Review of care service definitions: challenges and recommendations

3. Background and methods

3.1 Policy Context

The definitions established in the Public Services Reform (Scotland) Act 2010 determine which services the Care Inspectorate regulate and inspect, and dictate the Scottish Social Services Council's registration of social care workers. However, over the last decade, the introduction of the Health and Social Care Standards, the implementation of Self-directed Support (SDS), and health and social care integration have led to significant changes in the sector in terms of how social care is commissioned, provided and how people access this care and support. Since the implementation of the 2010 Act, different approaches are needed to deliver person-centred, flexible care and support, in the right place at the right time for people. More recently, the COVID-19 pandemic has further highlighted the need for flexibility in the delivery of health and social care support.

Below details some of the key pieces of legislation and policy developments which frame the current social care landscape.

Regulation of Care (Scotland) Act 2001

This sets the foundation for social care workers' registration in social services.

Self-Directed Support

The Social Care (Self-Directed Support) (Scotland) Act (2013) came into effect in April 2014 and placed duties on local authorities to provide options for individuals to choose how much they want to be involved in the organisation and design of their care and support.

Health and Social Care Integration

Integration was a fundamental change to health and social care services in Scotland. Integration aimed to improve care and support for people who use services, their carers and their families. In Scotland, integrated care was formalised with the Public Bodies (Joint Working) Scotland Act (2014). The Act was intended to help shift resources away from the acute hospital system towards preventive and community-based services.

Carers (Scotland) Act 2016

The Act gives carers rights to a new adult carer support plan or young carer statements. This reflects a preventative approach to identify carers' personal outcomes and needs for support. This preventative approach is also reflected in the requirement to provide information and advice services to carers.

Health and Social Care Standards

The Health and Social Care Standards were introduced in 2017 to drive improvement, promote flexibility and encourage innovation in how people are cared for and supported. All services and support organisations, whether registered or not are encouraged to use the Standards as a guideline for how to achieve high-quality care.

The Promise

The Promise (2020) was an Independent Root and Branch Review of Care ('the Care Review'), driven by young people with experience of care.

Adult social care: independent review

The recent Independent Review of Adult Social Care in Scotland (2021), chaired by Derek Feeley ('the Feeley Review'), reinforced the emphasis on people who use social care support, families and carers, and social care workers, being at the centre of service delivery. The review recommended improvements to adult social care support in Scotland, primarily in terms of the outcomes achieved by and with people who use care and support services.

3.2 Methods

This research involved a mixed method approach, including desk-based research and stakeholder engagement.

Desk-based document analysis

A rapid review of key policy documents and legislation was produced to gain an understanding of the context of the current definitions and to help prompt discussion with stakeholders.

Semi-structured individual and group interviews

23 interviews were conducted with a total of 55 stakeholders representing organisations from across the social services, health, and education sectors as well as local and national government (see appendix 2 for the stakeholder list). Of the interviews, 9 were with individuals and 14 with two or more stakeholders.

Some additions to the stakeholder list were made in response to requests from stakeholder organisations. One organisation requested another, closely related organisation join their group interview. Another stakeholder felt strongly that they needed to ask for the views of people accessing support before taking part in this research and so conducted a short poll using the interview questions from this research. Feedback from the poll was shared with Iriss so it could be included in the analysis. Another key social services organisation offered to contribute and so were also added.

All interviews were conducted remotely, using mainly video calls with some over the phone. Interviews were semi-structured and the questions, information sheet and consent form were shared with interviewees ahead of time. Each interview was audio recorded and transcribed.

Analysis

Each transcript was comparatively analysed using secure data analysis software and coded to extract commonality and themes, as well as highlighting areas of importance to those representing specific parts of the sector.

Views of stakeholder organisations were summarised to protect anonymity. Quotes included in the report were drawn from across the data with longer direct quotes attributed to organisations.