Costs and Benefits
Establishment of the National Care Service
The Financial Memorandum for the Bill sets out details of the costs of establishing the National Care Service. The costs and benefits of this and the other options will be discussed in the Strategic Outline Case to be published separately and a future Programme Business Case.
Under all of the options considered, there may be additional funding requirements for social care and additional improvement for example, to improving pay in social care, strengthening implementation of Self-directed Support, moving services towards more prevention and early intervention. Under all of the options considered, it would be possible to establish a National Social Work Agency to improve support for the social work profession.
The introduction of the Charter of Rights will provide clarity to people accessing services about what they can expect, and a breach of rights within the Charter can be the basis for a complaint. The proposed reforms to complaints and redress processes will provide clearer pathways for people to make complaints about the NCS. These will support people accessing NCS services to better hold the system accountable and receive the services they need to thrive. However, it is possible that this greater accountability may lead to an increase in complaints or feedback from people accessing services which could increase the administrative and resource burden on some delivery bodies and oversight bodies. Taken together, it is anticipated that the Charter and the reforms to complaints and redress will have minimal impact on sectors but will result in increased accountability to people accessing services that will in turn facilitate service improvement.
The information sharing and information standards within the Bill will enable the creation of the integrated social care and health record, as well as support wider digital and data services to deliver the NCS. The social care and health record will allow safe, secure and efficient sharing of data across relevant care and health settings and with the individual. Individuals will be enabled to engage positively with their care to help them live independent and fulfilling lives. Having up-to-date information will support high quality care, portability of care and ensure individuals do not have to repeat their stories.
More widely improved data and digital infrastructure will underpin the ambitions of the NCS. Having consistent information standards will ensure all relevant bodies are using the same approach to data and digital, ensuring national consistency. There are no immediate impacts to businesses, however, this may result in associated costs in the future as organisations adapt, update and change systems to be able to meet these standards. There may be future opportunities for businesses in the delivery of digital services. There will be further business and regulatory impact assessment at the time that these regulations and standards are developed.
The transfer of functions from local authorities is likely to have additional financial implications and there will be risks to manage. These may include, for example, costs for the transition process, and potential savings on central services. It is possible that people (staff), assets and contracts could be transferred from local authorities to the NCS when the functions are transferred. It is also possible that local authorities could continue to deliver social care, commissioned by the local care boards. These changes will have impacts on local authorities, not least in terms of their workforce and the assets they manage. The transitions to the new arrangements, once these have been determined, will need to be managed very carefully to make sure that there is no detrimental impact on people accessing social care and support and care workers.
It is not possible to quantify these impacts until decisions are taken on what services are to be included in the NCS, when the transfer is to take place and how the transition process will be staged. The Scottish Government will work with COSLA to identify the implications at the appropriate time, and further impact assessment information will be developed alongside the relevant secondary legislation.
The financial implications for health boards are expected to be less significant, because of the expectation that they will continue to deliver services commissioned by the NCS. As with local authorities, those implications will be considered when more detail of the arrangements is known.
It is not anticipated that the establishment of the NCS and local care boards, and the transfer of functions to those bodies, will have any financial implications for any other public bodies, businesses or third sector organisations, or for individuals.
When social care functions are transferred from local authorities to the local care boards, it is assumed that in the first instance, all contracts and arrangements with external organisations for the provision of social care support services will also transfer. Over time, changes to policies on ethical procurement and Fair Work may lead to changes in the requirements on potential providers. While the Bill will enable the Scottish Ministers to promote such policies more effectively, the detail is not set out in the Bill and will be subject to separate financial and regulatory impact assessment.
As set out in the Policy Memorandum and described above alternative approaches to establishing a National Care Service would allow for improvement in people's experiences of care in line with current work that is already underway. Under all of the alternative approaches, we expect that outcomes for people accessing care and support and care workers would be similar. In all cases, the lack of national leadership, oversight and accountability would continue, and therefore the scale and impact of the changes that the IRASC proposed could not be achieved. Existing measures to address the current problems in social care have fallen short, as highlighted in the IRASC. The NCS can only effectively fulfil its purpose to improve social care if there is a clear line of accountability for improvement to Scottish Ministers which can be exercised locally by local care boards.
Making Scottish Ministers responsible for social care and social work with local care boards commissioning social care and community healthcare together enables:
- The development of a system based on and driven by shared principles which enshrine human rights and person-centred care with opportunities for the voice of lived experience to be embedded in all levels of decision making;
- Opportunities to build on health and social care integration and to bring together different services with a focus on outcomes and to help smooth transitions for people - noting that there needs to be further evidence gathering to see if children's services and justice social work should be brought within the scope of the NCS;
- Strengthening of ethical commissioning of care;
- The development of clear and consistent standards and to support the delivery of high quality services and improve consistency; and
- Market oversight to promote the financial sustainability of social care providers and, where necessary, inform service design and market shaping to help ensure the market for social care as a whole remains vibrant and stable which will ensure continuity of quality social care provision.
This in turn, is expected to lead to benefits for people and for Scotland's wider society and economy through improved community health and social care and support for people who need it and their families, with people accessing services when they need to.
It is also expected to lead to improved experiences for those who work in social care through strengthening Fair Work in the sector. This will help with workforce retention and recruitment.
There will also be an opportunity to support and invest in the whole social work profession through the National Social Work Agency, enabling social workers to work with people to transform their lives and implement rights-based practice as part of the overall objectives of the NCS. We expect that the changes will lead to improved recognition and status of social care and social work.
We anticipate there will be wider benefits for society in terms of increased health and well-being, tackling inequalities, including child poverty, and providing a means of addressing the climate crisis and wider environmental objectives.
These wider benefits are set out in more detail in the National Care Service Statement of Benefits.
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