The establishment of a National Care Service (NCS), and associated changes to the broader system, represent one of the most significant pieces of public service reform to be proposed by the Scottish Government. This offers an opportunity to address the challenges that have been evidenced by many across health and social care. These challenges are not new. They have been highlighted by people before, during and in the early stages of recovery from the pandemic.
The Scottish Government welcomed the recommendations made by the Independent Review of Adult Social Care (IRASC) and consulted on proposals to achieve changes to the system of community health and social care in Scotland in the autumn of 2021. Whilst the IRASC focused on adult social care support, many integration authorities have delegated responsibility for a broader remit. In many areas that remit includes children and families and justice social work delivery. The limitations of the integration structures, therefore, have much broader relevance. Our consultation proposals considered widening the NCS scope to include community health functions, children's social work and social care, justice social work, addiction and rehabilitation and related services.
The proposals sought to ensure:
- consistent delivery of quality social care support to every single person who needs it across Scotland, including better support for unpaid carers; and
- those care workers are respected and valued.
The NCS consultation responses supported a change in the way we deliver care and support across Scotland. There was strong agreement that placing human rights at the centre of our decision making was fundamental to ensuring equality, non-discrimination and the dignity of individuals.
People described accessing care and support in the community as 'notoriously difficult', 'over-complicated' and 'bureaucratic'. There was a recurring theme of frustration about having to repeat the same personal information across the health and social care system. In addition, there were references to 'fighting for' and 'justifying' their right to support. Accessing social care support specifically was described as being difficult from the start, with an inadequate referral process and not enough information about support available, including peer support.
A complete summary of the NCS consultation responses is set out in the independent consultation analysis, which is published on the Scottish Government website, together with accessible versions. We have carefully considered the views expressed in almost 1,300 written responses and over 100 public engagements.
Through the consultation process, people have confirmed that they want a NCS, accountable to Scottish Ministers, with services designed and delivered locally.
It is now time to co-design a change programme, working with partners, stakeholders and people with lived experience of receiving and providing care and support (and people who are impacted by related services), to deliver this. This document sets out the benefits which can be realised through forthcoming legislation and co-design, as well as highlighting where further evidence gathering and consideration may be required to inform future decisions around the NCS (including children's services and justice social work).
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