The Future of Residential Care for Older People in Scotland - Full Report

Opportunity

Origins of the Task Force

Whilst agreement between the two parties involved in the National Care Home Contract does not fall within the explicit remit of the Task Force, the forming of the group does present the opportunity to ask if the product being commissioned now is the product we want to commission in the years to come. Indeed, going a step further, we can ask questions about the very manner in which we commission services.

There was broad consensus across representatives from the public and independent sector that a Task Force to look at the future of residential care was a step in the right direction. In approaching potential members of the group, an effort was made to ensure those people had the skills, knowledge and experience of the sector, but also the authority and autonomy to represent their organisations and to agree to pieces of work and final recommendations that might impact on those organisations. We were particularly pleased to have strong representation from colleagues in the Housing sector, as any discussion regarding the future of residential care needs to acknowledge housing's role as part of the continuum of care, rather than a stand-alone entity.

A list of the Task Force and Sub Group members is attached in Annex A of this report.

Remit

The Task Force's primary objective is to examine at a strategic level the key purpose and desired structure of residential care services fit for the aspirations and needs of future generations.

The remit of the Task Force was to:

• Outline strategic outcomes and priorities for adult residential care for the next 20 years;
• Scope out capacity planning processes and the interface with other services within the context of integration, joint commissioning strategies and diversification of the sector;
• Review the fee structure of care home placements, and provide options for a new fee structure and alternative methods for procurement;
• Audit the commissioning levers available to local Health and Social Care Partnerships and make recommendations about how these can be strengthened to ensure that the sector responds to the needs of the local population;
• Agree a compulsory risk register, to provide an early warning system for care providers experiencing challenges to the continuity of care - and an associated ladder of intervention for public authorities to co-produce solutions for exit or redesign of struggling services;
• Review of the basic structure of residency, exploring parallels with the housing sector and the introduction of a rights-based frameworks for residents, and whether it is desirable to separate-out daily living costs such as rent, food and utilities from the cost of care, allowing a move to tenancy arrangements; and
• Assess whether the various operational models of care home businesses bring different levels of risk (particularly around the split between property owner and care provider), and if appropriate make recommendations about how these might be overcome.

Intended Outcomes

The intended outcomes, and indeed the success of the group's work can be seen as its response to the points highlighted in the above remit. We have however, agreed an overarching 'Vision' which captures the kind of care services we would like to see created as a result of our work and which provided a focus for the work of the Task Force.

Vision

To support older people in Scotland, now and in the future, to live in homes where they feel safe and respected as members of their communities. We will do this by:

• Adapting person-centred and personalised care and support solutions to people's changing needs;
• Developing accommodation and care options that are flexible, built around people's needs and also part of a wider community;
• Ensuring that rights to privacy and dignity are respected at all times;
• Nurturing a caring workforce which is passionate about delivering high quality person-centred services, and developing caring as a career of choice;
• Planning services responsibly to develop sustainable communities;
• Making funding and charges simple and transparent; and
• Assuring quality and safety.

Structure of the group

At the first Task Force meeting in July 2013, the group agreed the work should be split across six core work-streams, each led by a member of the Task Force, and reporting in the first instance to the Task Force Steering Committee. The work-streams identified were:

Sub-group leads were asked to identify (from within and out-with the Task Force) the people they thought would be best placed to contribute to their respective discussions and have valuable input in drawing up a set of recommendations. They were tasked with providing a summary paper with those recommendations for the wider Task Force to review ahead of the writing of the final report in December 2013.

The Task Force Steering Committee (led by the co-chairs), was responsible for monitoring the progress of the sub-groups, establishing meeting agendas, and drafting the final paper. This structure also allowed for issues to be identified and addressed in between Task Force meetings, making the work of the group generally more efficient.

Membership of the Task Force and the Sub-groups is detailed within Annex A.