National Care Service - governance and representation: co-design report

What we learned

Different views and experiences needed on the Advisory Board

The group agreed that all board members need to have knowledge and experience of the social care sector. This could be at a grassroots level or at a strategic level, to make sure that across the board there was a broad range of perspectives. The group agreed that the board should have a:

• broad social work perspective to look at system-wide issues, for example how they impact individuals through a social work lens. They did not mention social care or community health
• third sector perspective, such as advocacy support services or community brokerage. This was seen as a link between strategy and implementation at grassroots level
• disability or long-term health condition perspective. The board should include experience of advocating for and engaging with disabled people
• specialist service perspective, for example children social services and justice social work services. The board should know how different services will be impacted by decisions and understand how implementation should happen

Having these different perspectives would encourage collaboration across the sector. However, the group understood that this would depend on decisions made about what the NCS would include.

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

"[A board member with a social work perspective] would need to have experience of the system and should also pitch their input at a strategic level, rather than individual cases."

"They [the third sector] are an integral part of delivery of care. They're often aware of policy but also aware of how that plays out 'on the ground'. It’s only appropriate they should be included."

"Representation from disabilities sector in particular as they represent a big sector of people who access support."

"There are 1 million people with disabilities, and they should have a strong voice at the strength of this."

How we will use this

These insights came from discussions about a public body board. They are useful insights to help with recruitment to the Advisory Board.

Skills that board members need

The group also talked about what knowledge and skills board members need to help them with their role.

Participants said that all board members would need knowledge of the practices and challenges of the social care sector in Scotland. They suggested that this experience should be recent or current.

The group also said that it would be helpful if board members had experience of bringing about or advocating for change in the integrated health and social care system.

Participants thought that all board members would need the following skills:

• basic understanding of financial concepts and terminology
• strong communication and listening skills
• Analysis skills and experience of working with data and reports
• digital and technology skills
• critical thinking skills

They also thought members should have experience of working with communities to understand their challenges and advocate for improvements in social care.

Here are some of the things people said during our discussion

Participants said that board members should have the core skills listed above but added that members do not need to be experts. The group agreed that some members might need extra support. This would help make the board accessible to a range of perspectives.

"Board members [need] to bring real-world insights into social care challenges, especially those experienced personally or within communities. Members should possess a robust understanding of policies, practices, and the broader landscape impacting social care."

"[Board members] don’t need to know everything about finance but it’s really important to have a level of knowledge as there will be a lot of financial terminology that will need to be understood."

"[Board] members should demonstrate assertiveness and confidence, express opinions within high-stakes discussions or in contexts where their views might not align with others present."

"[Board members need to have the] ability to take on others’ point of view, enabling them to appreciate diverse perspectives while staying open-minded and adaptable to a changing environment."

"Board members would need to review/challenge reports where necessary."

"Board members need to have the ability to challenge constructively and work as part of a team."

How we will use this

These ideas from co-design participants will be used as we create the NCS Advisory Board. They will help us to plan recruitment for members, which we will base on the suggested skills and criteria.

Skills that the Chair and Deputy Chair need

As already mentioned, we thought the board would be a public body, that meant when we were discussing the options for chairing the board we did not go into the detail of differences between a Deputy Chair and a Co-Chair. We framed our discussion around a Deputy, as that is what a public body would have had.

This needs to be understood when we look at the findings. However, it does not affect the outputs and suggestions as many of the skills and experience highlighted for that position would apply to either role.

All participants agreed that there is value in having a Deputy Chair.

A Deputy Chair could:

• support the Chair in their role
• strengthen leadership
• bring a second point of view
• support the chair with relationships between board members, groups or networks
• act as Chair if the Chair was not able to attend a meeting

A deputy with lived experience could help balance power and increase representation.

Skills that the Chair and Deputy Chair should have

Participants agreed that the Chair and Deputy Chair would probably have similar knowledge and skills.

Participants agreed that the soft skills needed were as important as experience. The group suggested that these soft skills should also be included in any future job advert for the role. The group said that the Chair and Deputy Chair should be:

• warm, friendly and compassionate
• resilient
• honest and trustworthy

Participants said that while the Chair and Deputy Chair are formal roles “they should also be able to bring their own character to the role to put people at ease”.

Participants made suggestions about how the Chair and Deputy Chair could have a role in creating a positive culture. For example, they should nurture board members to help them to work together.

They said that the Chair and Deputy Chair should have experience of:

• working with a group of people to develop a positive culture
• adopting practices that encourage transparency
• implementing a human rights approach to their role
• respecting and recognising diversity and inclusion
• conflict resolution
• chairing meetings and defining clear outputs and actions
• active facilitation, for example encouraging "quieter voices and actively listening to everyone"

Here are some of the things people said during our discussion

"Having a deputy chair doubles the voice in the room, brings a second viewpoint, and enhances the position of the board and their views. It strengthens leadership."

"There would be value in having a lived experience deputy chair or co-chair to increase representation."

“The chair should be able to give people confidence to be full and meaningful members.”

"Chair(s) should have knowledge of including both formal and informal parts of the sector (e.g. the value and role of the third / charity sector)."

"Chair(s) should be able to - Listen, analyse, arbitrate (arbitrating different views), harmonize, i.e. hear all differing views, and should make people feel listened, conclude and agree (rather than listened and ignored)."

How we will use this

These findings will support us to recruit an independent chair for the Advisory Board. We may also have a deputy chair, to support, chair meetings and strengthen leadership. We would use the suggested skills and criteria to do this.

Support from specialist groups

Participants agreed it was not realistic to expect board members to have all the skills and knowledge needed for the board to function.

They suggested that specialist support will be needed to help the board to make informed decisions.

The group considered the proposed functions of a board and what level of skill board members would need.

They suggested that other groups could share specialist knowledge with the board. These groups could help with:

• human rights support - to help make sure any decisions made by the board are underpinned by human rights
• financial support - to help the board to understand finance and budget planning
• performance and monitoring support to help understand the data and any issues affecting performance
• regulatory body support - to provide knowledge of national standards and statistics on the performance of social care
• issues and response support - to provide short-term support in relation to national issues
• engagement support - to provide expertise, share best practice and help train the board on how to engage with people with lived experience
• cross-sectoral workforce support - to advise on issues in the workforce, including community infrastructure, workplace culture and conditions and pay conditions
• private sector support - to offer a private sector perspective

Participants discussed how this would work in practice. They said members could:

• approach specialist groups for advice
• attend specialist groups to improve connections between them and the board
• receive training from subgroups to improve their skills for their role

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

"Human rights is a massive underpinning of all services and should be thought about at every level."

"[The performance and monitoring group] should include the integrated authorities’ data and information. There is wealth of statistics from SG that can help look at trends."

"[The national issues and response] group should be able to flex to respond to issues which are faced across the system and advise on how to fix those issues. Should be able to anticipate what's ahead of us."

"Local [workforce] representatives have better idea of what is going on as opposed to Unions."

“[Private sector support] could provide a fresh perspective [that] government needs to consider".

How we will use this

We will need to do more work to assess how these support groups can work together for the Advisory Board. We will aim to create a way for information and advice to flow to and from the board.

Support and information from people with lived experience

The group agreed that the board would need to engage with people with lived experience to carry out its role.

This is because it would help the board understand the realities of the sector. People with lived experience could also share ideas of how services could be improved.

Participants discussed:

• who the board would need to engage with as part of this lived experience support
• the role of this lived experience support
• how people with lived experience could engage with the board

As well as engaging with people accessing and providing support, participants thought that it was important for the board to engage with the following groups:

• unpaid carers
• people who manage and provide Self-directed Support (SDS)
• disabled people or people with long-term health conditions
• independent sector

The group thought that lived experience representation should advise the board about issues and have a 'horizon scanning' function. This would help the board make decisions in the interest of people accessing and providing services. It would ensure that the board’s work was ‘person centred’. It would also give the board the opportunity to hear about the potential results of policy changes.

Some participants suggested that the lived experience support groups could have a role as a critical friend(s). This means they would hold the board to account by reviewing the board’s performance and challenging the board’s decisions.

They saw the group(s) of people lived experience as a way of helping the board by giving:

• advice
• support
• information

These groups should represent a range of lived and professional experience from across Scotland.

Some participants suggested that membership should not always be the same. Instead, it could be changed regularly to make sure that different perspectives are heard by the board.

To make sure that the lived experience group(s) included diverse or seldom heard voices, some participants thought that we should have a ‘proactive outreach programme’. It could share best practices for engaging with seldom heard groups. The group(s) could also upskill board members to ensure they are able to engage with people effectively.

Participants said that we should:

• make sure that the board can access a range of lived experience
• foster relationships between lived experience groups and the board where they can advise and be asked for advice
• have a board member attend the group(s) and someone from the group(s) attend a board meeting
• help the lived experience group(s) to 'horizon scan' so that they can highlight issues
• help train the board on how to engage with people with lived experience including seldom heard groups
• continue to think about how we can make the board accessible for people with lived experience

Representation from stakeholders and people with lived experience

The group also thought that stakeholders and people with lived experience should be represented on the board.

They felt that this would be better than learning about lived experience through stakeholder organisations. They thought that learning through stakeholders could “be a filter on people’s real-life experiences.”

Participants said that the relationship between the board, specialist support and lived experience expertise should not be hierarchical. All 3 parts should work together to share their expertise. This relationship should be based on:

• seeking advice and being able to ask for support
• upskilling board members to do their own co-design
• holding the board to account
• evaluating the board’s performance
• evaluating how well the board engages with people with lived experience

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

"Almost 25% of the population are carers and they need to be heard.”

"There are 1 million people with disabilities, and they should have a strong voice at the strength of this."

"This [SDS] group will provide information about all geographical areas and identify the disparity in different areas."

"They [independent sector] bring the reality of how support is delivered and how it is meeting people's needs in a way that is different to social work."

"The lived experience group(s) should have a role in reaching hard to reach groups - going through stakeholders is not always the best way to engage with people."

"The gap between the board and lived experience needs to have as few intermediate layers as possible."

"Lived experience board members could meet with lived experience expert groups and get the current situation understanding. [This could be] a mechanism to know what’s going on, because they can never know everything that’s going on with other people."

"Local boards also need to feed into the national board to know what people are saying locally, also gives triangulation of information. E.g. there could be local board chairs group, and they can feed into the national board."

"If you have specific topics, you could ask local groups to discuss across their networks across the country ensuring you are capturing voices across Scotland."

“As soon as you start talking to organisations, it can be a filter on people’s real-life experiences.”

How we will use this

This feedback suggests a “2-way” relationship with the board. This should be based on “transparency and openness [and] a circular process of communication and feedback is important.”

A circular process could involve the lived experience group(s) raising issues that are affecting people and the board approaching the lived experience group(s) for their expertise.

We will continue our work on this relationship. We are aware of the risk that it may make the role of the lived experience member onerous. To combat this and allow for the views to be fully heard by the board, we will ensure that all board members have opportunities to attend some of these meetings.

How the board would engage with people with lived experience

We wanted to explore how engagement between the board and a range of lived experience would work.

In other areas of government, we have used people’s assemblies or panels for engagement. Some participants had concerns about these engagement methods because:

• these methods have specific meanings. Engaging should not be limited by these existing definitions. We may need to adopt different methods for different groups
• having multiple groups can lead to better outcomes
• some participants had experience of panels which they thought were tokenistic

The group stressed the importance of relationship building between the board and local structures. They highlighted the need for local engagement with the board. We wanted to test how the board could tap into local knowledge to help understand issues affecting people in different parts of Scotland.

Participants highlighted that there were existing networks that the board could contact. They felt that engaging with existing networks would be a good way to build a picture of issues using local representation.

However, some participants already engaging with local groups felt that it may lead to more pressure being put on these representatives. It was also highlighted that there needed to be a more direct link between people using services and the board.

Participants suggested that instead there could be a network which could add to items on the board agenda or respond to calls for evidence from the board. They felt this would be particularly good for hearing from rural groups. Setting up a network, rather than a formal group would also make it easier to co-ordinate representation from across Scotland.

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

“There needs to be a clear link between people accessing services / unpaid carers and the board. In [some existing Boards], there are so many layers between the [Board] and the actual person at the end of it – the support worker, the social worker, the carer, stakeholder organisations - everyone who gives support. This dilutes and filters the actual experience people have before it gets to the board. There needs to be a clear and direct link between those two parts.”

"There's a lot of well placed, talented, articulate people who would be able to support and advise the national board. They already know the system and are more likely to be bought in to the NCS."

“A real sense of what's going on at the coalface, not the disinfected version that can be provided to boards"

"There are a lot of well-placed and talented people who'd be able to advise on future work"

"It would be a shame to have that experience limited -having a clear voice and giving advice is important"

How we will use this

We will use these insights as the basis for working with stakeholders and colleagues to explore what engagement could look like for board members and stakeholders.

Training and support for all board members

Co-design participants suggested that members will need training when they start on the board and when they are developing in their role. This will help to create a culture of support and development for the board.

Participants stressed that all board members will need training at the start. Participants said all board members should have the same training "even if you’ve had similar training in your job”.

Examples of training include:

• equalities training. This will promote an inclusive culture on the board.
• safeguarding and trauma informed training. This will support members if there is conflict and help avoid potential triggers
• training on policies and board structures. This will make sure that members are all starting with the same training. It will also make the role of members clear

It was suggested there should be ongoing training for continued learning and development. This could help to upskill and professionalise the role of board members.

The group highlighted some training needs for members, including:

• assertiveness training so that everyone can contribute to meetings
• conflict management training to work through disagreements
• digital proficiency training to remove barriers to digital technology
• health and social care landscape training to help with knowledge of different parts of the health and social care system
• disabilities training to bring awareness and respect for other experiences. The group suggested that this could be provided by a Disabled People’s Organisation

Training and support for lived experience board members

Participants suggested that additional training may be needed for lived experience board members.

Participants said that the board should play a role in “investing in lived experience members”. We heard examples of programs such as the:

• aspiring chairs program
• national apprenticeship scheme

We also discussed practical support to remove barriers to participation, especially for lived experience members. Ideas for practical support included:

• helping with reliable technology for online meetings
• organising transport to meetings
• remuneration

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

“You’d need to invest in [board members]. It should be about more than just turning up to meetings”

"You will know about the bits [of social care system] that you see but maybe not everything else. But you can't have expertise in all of the system." Training should fill this gap of understanding of the integrated health and social care system.

"Bringing an awareness into what people face."

"Important that people feel comfortable with level of ability and feel comfortable that it can be addressed and highlighted and developed when needed [through training and support]."

"Lived experience members might need training to ensure members were appropriately equipped to participate and contribute. If they don’t have that then there’ll always be the power imbalance with other members."

“Some people might not be able to afford to be on the board without remuneration.”

How we will use this

We will use these suggestions to be proactive in our approach to investing in our potential board members ensuring there are opportunities for training and ongoing development.

Recruiting board members with lived experience

At the time of the co-design sessions, it was assumed that the national board would be a public body. Because of this, we discussed the recruitment process for a public body.

Participants made suggestions about the recruitment process, focusing on how to make it inclusive and accessible.

Building awareness of the role

Participants said that it would be important to advertise board vacancies widely to encourage a range of applicants.

Participants offered suggestions about how vacancies should be advertised. This included:

• digital and non-digital advertising to reach a diverse audience
• targeted recruitment approaches to encourage applicants from seldom heard communities or people with protected characteristics. This could be done through stakeholders
• clear role descriptions and support options
• highlighting support available during the recruitment process to boost people’s confidence to apply

Support during the application stage

The group discussed the recruitment process for board members. They focused on how it could accommodate lived experience applicants.

Overall, they suggested that the application process should take account of accessibly needs to enable people with accessibility requirements to apply. Some of the suggestions included:

• assessing accessibility needs and making sure that the process can meet those needs
• proactively offering support to give confidence to applicants
• pre-application webinars or guidance materials to make the recruitment process clear
• providing opportunities to connect with someone who can answer any questions
• feedback throughout the process to help applicants feel valued and motivated

How we can improve recruitment

Participants identified ways that the selection process could be improved to be more inclusive and supportive.

Currently, applicants who successfully pass the sifting stage are invited to participate in an interview or assessment, as outlined in the public appointment guidance. Participants suggested ways to make this stage of the process more accessible:

• accessibility needs should be identified and supported before interviews or assessment begin
• rather than relying on a written application, allowing applicants to submit an application in an alternative format (such as by video).
• adding in an extra step to talk with each candidate who meets the minimum criteria. This would allow the panel to assess the applicant’s suitability for the role
• allowing applicants to be assessed in different ways, rather than through an interview. This would allow them to show skills in a way that suited them

How we can improve the interview panel

Participants suggested ways to strengthen the interview panel to ensure fairness, including that:

• panel members should have the skills and experience to select the most suitable candidates
• the panel should include people with lived experience relevant to the role
• panel members should have the skills and training to assess applicants fairly, considering both professional skills and the unique perspectives that lived experience can bring

There were concerns about the role that ministers had in the public appointments process, in approving the interview panel’s recommendations for board members. It was suggested that the appointment should be based on suitability and merit only.

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

"[The role should be widely advertised, so that] you're not just left with the usual people applying."

“If an applicant hears they have an interview someone should get in touch with them to find out what support they can get.”

“Research shows interview process is of very limited value as a way of selecting the best people. Candidates could be given a board paper to review and discuss what came to mind. There would need to be the same support available at interview as would be provided to members.”

"[Having lived experience people on selection panel] will help the lived experience applicants feel confident to see someone like themselves on the panel."

How we will use this

While the recommendations focused on adaptations to a regulated process for ministerial appointments to public bodies, we can still apply them for recruiting advisory board members. Suggestions we could apply include:

• advertising board member vacancies widely to encourage a range of interest
• providing support for applicants throughout the process
• meeting the accessibility needs of applicants during their application and interview
• ensuring the interview panel is fair and unbiased

We will aim to include these suggestions in our recruitment process for final Advisory Board recruitment.

Building a positive culture and supporting board members

Early co-design showed the importance of creating a positive working culture so that board members with different backgrounds can work together.

Participants gave many suggestions on how to create this positive culture. They said we need to make sure that board members with lived experience do not find it difficult to speak up when there are 'influential' or 'professional' people in the room.

Creating a positive culture on the board

Participants thought that creating a positive working culture is something that should be done from the start. Ensuring positive ways of working would help to:

• create positive ways of working
• build relationships quickly
• develop teamwork

Suggestions that we could use for the Advisory Board include:

• creating an information pack for new members to help them to feel confident and supported from the start
• having one member of staff who could answer questions to provide consistency for new board members
• having a buddy system. Matching new members with an existing board member could help build relationships. Buddies should be assigned so that pairings have different perspectives. For example, 2 lived experience members would not be buddied together
• team building activities before the board members start working together. We should be creating a board where members get to know each other and build relationships. One participant said: “This needs to be set up not just as a work meeting if people are going to work well together. I’d want to know people’s stories if I’m going to be in the meeting with them and we have to work together”
• training when the board first meets. This should be with an independent facilitator. This would help all board members to start working as a team. An independent facilitator would be seen as ‘neutral’
• clear remit and agreed terms of reference. Providing clarity on the role of board members and agreeing how board members should work together would give us a strong basis for creating a positive culture

How the Chair can create a positive culture and help build relationships

Participants said that the chair and deputy chair should play a key role in creating and developing a positive culture. Participants thought that the chair should be approachable and available to be contacted outside of meetings.

Other suggestions for the chair included:

• having 1 to 1 check-in meetings with members to understand their training and support needs
• using accessible language in board meetings and papers to make it inclusive
• enforcing the co-designed code of conduct in board meetings
• using team building activities to understand the different personalities of board members, their strengths and ways of working
• encouraging constructive feedback from all members. One participant said that “having people who are able to provide and respond to constructive feedback is a sign of having a positive culture. That's what will help you improve and get this right”

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

“There’s no way you’re going to get this right first time, so you’re going to need to build that with people”

“to build a positive culture. This takes time and resources”

“100% - culture set really matters and sets the course for the board.”

How we will use this

We will act on these insights from co-design. We will aim to use the insights to establish the Advisory Board with the correct culture. We will use these suggestions to support members to work together and get agreement on ways of working in the development of the role and behaviours of the Advisory Board members.