Adult social care: independent review

Foreword

I am grateful to the Cabinet Secretary for Health and Sport for the opportunity to chair this independent review of adult social care support in Scotland. I also want to thank the panel of advisers who guided this work so expertly, our excellent team in the Scottish Government, and most of all the many people, carers and staff who have contributed their experience and insight so generously in the most difficult of times.

A good deal of public attention to social care support has been recently focused on care homes. We make a number of recommendations specific to the care home sector and, at the same time, it is important to recognise that most social care support is delivered in local communities and in people's homes. We want that pattern to continue, and wherever possible, to intensify. The Covid-19 pandemic has tended to focus attention still further on a small part of the system. Of course, there is learning to be had from people's experience during the last year. However, the vast majority of the challenges we are addressing in this review pre-dated Covid-19 and will outlive the pandemic unless we tackle them now. And we know that social care support touches upon the lives of a very wide range of people and settings, so we have taken as inclusive an approach as we can to understanding both the diversity and similarity of their experiences.

The core remit of the review was to "recommend improvements to adult social care in Scotland". The more work we did, the more it seemed like that was the right framing for the review. While we have not undertaken a review of social work, we have considered the key role of social workers, particularly in relation to assessment. I want to be absolutely clear from the outset that there is much about adult social care support in Scotland that is ground-breaking and worthy of celebration. The introduction of self-directed support, the integration of health and social care, and the promise of the Carers Act form the scaffolding upon which to build. When we add to those foundations the commitment and compassion we saw in the workforce, the immense contribution of unpaid carers and the will to improve that we saw across the sector, many of the ingredients for improvement are in place. And of course adult social care support does not stand alone: it has deep, historical and important links to social work, with children's services and the wider public sector.

And yet, the story of adult social care support in Scotland is one of unrealised potential. There is a gap, sometimes a chasm, between the intent of that ground-breaking legislation and the lived experience of people who need support. In the improvement world, there is a maxim which reads something like "every system is perfectly designed to get the results it gets". That is the basic challenge for us. We have inherited a system that gets unwarranted local variation, crisis intervention, a focus on inputs, a reliance on the market, and an undervalued workforce. If we want a different set of results, we need a different system.

We also need to have an eye to the future. For example, the projected increase in the number of people living with dementia means that we need to start planning now for a future in which people can live well, in their homes wherever possible. The answer to tomorrow's challenges in social care support is not more of the same.

In the chapters that follow, we set out our vision for that new system. We describe how a National Care Service can drive consistent, high quality social care support in partnership with people who have a right to receive that support, unpaid carers and the workforce. We also look carefully at funding and make some recommendations about investing in social care support and ending all non-residential charging for services. To achieve that new system, we need the structural change and the new accountabilities that a National Care Service will bring and we need more. We need a new narrative for adult social care support that replaces crisis with prevention and wellbeing, burden with investment, competition with collaboration and variation with fairness and equity. We need a culture shift that values human rights, lived experience, co‑production, mutuality and the common good.

In her Programme for Government speech that launched this review, the First Minister said "this is a time to be bold". The good news is that everyone we spoke to agrees with her. What follows is a plan for how. It will take time. It has taken over 50 years for our current system to form. It will take investment. It will take partnership. But we have an opportunity to create a system of social care support where everyone in Scotland has the opportunity to flourish. If not now, when?

Derek Feeley
February 2021

I want to be absolutely clear from the outset that there is much about adult social care support in Scotland that is ground-breaking and worthy of celebration. The introduction of self-directed support, the integration of health and social care, and the promise of the Carers Act form the scaffolding upon which to build."