Social Covenant Steering Group minutes: February 2024

Attendees and apologies

Social Covenant Steering Group Members

• Tommy Whitelaw
• Dr Caroline Gould
• Dr Pauline Nolan
• Marion McArdle
• Shubhanna Hussain-Ahmed
• Dr Jim Elder-Woodward
• John Whitfield

Scottish Government

• Maree Todd, Minister for Social Care, Mental Wellbeing and Sport
• NCS Communications and Engagement, NCS Programme, NCS Co-design

Items and actions

Welcome

The Chair welcomed everyone to the meeting.

The Chair began the meeting by letting the group know that on 17 January the Scottish Parliament made the decision to extend the deadline for the stage 1 debate to take place by 1 March 2024. The delay is unlikely to impact on the pace of passing the legislation, and although stage 2 will be a little longer than average, we will be back on track by stage 3.

The Chair reiterated the commitment to delivering a National Care Service (NCS) within the lifetime of this Parliament, that delivers the positive change needed for people, makes best use of public funds, and puts individuals at the heart of the service.

The Chair went on to say that the Scottish Government (SG) has worked with more than 1000 people on co-designing the NCS, and added that she had recently held a series of round table discussions with people with experience of providing or accessing social care support.

The message from people, right across Scotland has remained the same: people deserve more and, while we’re working hard to implement changes now, the reality is we need longer term, widespread reform to fix some of the ingrained issues within the system and ensure sustainability for the future. 

The new shared accountability framework, agreed with COSLA, will bring in a new structure of national oversight to improve outcomes and maximise resources. Despite all the progress there is still some mixed perceptions of the NCS. Social care has felt like something done to people and the NCS Bill is a real chance for us to develop a more ethical, human-rights based system that’s designed by the people who use or work within it. It will not only deliver a more regulated system of care that has stronger governance, but also a more equal, transparent approach. 

The Chair thanked the group for their support to date and stated that in the run up to the Stage 1 debate, it's necessary for those who believe in social care reform to make their voices heard to ensure the opportunity isn’t lost. 

The Chair asked the group to publicly voice their support for the NCS. This is our chance to make a real difference to the social care system, including a shift to a preventative approach, it might be the only chance we get for years to come.  

The Chair explained that a stakeholder communications toolkit that has lots of key dates and messages had been developed and can be shared with the group after today’s meeting.

Action: Share Stakeholder Communications Toolkit

The Chair then opened for discussion.

The group asked what the impact would be of the Scottish Human Rights Bill on the NCS Bill? There are rights to independent living in the Human Rights Bill which closely connect to rights to social care support.

The Chair shared that there is a commitment from this Government towards taking a human rights based approach. However, we know that people’s rights are not always realised and more needs to be done to uphold people’s rights in service and support delivery. The progress of the Scottish Human Rights Bill is at an early stage and the Chair shared her experience of incorporating human rights into domestic law from the passage of the UN Convention on the Rights of the Child (UNCRC) Act.  While human rights are devolved to the Scottish Parliament, the rights themselves often touch on reserved areas, which may limit what or how we incorporate some rights. This doesn’t stop SG from taking a rights based approach though.

The group highlighted that the difficulty with a human rights based approach is that the local authority control the finances. A member of the group noted that there wasn’t a right to social care and shared frustrations regarding the Charter of Rights and Responsibilities.

The Chair responded that the challenge with writing legislation that makes rights real is that it is generally written, not from the perspective of the person whose rights are being upheld, but the expectation of the duty bearers.

The Chair noted the groups frustrations about the Charter.

The Chair then passed to SG colleagues to provide an update on the program delivery board.

Program Delivery Board update

SG thanked the group for having her at the meeting and outlined that her role as programme manager for the NCS is to provide structure, process and oversight, to ensure that whatever is co-designed delivers the changes intended.

SG went on to say that she is supported by a small team that support the delivery of the Programme. The team essentially carry out the activities outlined in the management case of the latest iteration of the NCS Programme Business Case. This includes Governance supporting the Programmes decision making, Risk management, delivery planning, business cases, benefits management and assurance activity.

All of this activity is designed to ensure the Programme achieves its outcomes on time and to budget.  As with any big programme it is important that there is independent review of that program and the team help to support that review.

SG informed the group that there is a Program Delivery Board (PDB) that is chaired by Donna Bell, Director of Social Care and NCS Development, as our senior responsible owner (SRO). The PDB has membership from across the SG representing different areas of business.

The PDB brings together key people from across the Scottish Government to ensure the co-design is reviewed ahead of providing advice to Ministers. In addition the PDB hears regular updates on progress, primarily around where we are on the NCS Bill and any actions we need to take. In the fullness of time the PDB will focus on implementation of the policy intent and direction.

SG then opened to the group for questions.

The group asked a question about the integrated health and social care record. The NCS programme business case and financial memorandum has no cost basis put in there for this. Is that realistic?

SG responded that the integrated health and social care record is a large scale digital programme in its own right. It is referenced in the NCS business case but not in detail. The expectation is that it will have its own business case which will go into that detail and there will be a need to co-design. Data is important and it's critical to get it right.

The Chair thanked SG colleagues and said that there is a general feeling, particularly among people with lived experience, that they are invited to give their views regularly but don’t see the output, could SG respond to that?

SG explained that they are linked in with the co-design team and that it’s a key part of their processes. So, when the programme delivery board are providing an overview or making recommendations to Ministers, part of the package presented includes the insights gathered from co-design.

The Chair thanked SG and then welcomed SG colleagues from the co-design team for an update on co-design activity.

Co-Design update

SG provided a verbal update to the group on the co-design activity that has taken place from late autumn.

SG clarified that this update doesn’t go into the insights we have been learning or the outputs yet, as we are not at that stage with the work, but we are close to it. SG said that they would come back at a future meeting to talk about the learning and insights and how it feeds into the policy work.

SG reminded the group of the summer regional forums, the autumn forums and all the online forums that had provided a great opportunity for geographical diversity of engagement and volume. Reports on these forums are now published on the NCS website.

However, the nature of that style of engagement meant that we couldn’t reach all key groups. We decided instead to engage through organisations that have existing good links to the communities that it has been difficult to get access to.

We are calling this work seldom heard voices work.

It took us a little while to get the relationships set up and agreed. For some organisations they already had people who were used to facilitating workshops and had experience of user research, so we were able to take more of a back seat. The organisations were able to take forward the work, based on what we wanted to explore and we came in as notetakers or observers.

Other times, for some organisations, it was a new way of working, so we embedded ourselves and had our team coming in to provide support and help with accessible communication.

Slides were shared that detailed the organisations and the work that had begun.

SG explained the design themes that have been focused on during this work:

• ‘making sure your voice is heard’ with conversations around complaints, redress and independent advocacy
• ‘information sharing’ which is the work around the integrated records, talking about people's data and what we are comfortable sharing and what might work well in terms of a meaningful record

We are starting sessions to explore the NCS National board, which is a big focus of our work over the coming months. We will look at questions on what meaningful engagement and representation could look like on the National Board, for people with lived experience. What might the support structures be and what does meaningful representation look like?

The seldom heard voices organisations will write reports of their findings and we hope to publish these later this year.

SG opened for questions from the group.

The group asked if we would stop using the word ‘eligibility’ as it has connotations and would rather we use the word 'access’.

SG noted how helpful that is to know and will feed that back to the team.

The group asked if the co-design team were working with People First as part of the seldom heard voices work.

SG informed the group that currently they are not part of the seldom heard voices work but People First have signed up to the Stakeholder Register.

The group asked if they were finding anything different depending on the communities they were engaging with? Could that lead to different thinking on what the NCS could look like?

SG said that the work has been very successful. One reason it has gone so well is that we have been working closely with community health workers, who are trusted individuals within communities. This has given us the opportunity to hear from groups that would not choose to engage with the government and would not come along to a forum.

The flow of work is still the same but the opportunities for how we do the work are very broad. The team has been learning to adjust the pace and scope, learning to adjust as we go, depending on who we are working with.

The group wanted to reiterate that the focus has to be on the individual and if we keep that, we will get it right.

The Chair reiterated that what people tell us and how that informs policy takes trust. The only way we can maintain and build that trust is to make sure we listen. The Chair stated that the group helps us all to remain focused on how services should be person-led rather than person-centred.

Action: Share the slides after the meeting.

Any other business

The Chair let the group know that the next informal meeting is on 27 March 2024 and the next formal meeting is on 23 April 2024, then opened for any other business.

The group mentioned that there had been discussions previously about having a meeting with the local authorities, and asked where we are on that. It would be useful to engage with people with other ideas about the NCS and to allow them to hear our point of view.

The Chair responded that she meets fortnightly with COSLA and she would add that to the list of things to discuss.

The group also raised a point on how we talk about the cost of care but what about the value of care?

The Chair replied that she agreed we should focus on the value of care. If we can support people earlier in their journey we will get a huge economic benefit and prevent a lot of harm. If we can support people doing unpaid care to work, rather than having to give up work to care, we will get an economic benefit. I want to shift how we talk about social care to an investment that we can all make as a society.

The Chair said that she had agreed to provide the Finance and Public Administration Committee with more detail around the business case and welcomed the scrutiny of costs. This will be one of the most heavily scrutinised pieces of legislation going through parliament.

The Chair then thanked everyone for coming, the Alliance for providing the Zoom link and the note taker for providing live captions.

The Chair closed the meeting.