The proposed reforms around social care represent one of the most significant pieces of public service reform to be proposed by the Scottish Government, and have the potential to be the biggest public sector reform in Scotland for decades.
The implementation of the recommendations of the Independent Review of Adult Social Care (IRASC), and particularly the establishment of a National Care Service (NCS), is an opportunity to address some of the challenges across social care highlighted before and during the pandemic.
This is an opportunity to change the way we deliver support and services - to place human rights at the centre of our decision making; shift our emphasis to prevention; empower people to engage positively with their own care; embed fair work and ethical commissioning; and strengthen our commitment to integrating social care with community healthcare, which we last legislated for in 2014.
Independent Review of Adult Social Care
The delivery of social care support is currently the statutory responsibility of local government under the 1968 Social Work (Scotland) Act. The Scottish Government sets out the policy and makes legislation on social care and therefore has a role in supporting improvement and ensuring positive outcomes for people across the country by having the right policy and legislation in place.
In February 2021 the Independent Review of Adult Social Care report was published. It concluded that whilst there were strengths of Scotland's social care system it needed revision and redesign to enable a step change in the outcomes for the people in receipt of care. The review provided a number of high level areas of focus:
- Ensuring that care is person-centred, human rights based, and is seen as an investment in society
- Making Scottish Ministers responsible for the delivery of social care support, with the establishment of a National Care Service to deliver and oversee integration, improvement and best practices across health and social care services
- Changing local Integration Joint Boards to be the delivery arm of the National Care Service, funded directly from the Scottish Government
- The nurturing and strengthening of the workforce, and
- Greater recognition and support for unpaid carers.
What we are already doing
The Scottish Government is committed to implementing the recommendations of the IRASC. Before the pandemic began, we had been working with a wide range of partners, including people who use social care support, COSLA (the Convention of Scottish Local Authorities), unpaid carers, the social care sector and the workforce, to address many of the areas highlighted in the review. This work provides a strong context from which to implement the recommendations of the IRASC, including how social care is understood and valued by individuals and our society; how it is funded and paid for into the future; what approaches to care and support we need in Scotland and how they are delivered; and how we achieve Fair Work for all of our social care workforce.
That work was largely paused due to the pandemic, but we have continued to work on key priorities including working with the trade unions and sector stakeholders through the Fair Work in Social Care group, to make progress on the recommendations in the Fair Work Convention's Fair Work in Social Care Report and in doing so, improve fair work practices across the sector. We have also worked with Social Work Scotland and others to develop the Self-directed Support (SDS) Framework of Standards to drive a more person centred, human rights based approach to care.
This year we provided funding of £64.5m to ensure that adult social care workers in Scotland will be paid at least the Real Living Wage of £9.50 per hour.
To support the development work required to design and establish a National Care Service and related reforms we have set up a steering group including people with lived and living experience of social care to help us devise a social covenant. The aim is to ensure the new service is designed around the needs of people who access social care and supports the needs of unpaid carers and care workers.
As part of a rights-based approach to care, the Scottish Government has committed to strengthen residents' rights in adult residential settings. This will include delivering 'Anne's Law' – ensuring that care home residents have the right to contact with their families and friends to support their overall health and wellbeing at all times.
As part of taking forward the 30 recommendations from the National Taskforce for Human Rights Leadership for a new human rights framework for Scotland, a Human Rights Bill will be introduced in this parliamentary session. This new Bill will complement the work in relation to developing a new National Care Service.
We will not wait for a National Care Service or for new legislation to continue with work to improve social care. We are establishing a Proactive and Preventative Care Programme, as part of the "Remobilise, Recover, Redesign" of Scotland's Health and Care services as we strive to ensure that more consistent and equitable support and services are in place across the country and that they operate in a person centred way. We are keen that this will embed change at a practice level and deliver integrated support for people, so that the foundations are right when the NCS is created - regardless of the structural arrangements. It is crucial that we continue to make improvement as soon as possible and that we do not see stagnation, a lack of innovation or significant disruption during the development of the NCS.
What is the purpose of the consultation?
This consultation is focused on exploring the suggestions for significant cultural and system change that will need to be supported by primary legislation, new laws, to ensure the governance and accountability across the system to deliver successfully for people.
New laws are necessary to implement the scale of change required to refocus the system to one that upholds human rights and promotes the health and wellbeing of people who access and who offer care and support.
Moving forward there needs to be a focus on high quality delivery, continuous improvement and consistent access to services regardless of what part of Scotland you live in.
Transparency is paramount. Transparency of expectations and standards. Transparency of care plans between providers and recipient. Transparency between services to promote preventative and proactive care plans.
Achieving this will facilitate a shift from a system that supports people to survive to one that empowers them to thrive.
Inclusivity and wholescale improvement
It is important to use this opportunity to consider the scope, remit, inclusivity and delivery mechanisms of the National Care Service in its widest sense. The assumption is that as a minimum it will cover adult social care services. However if we want to build a community health and social care system to make sure that all people receive services that cluster round them to deliver the best possible outcomes, then we must consider the merits of extending the scope of a National Care Service to oversee all age groups and a wider range of needs including:
- children and young people;
- community justice;
- alcohol and drug services; and
- social work.
This consultation sets out proposals for an expanded scope for the National Care Service. The priority in these considerations for each and every one us needs to be the people these services support and improving the quality of outcomes for them.
The proposals set out in this consultation paper will have a cost to the public purse. But, as the IRASC emphasised, social care support should not be seen as a burden. It is an investment in society, it creates jobs and economic growth, and allows people who access care and support and their carers to fulfil their potential and, in many cases, access employment themselves. Done well, a focus on early intervention and prevention avoids the need for more costly action at a later stage. For example, supporting unpaid carers so that they can continue their caring relationship, supporting families to prevent family breakdown, or ensuring appropriate care to prevent deterioration or falls resulting in a need for hospital treatment, all result in benefits for individuals and families, and for our health and care services.
This Government has committed to increase investment in social care by 25%, but public resources are still limited. As we consider the feedback from this consultation, all proposals will be assessed for value for money, to make sure the maximum impact is achieved from that investment. But in doing so we will look at the overall benefits of improving people's experience of care and the outcomes they achieve, as well as the direct costs or savings of providing that care.
What is social care?
Social care is there for people of any age who need help with day-to-day living because of illness, physical disability, learning disabilities or mental health conditions, or because of older age, frailty or dementia. Social care also supports people with or recovering from alcohol or drug addictions, and those who are or have been homeless or are at risk of becoming homeless. Children's social care services also provide help for children and families who may need additional support, or where children are unable to live with their own families.
Social care may be provided in people's own homes, including through remote care and technology enabled care, in residential accommodation and care homes or in the wider community, including many advice and support services. The population receiving social care and support is diverse, with wide ranging needs and circumstances.
For example, based on 2018/19 figures:
- Around 245,000 (1 in 20) people in Scotland, of all ages, receive social care and support.
- Around 60,000 people are receiving home care at any one point.
- On 31 March 2019 there were around 35,500 people residents in care homes, of which around 90% are aged 60 and over.
Of the total 245,000 people receiving social care, just over 1 in 5 (23%) were under the age of 65. Of those:
- Just over 1 in 3 (34%) have a physical or sensory disability
- Just over a quarter (27%) have a learning disability
- Around 1 in 6 are receiving social care support due to mental health issues.
- People can be receiving support for more than one reason. Other reasons include problematic substance use, neurological conditions, dementia, palliative care, autism or other vulnerabilities
On 31 July 2020 there were almost 14,500 children in Scotland being supported at home, with kinship carers, with foster carers or in residential accommodation.
The system of adult social care is planned, commissioned and delivered by a wide range of partners. This includes organisations in the public, independent and third sectors.
- There were 206,400 people employed in the social service sector in December 2019. Of these around half were employed in adult services and around 45,000 in daycare or residential care for children. There are many more individuals supporting delivery through our multidisciplinary health and social care teams.
- It is also important we recognise the invaluable role of unpaid carers with an estimated 700,000 to 800,000 carers in Scotland, including around 29,000 young carers.
- In 2019 there were 5,957 social workers employed by local authorities. Almost half of these work in children's services.
What happens next and when?
This consultation is intended to start discussion and debate about what changes should be made to achieve better outcomes for people. We are asking you to engage, to challenge and suggest innovative solutions. By working together, the role of a National Care Service and the system that supports it will be stronger.
Our commitment is to seek the views of as many people as possible to shape a better future - including users of social care services, members of the workforce and members of the public, carers, and potential future users of services, which includes everyone. In addition to this consultation paper we will engage with people, both online and in person where possible, to ensure that as many people as possible are able to have their say.
We recognise that there will be many different views as we explore new options, however a shared vision for a future community health and social care system for Scotland that works for people is essential. To do that we must focus on practical suggestions that can be implemented in order to improve outcomes and support.
There will be further opportunities for people to shape and design the detail of how the system will operate once we have identified what it will be.
At the end of the consultation process all of your feedback will be analysed and the conclusions will be used to shape and develop new legislation (a bill) which will be introduced in the Scottish Parliament in summer 2022. As we reach conclusions on the National Care Service we will continuously consider how it will integrate with the National Health Service and any implications for the NHS.
We will also consider the impact of our proposals on equality groups and others, including businesses and island communities and will carry out a suite of impact assessments before finalising the proposals.
The legislation is likely to be extensive and complex and is likely to take at least a year to be scrutinised by the Parliament. After that we need to set up the organisation and put the legislation into effect. We intend the National Care Service to be fully functioning by the end of the Parliamentary term.