National Care Service - national systems of social care in Nordic and Scandinavian countries: learning and evidence review

Key messages for decision makers

This rapid review^[1] presents research evidence and learning from Nordic and Scandinavian national systems of social care to inform the development of the Scottish Government's proposed National Care Service for Scotland. Nordic and Scandinavian countries were selected as they have similarities to Scotland's demographics and type of delivery provision in terms of health and social care. The review includes evidence from qualitative research studies with service users and other key informants,^[2] and quantitative research studies reporting population health outcomes.

Although national social care systems varied between countries, we did not find any that could be described as specific "models" of national social care structures in the Nordic and Scandinavian countries. The majority of the identified literature focused on the integration of services between health and social care and how services are delivered at national and local levels. One regional level model - the Norrtaelje^[3] was identified in Sweden, where a single regulatory body was established to deliver care to the regions' population.

Neither did the evidence we reviewed identify any consensus positions around preferred structures of governance and finance of national social care systems. However, the evidence from service users and other key informants suggests a number of key principles that would facilitate the integration of social care services, regardless of the types of finance and governance structures. There was evidence of barriers and enablers to effective implementation relating to person-centred care and user involvement, communication, collaboration and trust between organisations and professionals.

There was limited evidence regarding national care structures and population health outcomes. A number of studies highlighted issues relating to inequalities in access to social care services. Findings were mixed as to whether integrated health and social care resulted in lower demand for services elsewhere in health care. An important evidence gap was the lack of quantitative studies that evaluated the impact of national social care policy implementation within or across countries.