National Care Service - keeping care support local part 1 – local services: regional forums - findings summary

What we learned

The key themes that we discovered from the sessions were:

• how services are working at the moment
• how people would like to be involved in decisions about services in their area
• finding the balance between national consistency and local flexibility
• what ‘local’ means to people
• ambitions for the National Care Service

How services are working at the moment

People told us that, when services work well, it is due to strong relationships between people providing support and those accessing it.

We heard about:

• specific health and social care workers who provide excellent care and support because of their integrity and commitment to helping others
• Specific examples of innovative and effective services

However, people also told us about many problems with the way services currently work. They said that:

• sometimes the support available is rigid and task-orientated, focussed on meeting people’s basic needs rather than helping them thrive
• high staff turnover was a particular problem, given the time and energy required to build trust and understanding between people accessing and providing social care support
• In some areas, for some types of services, people said waiting lists are very long and caseloads are high – creating concerns that people are unable to access support that is essential to their health and wellbeing.

We heard that challenges were even greater in rural areas, due to:

• lack of facilities
• shortage of health and social care workers
• infrequent or unreliable transport
• lack of affordable housing for health and social care workers

Other points that came up in these discussions were:

• having to fight for services through bureaucratic processes
• some people spoke of being afraid of moving local council area as this would mean starting again with care and support
• self-directed support has been implemented well in some areas but not others

People told us that:

• they felt they had to be confident and capable of navigating bureaucratic processes in order to secure the services they needed
• some people said they were afraid to move because different local authorities have different approaches to assessment of need, the application of eligibility criteria, and charging for non-residential social care services.
• people were not always able to take their care records with them to new areas and people said moving might also affect their eligibility for social security payments.
• this caused frustrations as people felt they were having to make important life decisions based on available care in particular areas rather than based on other factors such as wellbeing, proximity to family, or finances.
• self-directed support has been implemented well in some areas but not others

How people would like to be involved in decisions

People were enthusiastic about the idea of having a greater say in how care services are managed and delivered.

A range of suggestions were made for getting people involved:

• some participants said that it would be necessary to use several different methods to make sure that everyone can engage ‘on their own terms’.
• suggested methods included running events, online engagement, bringing together panels of engaged citizens to discuss particular issues and having people with lived experience on boards that oversee community health and social care services.

People told us that:

• collecting and taking action on informal feedback from both people who use services and paid workers was important
• information from ‘everyday conversations’ should be used to shape services on an ongoing basis
• long-term investment is needed to build the capacity of communities so they can engage in decision-making

They also said that:

• they want to be involved in making specific decisions that they can genuinely influence, not just talking about values and principles
• online forums, such as Care Opinion, were seen as a good way for people to provide feedback on services because organisations are accountable to the public for their response

Some people talked about the challenges of being involved in more formal decision making about services – for example as a service user or unpaid carer representative on boards responsible for health and social care services. They said:

• board papers were long and hard to use so
• it was hard to find time to ensure they understood the views of people they were representing
• they sometimes felt that the views of lived experience representatives were not given proper attention.

Ideas for how to support people with lived experience to perform a board role well people suggested included:

• training and practical support, for example, with finances, technology, accessibility, or respite care
• for people accessing care support services, it was suggested that the person’s involvement in a board should be written into their care package to make sure they received the right support
• membership of boards should be changed to include more people with lived experience and a greater range of interested parties (such as care providers, trade unions, community groups, and third sector organisations).

People also told us that:

• we should learn what is working well in existing integration authorities and we should not ‘reinvent the wheel’ when devising future governance models
• there should be a clearer process for how service user and unpaid carer representatives are appointed to the board, possibly via elections,
• there should be maximum terms for those appointments.

Finding the balance between national consistency and local flexibility

People had similar views on this subject across different parts of Scotland. People felt that certain aspects of care provision should be standardised around the country. These included:

• eligibility and the right to receive social care services
• assessments
• the type of services available
• minimum levels of care available
• the quality of services
• how much services cost
• timeframes for care to start after a referral
• consequences for providers when standards are not met

Suggestions for how to ensure these included:

• streamlining the layers between central funding and people accessing services so that more money can be spent on community health and social care services for people.
• care packages should be tailored and person-centred and support existing family ties.
• ensuring a consistent and robust approach to implementing Self-Directed Support across all local authorities
• making sure decision-makers consider different needs in different locations or subsidising services in less populated areas.

However, people also recognised that community resources will vary between areas and there could be different ways of achieving the same outcome. For example, in an area where there is a shortage of care home beds, it would be acceptable to offer someone a care at home service instead, as long as that would also fulfil their needs.

People also said that local flexibility in commissioning of services was a good thing, as it meant services could be tailored to the needs of local populations and people could get involved in shaping those services. Some people suggested that small organisations could be more responsive and flexible.

What ‘local’ means to people

We already knew that it is important for community health and social care to be rooted in local areas, but we wanted to understand what that meant to people in practice.

People talked about the importance of:

• feeling involved in the local community
• taking part in community groups or community leisure activities
• accessing facilities and activities beyond just ‘social care’
• wanting better links between social care support provision and leisure, housing and third sector amenities within areas

We also heard that:

• carers from local areas had better understanding of needs and made people feel more comfortable
• though in small communities where you might know your local carers, a carer from outside the community could preserve your privacy and dignity
• care support organisations don’t need to be based locally, as long as carers themselves have local knowledge
• social care support services don’t have to be delivered by local authorities in order to be well connected to the local area

People had different views about the value of support being provided over the internet. Advantages and disadvantages included:

• people can be digitally excluded by factors such as age, sensory impairments or low income
• the quality of communication can be poorer when people are interacting through screens
• online services work well in some cases
• online services can help people access services in areas where there is a shortage of workers

Ambitions for the National Care Service

People shared some heartfelt and well-thought-out aspirations for the National Care Service. We heard that:

• the National Care Service should take a preventative approach, providing early help to sustain a high quality of life for people for as long as possible
• nature prescriptions, support for people to engage with the natural world in their communities, and support for people to change their lifestyles were mentioned as some ways to improve public health.
• people wanted to know what the National care Service could do about public health problems such as air pollution or poverty in order to stop people needing care to begin with
• some people said that a ‘shift in society’ was needed. They said care support should be about communities coming together to help one another.
• people also said they needed support to understand the community health and social care support system in their local area and what care support is available to them
• they also suggested that the system might need to become less formalised and rigid, for example by making it easier for people to take on paid caring roles for a few hours per week, alongside other responsibilities.
• a clear and compelling vision for the National Care Service will help motivate people to bring about change.