National Care Service: business and regulatory impact assessment

Background

As set out in the Policy Memorandum, around one fifth of people in Scotland are directly involved in social care, either through accessing care and support, caring for loved ones or as part of the workforce. The adult social care sector is a major employer in the Scottish economy, particularly in areas of high socio-economic deprivation and can be an important employer for young people.^[1] It is also a major contributor to the Scottish economy. The total estimated economic value of the adult social care sector is between £3.5 billion ‑ £3.9 billion. In 2018, the sector made up 3.2% of the Scottish economy and had grown by 18% in real terms over ten years compared to 11% for the economy as a whole. The Policy Memorandum, the Financial Memorandum and the evidence papers provide more details.

Improving social work and social care support, particularly increasing early intervention and prevention and supporting unpaid carers to protect their health and wellbeing, also reduces costs which would otherwise fall on other parts of the public sector. This can include unplanned hospital admissions, additional residential care needs, and family breakdown.

Right to Breaks from Caring

Scotland's health and social care systems rely heavily on the input of unpaid carers. There were 700,000 – 800,000 unpaid carers before the pandemic, including 30,000 young carers. Latest estimates suggest that there were 839,000 adult carers in September 2020.^[2]

Breaks from caring are a vital element of the support many unpaid carers need to cope with their caring role and look after their own health and wellbeing. Breaks can take many forms and should benefit both the carer and cared-for person.

The Scottish Government estimates unpaid care is currently saving Scotland £12.8 billion per year in social care costs, plus £320 million in health care costs – a total saving of £13.1 billion per year.^[3] For comparison, in 2019 the NHS Scotland budget was £13.4 billion.

Anne's Law

Currently, visiting arrangements are undertaken with reference to Scottish Government Guidance Open with Care and the Health and Social Care Standards which have been strengthened to ensure that people living in care homes and their families remain connected even during infectious outbreaks. The Health and Social Care Standards form the basis of the Care Inspectorate's oversight of adult care homes and although non-compliance with the Standards may result in actions for care homes to improve, the intention with these proposals for Anne's Law is to create legal obligations to support visits. The preference for legislation in addition to the Health and Social Care Standards was a clear outcome of the Scottish Government's public consultation on Anne's Law

The proposals for Anne's Law are intended to apply to adult care homes registered with the Care Inspectorate. There are around 1,000 care homes for adults and 33,000 residents aged 18 years and over in care homes in Scotland.^[4] The vast majority are long term, providing support for elderly residents many of whom will have disabilities such as dementia (approximately 64%). Most care home provision is delivered by the private sector (around 75%) but local authorities (15%) and the voluntary and not-for-profit sector (11%) also play an important role.