National Care Service: business and regulatory impact assessment

Purpose and intended effect

The purpose of the National Care Service (Scotland) Bill is to improve the quality and consistency of social care and social work support alongside community health across Scotland. It aims to improve the experience of people who access care and support, provide additional support for unpaid carers, and ensure the workforce is skilled, professional and valued. It also aims to strengthen the integration of health and social care by enabling the creation of a single system and accountability for social care, social work and community healthcare.

The Bill seeks to do this principally by setting a framework to create a National Care Service (NCS), making Scottish Ministers accountable for social care and social work support which will be delivered through a network of local bodies, known as local care boards. The proposal is that the local care boards would be responsible for strategic planning and ethical commissioning of all social care support and community (i.e. non-acute) healthcare. Healthcare would continue to be delivered by health boards with the local care boards responsible for delivering social care through procurement or other arrangements including with local authorities who may choose to continue to deliver care or through in-house delivery. Both nationally and locally, the NCS will work within a set of principles to ensure social care, social work and community healthcare is designed with those who use it, supports the realisation of human rights, and is recognised as an investment in society.

As part of the NCS, the Bill

• Requires Scottish Minsters and the local care boards to produce strategic plans and ethical commissioning strategies for the delivery of care;
• Provides for a streamlined system of complaints about NCS services, and the introduction of a Charter of Rights;
• Provides for Scottish Ministers to have the power to set up a statutory scheme through regulations to permit data sharing for efficient and effective provision of services by, or on behalf of, the NCS and NHS. Scottish Ministers will also have the power to set information standards; and
• Enables the invitation to tender for social care contracts to be restricted to mutual organisations.

This BRIA identifies the costs, benefits and impacts of these changes, where they are known at present.

The Bill also makes a number of other legislative changes aimed at improving people's experiences of social care and support but which are not directly connected to the establishment of the NCS:

• The creation of a right to breaks from caring for both adult and young carers who provide unpaid care, which aims to reduce any negative impacts of their caring role,
• "Anne's Law", to create a right for adults living in care homes, in circumstances where restrictions are needed to prevent infection, to have a named person (or substitute) that is supported to see the resident in person, and
• Strengthening the regulation of care services so that regulators can take action more quickly when services do not perform as they should, provide better protection to people who access care and support and drive up the consistency and quality of care.

As appropriate, this BRIA assesses the impact of these provisions in the Bill under separate headings within each section.

This BRIA should be read alongside the Policy Memorandum and Financial Memorandum for the Bill which provide more details on the provisions of the Bill. It should also be read alongside the National Care Service Statement of Benefits and the social care evidence papers that have also been published. More details about the costs, benefits and impacts of the National Care Service will be set out in a Strategic Outline Case that will be published separately and the future publication of a full Programme Business Case.

Framework and Co-design approach

It is essential that the NCS and other improvements are co-designed with the people who access support and those who provide it. The Bill therefore does not set out full details of how the new system will operate. Instead it establishes the overall framework and gives Scottish Ministers powers to fill in the detail following further co-design and engagement with people. This also allows flexibility for services to develop in the future and to respond to new approaches.

The Bill enables children's services and justice social work to be brought into the NCS alongside adult social work and social care. This is a significant change in the way that these services are organised, particularly in the case of children's services and justice social work and it is important that the risks and opportunities, costs and benefits are fully assessed before a decision is made to implement the transfer. Recognising that more data and evidence is needed before a transfer of children's services and justice social work, the Bill requires Scottish Ministers to carry out further consultation on a proposed transfer of a children's or justice service from local authorities. A summary of the consultation process and responses must be laid before the Parliament with the implementing regulations for parliamentary scrutiny before any transfer takes place.

This BRIA does not detail all the potential costs, benefits and impacts from the establishment of the NCS and the related provisions in the Bill because the details still need to be developed through co-design and further engagement. As further decisions are made, and particularly where they are implemented through secondary legislation (under this Bill or through pre-existing powers), they will be subject to further business and regulatory impact assessment.

As set out in the Financial Memorandum, the establishment of the NCS and other changes made by the Bill are part of a wider programme of social care reform, backed up by a commitment to increase public investment in social care by 25% over the current Parliamentary session ahead of the NCS being established. Once established, the NCS will support many of these reforms; for example, it is intended that it will support greater consistency in the provision of services focusing on early intervention and prevention, and it will support the strengthening of Fair Work in social care and human rights based and preventative approaches to care. However, these are developments that are made easier by the new arrangements for accountability and delivery of community health and social care, not necessary consequences of the Bill provisions and so they are not considered in detail in this BRIA.