One person was told that because they had two brothers living with them they didn’t need any formal support but she didn’t feel comfortable with them helping with intimate care.”

“They need to have a better understanding of different cultures. For example, some people don’t want to put parents into care homes etc as Islam says to look after families”.

“Language barrier/ interpretation is an issue. People won’t open up unless in a comfortable environment”.

How we will use this

Our ambition is to take a human rights-based approach to access to social care. Assessments should be based on real conversations and consider the whole person, including their family and home life.

Through our training and support for social workers we aim to ensure they work to a set of core values based on the principles of respect, dignity and integrity. To become a social worker, people must meet certain standards. These are called the Standards in Social Work Education (SiSWE). These standards say social workers must work in a way that respects people’s backgrounds and cultures.