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Scottish government proposes National Care Service

The Scottish government is proposing a National Care Service incorporating children and adult social work to “to consistently deliver high quality services to every single person who needs them, across Scotland”.

Kids in wellies

A consultation published by the Scottish government proposes the establishment of a National Care Service (NCS), as an opportunity to address some of the challenges across social care highlighted before and during the pandemic. It follows the publication of the recommendations of the Independent Review of Adult Social Care in February.

“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,” said the consultation.

While the assumption is that as a minimum it will cover adult social care services, the government wants to 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
  • social work.

The National Care Service would, the Scottish government says, ensure national minimum standards, improve consistency, and raise the quality of services across the country.

The establishment of the NCS, accountable to Scottish Ministers, would:

  • Achieve consistency across the country, and drive national improvements
  • Ensure strategic level integration with the NHS that promotes preventative care and reduces the need for hospital stays
  • Set clear national standards and terms and conditions for the commissioning and delivery of services
  • Bring national oversight and accountability to ensure that all individuals universally have access to the services needed.

The consultation highlights that currently, local authorities have statutory responsibility for providing social care support, and Scottish Ministers, through local Health Boards, have responsibility for health care. Under the Public Bodies (Joint Working) (Scotland) Act 2014 (PBJWSA), and secondary legislation made using powers granted by that Act, local authorities and Health Boards are required to delegate certain functions (and budgets) to a local integration authority, and may delegate others. In most areas the integration authority is an Integration Joint Board (IJB) which includes members from both the local authority and local Health Board.

A number of Integration Joint Boards (IJBs) already have children's services delegated to them with the remainder remaining within local authorities. Where children's services are not delegated to an IJB they have remained within the local authority, often within the Education Department.

Alongside this is a complex statutory framework for social work and care, contained in a number of pieces of legislation cutting across both adult and children's services, in addition to children-specific legislation, the consultation adds.

“Not including children's social work and social care within the National Care Service (NCS) risks fragmenting the current system of care and assessment and further adding to complexity for services users – a key issue highlighted by Independent Review of Adult Social Care (IRASC),” it says.

“Separating the delivery arm of the process by creating a National Care Service focused solely on adult social care would also have consequences for the ambition that improved planning and commissioning functions will deliver through having both social work and social care within the NCS, whilst ensuring continuity of risk management and the protection of human rights,” the consultation adds.

Whilst the IRASC specifically focused on adult social care, the government believes it should be seen in the context of the Promise, the United Nation's Convention on the Rights of the Child (UNCRC), Getting It Right for Every Child (GIRFEC), and other children's policy areas such as increasing the Age of Criminal Responsibility.

The Promise concluded that "for Scotland to truly to be the best place in the world for children to grow up, a fundamental shift is required in how decisions are made about children and families". For this fundamental shift to happen services have to be designed in a truly collaborative way – IRASC therefore provides an opportunity to look holistically at the system of support for children, young people and their families.

To support the development work required to design and establish a National Care Service and related reforms a steering group has been established including people with lived and living experience of social care to help 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.

However, COSLA has stated that the proposals for a NCS put at risk the vital links that exist across the essential services that many vulnerable people rely on every day.

COSLA’s Health and Social Care Spokesperson Councillor Currie said: “Many of the people who access the services included in the Scottish Government’s NCS proposals also rely on other services delivered by Local Government, including housing, education, welfare advice and employment support.  These essential services cannot be seen in isolation, they work best when they are connected.  It is vital that the links between them are preserved if we are to provide the most effective support for people who rely on these essential services the length and breadth of Scotland each and every day.

Councillor Currie continued: “COSLA is clear that change is needed and that the service user must come first.

“Reforming how we deliver our health and social care services offers an opportunity to change our focus and position health and social care as part of a wider approach to improving public health and community wellbeing.

“By embracing this approach, and by providing the necessary investment to tackle the long standing and chronic underfunding that exists in social care, we can take meaningful strides in addressing the challenges that continue to confront our health and social care system every year.

“This is an opportunity that we have to take and it is disappointing that the proposals set out by the Scottish Government do the opposite and will only serve to impact on the ability to deliver a joined-up approach across all of the Local Government services that impact on a person’s health and wellbeing,” he concluded.

The consultation closes on 2 November 2021.

A National Care Service for Scotland

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