National Care Service: business and regulatory impact assessment

Right to breaks from caring

As set out in the Financial Memorandum, based on data from the Carers Census, we estimate that it will take approximately ten years to build gradually to a steady state of support; and that by 2034/35 the additional cost of breaks as a consequence of these provisions will be between £82 million and £133 million. As explained in the Financial Memorandum, the easy-access breaks support element of the policy does not require new legislation and the full cost of the right to breaks policy including that aspect is estimated at between £116 million and £170 million, with the central estimate being £143 million.

Costs for the other options would be similar, but the proposed option is considered to provide the greatest benefit to unpaid carers and those they are looking after.

These measures are designed to protect carers' health and wellbeing, helping sustain caring relationships. This will reduce costs which would otherwise arise for the NHS, Local Authorities and Integration Authorities through unplanned hospital admissions, failed hospital discharge and additional residential care when caring relationships break down. Protecting carer health and wellbeing should also lead to wider benefits to the Scottish economy by enabling more carers to remain economically active, reducing the gender pay gap and social security costs.

As set out in the Financial Memorandum, it is not possible to estimate the size of these wider savings and benefits but to illustrate their potential scale:

• There are around 156,000 people in Scotland providing 35 hours of unpaid care or more per week.^[5] If the right to breaks helps prevent 1% of these intensive caring relationships breaking down, that will save £68 million per year in health and social care costs. If the right to breaks protects 5% of these intensive caring relationships, the saving will be £318 million per year.^[6]
• If the right to breaks helps 1% more carers to remain in work, the benefit to them and to Scotland's economy would be worth £71 million. If it means an extra 5% are working, the benefit would be £353 million per year.

Care Inspectorate – Enforcement and related powers

It is not anticipated that the proposed changes to the enforcement powers would incur additional costs or resource requirements to service providers, the Care Inspectorate, local authorities, health boards or Integration Authorities.

There is, however, potential for increased legal costs to the Care Inspectorate should the regulator's enhanced enforcement powers be contested in a court of law. The Care Inspectorate may need to engage external Counsel to pursue a new raft of actions or increase in appeal cases. These potential costs have not yet been determined.

Anne's Law

Feedback from care home providers is that significant costs from Anne's Law are not anticipated. This is, however, conditional on the future provision of Personal Protective Equipment (PPE) and testing kits etc. in the event of an upsurge in COVID-19 infections or a future pandemic. During the current COVID-19 pandemic these have either been widely available and either low cost or free and/or something that families themselves have taken responsibility for e.g. bringing their own face coverings. In case of a future pandemic similar to COVID-19 it would need to be considered who was to pay for any PPE and testing kits (for example) should these be required to support visits. This could be a concern for care home providers if it was to be expected that they should pay for these. A related concern would be if visitors to care homes were required to pay for any PPE or testing and they chose not to do so. This could create an awkward conflict between requirements for care homes to facilitate visits and a visitor choosing not to comply with a Direction or guidance that recommends or mandates PPE or testing. Care home providers' ask would be that central support for PPE/testing costs is considered so that they are not put in this position and to avoid them facing sanctions for non-compliance.

The Care Inspectorate will incur costs in the lead up to and following the introduction of Anne's Law, as there is a need to promote new guidance and prepare the sector for Anne's Law with the aim of building capacity and capability within the sector for improvement.

This is likely to involve dedicated support for care homes to develop policies, staff induction and training; resources to support self-evaluation; improvement support for services; and developing capacity within the Care Inspectorate to enable immediate resolution of complaints through direct engagement with providers and services. In the year 2022/23, total Care Inspectorate costs to support the introduction of Anne's Law and handle increased complaints are estimated to be £186,000, and £90,000 in 2023-24.

The possibility of an upsurge in complaints was noted and we estimate that there will be heightened public interest in the new legislation and this may result in adults living in care homes, or their friends and families, exercising their right to complain. Complaints to the Care Inspectorate may increase in the short term, while improvements to visiting become embedded in the sector, but are expected to fall away within 2 years. It was felt to be manageable based on past experiences of changes to visiting guidelines during the pandemic.

In terms of benefits, care home providers welcomed the clarity that legislation would bring. Providers noted that one of their main aims is to foster a positive environment in their homes that welcomes both residents and their families. Restrictions during the pandemic had a detrimental effect on this to an extent, particularly where there was confusion as to what was permitted in terms of visits. The clarity that legislation can offer has been noted by multiple care home providers and also by the Care Inspectorate.

Benefits should also be viewed in the context of the benefits to the health and wellbeing of adult care home residents and their friends and families, with a case to be made that there will be savings realised in other aspects of the Health and Social Care system.

In the consultation many respondents commented on their own experiences of family members being isolated in care homes over the course of the pandemic and the lasting harm this has caused.

Reference to the potential individual and wider system benefits as a result of improved health and wellbeing was highlighted by one stakeholder:

"There is a wide range of evidence internationally that social connectedness is required for good health. Anne's Law would reduce social isolation, poor mental health and associated effects on physical health. This creates a more efficient and effective service as there are less care needs for staff to manage and residents, carers and staff are happier"