National Care Service Forum 2023: follow-up questions and answers
On 30 October 2023, we hosted our annual National Care Service (NCS) National Forum in Glasgow. Here we have collected and answered some of the questions people asked on the day.
National Care Service Forum 2023 – Follow-up Questions and Answers
We collected some of the questions people asked at the National Care Service (NCS) Forum on 30 October 2023. Find these questions and our answers here.
Questions
How can we support people to access care and support?
How will the NCS support and facilitate digital inclusivity?
What does the Verity House Agreement mean for the NCS?
How are private care companies going to fit into the NCS? Will the government hold them accountable?
What does the Charter mean, and in practice what will it do and how?
How can the NCS make things better through mental health services?
The NHS is experiencing some of the most severe pressure in its 75-year history. How will that be "fixed" by a NCS?
The NCS will continue the integration of community health and social care support, which will help ease the pressure on the NHS. Community health represents the first point of contact for health and social care for individuals. It accounts for the most interactions with health services.
Achieving better outcomes in the community will reduce the need for NHS interventions. This will allow better use of resources.
How can we support people to access care and support?
Every local authority has an information and advice service for carers in their area, in line with their duties under the Carers (Scotland) Act 2016. These are usually local carer centres. They provide information and advice on a range of issues relevant to carers, including how to access support.
Independent Living is a crucial part of enabling human rights. This includes social care support from home, with Self-directed Support (SDS) playing a key role in delivering this. This is the case both under the current arrangements, and as part of the planned NCS.
The Scottish Government provides the policy framework to support people in their local communities to access the four options for SDS. It also supports people to access Scottish Government-funded free advocacy support and advice through the Support in the Right Direction programme.
The Scottish Government funds the Care Information Scotland website. It has up to date information on social care support for the public.
How will the NCS support and facilitate digital inclusivity?
All digital services provided by the NCS will also be available via other accessible channels and formats. These include phone, face-to-face, physical formats and translations.
Digital services are being co-designed with people with lived experience of receiving and delivering health and social care support services. This will help ensure they meet the needs of all the people that will use them.
The NCS will also work with all Scottish Government programmes that support digital inclusion, such as:
- Connecting Scotland
- Digital Health and Care Digital Inclusion programme
- Digital Citizen panels and Lived Experience Experts Panel (LEEP)
With the new agreement on shared accountability, why can't the required change be achieved in the current system without disruptive structural change? Could allocating resources now to support service pressures and local reform not achieve more?
In 2021 the Independent Review of Adult Social Care identified the need for change and recommended reforming social care in Scotland. Recommendations included a National Care Service (NCS) to deliver national accountability for social care support. They also included that Scottish Ministers should be accountable for adult social care support.
The NCS will enable consistency and improvement to be led at a national level. It will ensure services are locally accountable and responsive to the needs of their communities.
In terms of financial resource, we have made a manifesto commitment to increase social care spend by 25% over the course of the parliament. This will result in at least £840 million additional investment. The increased investment in social care relates to a range of areas. These include workforce, the recommendations of the Independent Review, ongoing rising demand pressures and a move towards the NCS.
What does the Verity House Agreement mean for the NCS?
The Verity House Agreement sets out principles to ensure local and national government work together to improve service delivery. This includes social care support.
Within our proposed new national framework, local authorities and health boards will keep service delivery functions, staff and assets.
We now believe we can achieve the aims of our proposed Care Boards through reforming the current Integration Authorities. There are still many changes needed at local level to bring consistently good quality services across the country. However, it's important that we don't bring about widespread change just for the sake of it.
Instead, amendments to the legislation will allow us to keep the knowledge and good work already happening. At the same time, they will improve the areas we know desperately need reform.
There must be strong oversight of these reformed Integration Authorities and a clear link between local and national shared accountability. Ministers will put forward amendments to the legislation which will make sure the Integration Authorities are accountable to a National Care Service (NCS) Board.
The NCS Board will be responsible for reviewing and overseeing the performance of local strategic plans. To support this, we are proposing to transfer Ministerial powers of intervention to the NCS Board. This will allow the Board to invoke those powers as a last resort. It will also give the Board the levers needed to drive and support performance and take action if required.
The involvement of people with lived experience will remain at the heart of these reforms, including at decision-making level. To achieve this we will extend who on the Board has voting rights.
The detail of this reform will be co-designed with:
- people with lived experience of accessing community health, social work and social care support services
- unpaid carers
- care providers
- workforce
- stakeholder organisations
How are private care companies going to fit into the NCS? Will the government hold them accountable?
Under the NCS, social work, social care support and integrated community health services will still be delivered by a range of public, private and third sector organisations.
External providers will continue to be held to account by local government and health boards through their contract management processes. They will be inspected, regulated and supported to improve by these bodies, as appropriate:
- the Care Inspectorate
- the Scottish Social Services Council (SSSC)
- Health Improvement Scotland
We are also considering how ethical commissioning and procurement can be used to embed the NCS Principles and support the proposed national care board support and improvement framework.
We are committed to engaging with people with lived experience and stakeholders. This includes procurement and commissioning professionals, workforce representatives and service providers. Through engagement, and co-design where appropriate, we will understand how best to use procurement and commissioning to support the oversight process. We will also develop tools and guidance to consistently embed an ethical commissioning and procurement approach.
What does the Charter mean, and in practice what will it do and how?
The NCS Charter of Rights and Responsibilities will set out people's existing rights and responsibilities when accessing NCS support. It will provide a clear pathway to make a complaint if those rights are not upheld. It will also tell people how to access information, advice and advocacy services.
We aim to ensure that the NCS Charter can adapt if needed. For example, if there are changes in the regulatory and legal landscape, such as the development of the Mental Health Law Review and the Scottish Human Rights Bill.
How will the NCS support unpaid carers to provide care and to live full lives whilst also preventing any stop in care?
The aim of the NCS is to improve quality, fairness and consistency of provision that meets individuals' needs. It is about improving people's lives, including unpaid carers', so they can thrive and lead a full life.
The NCS will provide support to anyone in Scotland who needs it through social work, social care and support for carers, and by planning and commissioning primary care and community health services with human rights at its heart.
The NCS will oversee the delivery of care, improve standards, embed enhanced pay and conditions for workers, and provide better support for unpaid carers.
The NCS Bill also makes changes to the Carers (Scotland) Act 2016 to deliver a new right to personalised short breaks support for carers who need it. This will help protect carers' wellbeing and help to sustain caring relationships.
We are collaborating on this with a stakeholder working group, involving unpaid carers, statutory services and carer centres.
As we build the NCS, we are continuing to listen to the voices of the real experts: people who use community health and social care, their unpaid carers, and the workforce.
Could eligibility criteria be removed, and if so how else could financial resources be managed and allocated?
The Scottish Government and COSLA are committed to working together on updating the approach to eligibility criteria and assessments. This process is still underway. The aim is to ensure that adult social care support is based on human rights and needs.
We are working together with stakeholders to identify a range of policy options. These will be considered by Ministers and the COSLA leadership.
Could third sector organisations with the right skills/experience help with undertaking assessments to reduce the burden on social workers?
As part of the development of the NCS, the Scottish Government is considering how to improve the services people engage with first. This includes the services people engage with when they first speak to somebody about their needs. It also includes how their needs are assessed and their support is planned.
Our aim is for the process of assessment and support planning to help people access the support they need at the point they feel they need it.
What learning from the implementation challenges from Self-directed Support (SDS) will be taken in designing and implementing the NCS?
SDS will be key to the success of the NCS. The proposals for the NCS have a strong commitment to a human rights-based approach, independent living and supporting people to thrive. SDS helps deliver all these principles.
We are working closely with local authorities, third sector organisations and COSLA to improve the implementation of SDS. Our SDS Improvement Plan was published last year. The plan aims to embed the SDS principles of participation, dignity, involvement, informed choice and collaboration in social care support in Scotland. This includes NCS service delivery.
How can the NCS make things better through mental health services?
Mental Health and wellbeing sits across both health and social care. The NCS is likely to involve more steps towards integration between health and social care.
This offers an opportunity to consider how Mental Health is positioned and governed within local integration arrangements. We will also consider the way mental health services are provided and designed, to better meet the changing needs of local populations.
Contact
Email: NCSCommunications@gov.scot
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