National Care Service: business and regulatory impact assessment

Rationale for Government intervention

As detailed in the Policy Memorandum, local authorities are currently responsible for providing social work and social care support and health boards for providing health services. The current arrangement is that local authorities and health boards work together as integration authorities to assess, plan and commission local community health and social care services.

There are 31 integration authorities across Scotland: 30 have formed integration joint boards (IJBs) with additional representation from carers, people who use services, private and third sectors. Highland has a different arrangement, known as a Lead Agency arrangement, in which Highland Council takes responsibility for all health and social care services for children, and NHS Highland provides all health and social care services for adults.

The health and social care partnership in each local area is responsible for the delivery of local community based health and social care services on behalf of the integration authority, including adult social services, primary care and most community health services. Some local areas also have responsibility for children's health, children and families social work and social care, justice social work, and homelessness and housing support.

Over many years, various issues have demonstrated that social care support, and the integration of health and social care services, is not working as well as it should. In September 2020, the Scottish Government commissioned an Independent Review of Adult Social Care (IRASC) to systematically consider the problems. The IRASC report concluded that whilst there were strengths in Scotland's social care system, it needed revision and redesign to enable a step change in the outcomes for the people accessing care and support.

The challenges identified by the IRASC include:

• Inconsistency of user experience ("postcode lottery");
• Complex and inconsistent governance arrangements;
• Lack of national oversight and collaboration;
• Lack of collaborative and strategic leadership;
• Non-integrated budgetary and financial planning.

The IRASC report recommended that Scottish Ministers should be responsible for the delivery of adult social care and that the integration authorities should be reformed to become the only bodies with responsibility for social care, social work and community health instead of this being shared by local authorities and health boards. It recommended that a National Care Service should be established on a similar basis to the National Health Service in Scotland to make these changes.