National Care Service and co-design

Co-design and the National Care Service

The National Care Service (NCS) will be designed together with the people who access and deliver social care support and other relevant services. It is important that we put lived experience at the heart of our future co-design programme to ensure that it embodies human rights principles and delivers for the needs of people and not the system.

This document explains the way in which that collaboration will work, how the views and expertise of those who have experience of the system will contribute to its development, and where responsibility for decision making will lie.

An important part of that collaboration will be the establishment of an annual NCS Gathering, involving a wide range of people with experience of social care support and other relevant services, which will serve as a yearly check point in the development of the NCS, including of the national co-design process and as an opportunity to reflect on how we have been engaging and where we can improve.

"…if we are to improve people's experiences of social care, we need to create a comprehensive system that cares for and supports people in a holistic way that empowers them to thrive. Human rights must be at the heart of all that we do here." Kevin Stewart, Minister for Mental Wellbeing and Social Care – Scottish Parliament, 16 November 2021

How has consultation happened so far?

The Scottish Government committed to beginning the consultation process on a National Care Service within the first 100 days of this Parliament. A consultation on the National Care Service ran from 9 August 2021 until 2 November 2021 and sought views on:

• improving how social care support is planned and delivered in practice, including rights to breaks from caring and non-residential social care support charges
• the role and remit of the National Care Service
• what might be included in the scope of the National Care Service
• how Integration Joint Boards will be reformed to become Community Health and Social Care Boards
• ethical commissioning and improving the commissioning of social care support across Scotland
• improving regulation and scrutiny
• valuing and supporting people who work in social care support

Throughout the consultation period, the Scottish Government hosted almost 100 engagement sessions inviting members of the public, partners, stakeholders and third sector organisations to share their views on the proposals laid out in the consultation. Around 15 sessions were open to anyone to join and several sessions attracted over 100 attendees each.

Due to Covid-19 precautions, the majority of events were held digitally. However, three face-to-face events were held around the country, one each in South Ayrshire, Aberdeen City and Inverclyde.

In total, an estimated 3000 people attended these engagement sessions. Over 1300 responses to the consultation were received and these were published (where permission was given) in February 2022, along with an independent report analysing the responses.

In addition, the Scottish Government has established a stakeholder working group made up of people who access and deliver social care support, to review plans for co-design and consultation, ensuring that lived experience and the views of people are central in the development of the National Care Service.

The majority of decisions about the National Care Service have not yet been made and the process of designing what the NCS may become and how it will function will be one that continues to develop. The consultation activity described above is the first step in gathering views to inform the development of a future National Care Service. It will be important to fully consider these responses and to continue to engage with the real experts – people with lived experience of social care support, whether they access or deliver social care support or are a family member of someone who does.

It will then be possible to bring forward the detailed plans for improvement to be undertaken over the course of this Parliament.

"Our commitment to create a national care service will deliver services that are founded on fairness, equality and human rights, and will place that service on the same level of esteem as our national health service." Humza Yousaf, Cabinet Secretary for Health and Social Care – Scottish Parliament, 1 June, 2021

How will design decisions be taken?

Scottish Ministers are accountable to the Scottish Parliament for the delivery of policy commitments and the use of public money. Ministers will therefore ultimately be responsible for taking decisions about the scope and functioning of the National Care Service at national level, and how local bodies are structured and governed. In doing this, they will take account of views from a wide range of stakeholders before taking proposals to the Scottish Parliament.

The Scottish Government will co-design parts of the National Care Service that will operate at national level with people who access and deliver social care support. This will include a Charter of Rights, a national complaints process, and an electronic social care and health record.

Local bodies will continue to play a crucial role in the design and delivery of services that people access directly for social care support. We will work with them to support a consistent approach to co-design across the country.

What do we mean by co-design?

Design is the process of understanding what people need to achieve a certain outcome, and the creation of all the processes and changes needed to deliver that outcome within the constraints of what is possible or available.

In the case of the National Care Service that means understanding what is needed to ensure social care support and other relevant services are fit for purpose. People who access and deliver social care support are experts in how current delivery of social care support works and can identify how we can improve outcomes. People working in national and local government and other organisations with experience in delivering social care support, or managing programmes of change will bring a different set of skills and expertise. That is why it is important that we design the National Care Service in partnership, building a shared understanding, imagining a better future, and putting in place what is needed to deliver it.

Of course, the National Care Service is there for everyone, so it is important that the co-design process is accessible and inclusive, and that we have representation from a diverse range of people different experiences.

How will we ensure co-design is effective?

In order to ensure that the people who access and deliver social care support are being consistently involved in co-designing these services, we will establish The National Care Service Design School – offering training and support to the organisations and the people who access and deliver social care support, enabling them to work in partnership to design services.

This is important as we know that successful co-design can only happen when people with lived experience have access to the information and training needed to take part in co-design, and the support to ensure that the barriers to doing that (such as transport, accessibility, and lack of practical and emotional support) are removed. It is also important that people working in national and local government and other organisations, who will be leading the co-design of particular parts of the NCS, understand the principles of co-design to ensure that people with lived experience are properly supported to take part. The National Care Service Design School will also offer guidance and training to help them do that.

First steps for co-design

April – June 2022:

Between April and June, we are holding a series of initial 'NCS Design Investigations' with members of the public to explore more deeply some of the key themes emerging from the consultation we have just completed. We are inviting a wide range of people with lived experience of using or delivering care services (including those who provide care to family or friends) to participate in these initial investigations. These events will give those with lived and living experience the opportunity to examine more deeply the evidence and issues around key themes and to begin to explore how co-design of these elements of the NCS might be taken forward. We will begin by focusing on a Charter of Rights, a national complaints process, and an electronic social care and health record.

We will take stock after the first few events, allowing us to reflect with those people who have been involved, and to identify how we can ensure that we continue to improve the process and outcomes of these sessions.

Summer 2022:

In the Summer of 2022 we will launch the NCS Design School, creating a space for collaboration between those who deliver and those who receive care services – the work which will become the heart and home of co-design for the NCS. The NCS Design School draws inspiration from the design school model developed and delivered by The Promise Scotland in partnership with the Scottish Government Office of the Chief Designer.

We will also establish a Lived Experience Partners Panel. This will be an opportunity for people to register an interest in being involved in co-design activities, and from which we will coordinate opportunities for involvement. This will be open to all Scottish residents and places will be advertised via the Scottish Government website.

The outcomes of the investigations described above, as well as the opportunity to reflect on the co-design process to date will form the basis of discussions at the first NCS Gathering, where we will bring together people who have participated in the co-design sessions to date with elected representatives from a range of political parties along with those with lived experience and other stakeholders to reflect on the results of the investigations described above.

Whilst we are commencing co-design activities already, this is not a one-off series of events, but instead will form the foundation for how we facilitate co-design activities that will continue to inform the design, delivery and continuous improvement of the National Care Service over the coming years.

How we will communicate

We will regularly publish information about progress on the development and co-design of the National Care Service. This will include information on how people can get involved in the co-design work that is happening – how they can contribute their views, creativity and ideas. It will also be the place where we let people know how and when the people who need social care support have been involved in the design of the National Care Service.

And finally…

Delivering the National Care Service is a huge endeavour – it will touch almost everyone in the country at some point, which is why designing it is everyone's business. We know it won't be easy and we know it will take us all time to learn how to do this together. The NCS Design School will give all of us across the community health and social care sectors, and the people of Scotland, the focus and support to do that.

"There is no doubt that the national care service will be the most significant change in public services, probably since the establishment of the national health service. We are committed to delivering a service by the end of this parliamentary session in order to ensure that everyone gets the high-quality care that they are entitled to, regardless of where they live in Scotland." Nicola Sturgeon, First Minister – Scottish Parliament, 20 January 2022