Future of the National Care Service: Ministerial statement

Introduction

“People with lived experience have invested huge amounts of time, energy and emotion in trying to make the National Care Service work. We cannot afford to let that effort go to waste by leaving social care in its current state.”

That is a quote from Sara Redmond, Chief Officer of the Alliance from November last year. It has been on my mind since I announced a pause to Stage 2 of the National Care Service Bill. I have reflected on the evidence taken by the Health, Social Care and Sport Committee, and views from stakeholders, people with lived experience, members of the public and political parties.

I am grateful to everyone I have spoken to, particularly those with lived experience, for their continued commitment.

Throughout my conversations with people, the case for reform has remained clear. Despite the best efforts of many, our social care system is not delivering the care and support people require to live and thrive. There is an overwhelming need for change now.

I also note that in England and Wales, similar discussions are underway and there is rising momentum for national approaches. We have spent three years developing plans, and significant commitment and resources from a wide range of people has brought us to this point.

Today, I will set out revised proposals for the National care service  Bill, and the other urgent actions to deliver improvements in the social care system. We remain committed to creating a National Care Service as recommended in the Feeley Review, and ultimately improving the individual experience of everyone in Scotland who relies on  care.

Stage 2 of National Care Service Bill

Part 1 of the Bill, and the June draft amendments, proposed reform of integrated social care and community health. We made considerable effort to find compromise and a way forward. But it is clear those proposals are not supported by this Chamber. 

I have concluded that we must deliver our Scottish National Care Service without legislating for structural reform, securing a different means to deliver our goals. 

It is therefore my intention to remove Part 1 from the Bill at Stage 2 and proceed with Parts 2 and 3 only.

Now I realise this will be a source of disappointment to many, particularly those with lived experience, who have been clear that greater transparency and scrutiny is necessary to drive the improvement that we all agree is needed.

I want to reassure those people that I remain committed to the ambitions of the National Care Service. We have already made significant improvements to social care during this Parliament, and later in this statement I will explain how I intend to continue this progress.

Parts 2 and 3

Firstly, I want to set out what will remain in the Bill.

Core elements of Anne's Law are already in place through strengthened health and social care standards on visiting for care homes. But more is needed. The First Minister and I have been profoundly impacted by conversations with the families on Anne’s Law. We are committed to enshrining Anne’s law in primary legislation, and working together to ensuring the Bill gets this right.

We know that sharing your story repeatedly can be frustrating and traumatic. The Bill enables information sharing across health and social care services, with consistent information standards. This will lay the foundation for an integrated digital approach, making it easier for people to access and manage their own information and care. Digital approaches offer a great opportunity to improving people’s experience of care and treatment.

Unpaid carers make an incredible contribution to Scotland’s communities, and our health and social care system. Through the Bill, we will introduce a right to breaks for unpaid carers. This builds on the £88m we invest through local government in support through the Carers Act, and the £8m a year already provided for voluntary sector short breaks, as well as the roll-out of Carer Support Payment across Scotland.

Across the Chamber, as well as across the sector itself, there is agreement that change is needed to support the vital role of social workers. We are committed to driving forward these improvements - in partnership – to bring sustainable reform that future-proofs the social work service in Scotland for generations to come.

NCS Advisory Board

It remains clear from the Feeley Review, from engagement with thousands of people with lived experience, from a wide range of stakeholders, and from the recommendations of this Parliament in its post-legislative scrutiny of the Self-directed Support Act, that enhanced national support and oversight is necessary.

Therefore, I will move quickly to establish a National Care Service Advisory Board, on a non-statutory basis. It is my intention that the Advisory Board will include people with lived experience of accessing care services, unpaid carers, those who work in the sector, care providers, the third sector, trade unions, the NHS and local government.

I expect the Board to meet for the first time in March this year.

I want the Chair of that Board to be someone independent, ideally with lived experience of accessing care or caring themselves, or who represents those with lived experience, who can hold the Scottish Government and all our other partners to account for the improvement that is needed.

Where it is indicated that agreed standards are not being met, progressive and targeted support will be offered to those areas to help them improve. I will ask the Board for advice on the best way to do this.

We know that the current system for integrated health and social care is not delivering for people. There is no shared understanding of what ‘good’ looks like, and no systematic approach to tackling problems in local areas quickly, when they first emerge. That  results in performance issues in some local areas reaching crisis point.

We will review our Health and Social Care Standards, agreeing local monitoring and reporting frameworks and improving access to information. This will enable a systematic approach to providing progressive and targeted support for local areas, and where necessary, using our powers of direction and guidance, when standards are not being met.

Other areas for national action

The Advisory Board will have a wide remit.

They will provide advice on national programmes that are intended to support improvement. This includes the existing implementation of the Carers and Dementia Strategies, work to embed a person-led approach through Getting It Right For Everyone (or GIRFE), and our work to reduce the number of people in Delayed Discharge and the Drugs Mission.

We will also explore with partners how we can plan and deliver more effectively for people with high levels of need, across current organisational and geographical boundaries.

We will empower people to understand their rights by publishing our co-designed Charter of Rights.

We will develop national standards and guidance for commissioning and procurement to deliver on our commitment to ethical commissioning.

We will also continue work to overhaul eligibility criteria in social care and I will consider how we will achieve our ambition to remove non-residential charging.

It is essential that we continue to support our workforce. We are delivering on our commitments to fund the real living wage for adult and  social care workers.

We also have a clear focus on national and local workforce planning, high-quality learning, development and leadership support for social care staff. We will build a well-deserved sense of professionalism in the sector and improve parity with the NHS workforce.

Integration Joint Boards

At local level, Integration Joint Boards will continue to plan and oversee social care and community health. I will consider what changes can be made to secondary legislation, guidance and the approval of integration schemes to ensure that the voice of lived experience is heard and increase accountability and financial transparency.

I will also support Highland partners who have decided to end their unique model of integration to align with the rest of Scotland’s integration joint board model.

UK Government action

I welcomed the news on the UK Government’s plans for an independent commission on social care, announced a few weeks ago. There are significant issues – on employment, on the relationship with taxation, on immigration, and on pensions – that can only be resolved through powers held by the UK Government.

That includes the impact that increasing employers National Insurance Contributions will have on the social care sector in Scotland. We are already engaging with UK ministers, and I will continue to urge the UK Government to reconsider this.

I note the comments made by the UK Government Social Care Minister, Stephen Kinnock, on previous UK Government attempts to reform adult social care failing due to a destructive combination of party-political point-scoring and short-term thinking.

I want us in Scotland to move forward collaboratively to focus on the importance of social care reform and the vital purpose of a National Care Service – to improve people’s lives.

Throughout this Bill process, I have said my door is always open to discussion. That is still the case today. We are all agreed that social care outcomes must improve, and I urge members across the chamber to engage constructively with us as we move forward. Together we can bring about the sustainable change to social care that people urgently need.