National Care Service: consultation analysis

Appendix 1: Summary of engagement events

Introduction

This Appendix (Appendix 1) provides a brief summary of the 34 engagement events hosted and moderated by the Scottish Government.^[5] It is based on notes of the events provided by the Scottish Government moderators at each event and is a summary of the opinions expressed at the events.

Please note that, given the wide range of issues raised, the points below are not exhaustive. It should also be noted that these points do not necessarily reflect the weight of opinion but rather a qualitative view of the meeting content as provided by the Scottish Government. The summaries also reflect the opinions voiced in the meetings and may not therefore reflect the views of the Scottish Government, or accurately represent the detailed ways in which health and social care are delivered.

Improving care for people

In relation to improving care, there was widespread agreement amongst respondents at the engagement events that a person-based approach, dignity and human rights should be at the core. There was a view amongst some participants that the system tends to "say no" as the default which risked a loss of dignity for people in the system. There was also a general view that clients find it difficult to navigate the system and there is a need to improve communication.

Overall, and as noted in the main body of this report, there is a clear view that there is currently a postcode lottery across Scotland in terms of access and provision of support and services. There was a particular concern amongst participants from the Scottish Islands about the impact of the proposed NCS on their communities and especially the economic and demographic profile of the Islands. There were also some concerns amongst some participants that a top down structure would not permit localised decision-making.

It was generally agreed there is a need to consider the needs of unpaid carers, and their health and wellbeing. Many are not aware that they are also entitled to Self Directed Support. It was said that social workers do not always make people aware of all the Self Directed Support (SDS) options and there is a perceived lack of training around SDS in health and social care overall. It was thought that communication could be improved amongst all aspects of care so that people can access the entitlements which they are due. It was noted that some people with no friends or family "fall through the net".

Mention was made of the local structures of provision, with education sometimes sitting with social care or alone, dependent on the local authority. Some services have not restarted since the lock downs. It was suggested that there is far less support than there was pre-pandemic with comments to the effect that throughout the pandemic, people have lost their social care packages and they are not being reinstated.

Self-directed support (SDS)

It was noted that SDS is at the heart of social care and should continue to be so under any new arrangements. There was an acknowledgement that people's networks and circumstances can also influence need - it is not just about their condition but also the wider context. There was a clear view that the system of assessment should be separate from finances, and assessments should be carried out in collaboration with the person accessing care and support. Removing eligibility criteria would allow a four point model that starts with the individual. Some thought that the SDS standard is not working at present. It was noted that people accessing care and support do not know what the standards are and that it can take 18 months to process an SDS.

There was a question around standards and reporting when people pass through different types of care, i.e. from local authority to private providers, where staff are working to different processes and working arrangements.

There was some discussion around the quality of care for those with dementia. It was said that currently those with terminal illnesses can receive a fully funded package of care while a person accessing care and support with dementia using Self Directed Support is required to make financial contributions to their care.

Right to breaks

In general, it was widely recognised that "it is a huge job to care for somebody and it is important that carers get breaks". Across the groups that addressed this subject, there was agreement that there is a lack of local based and flexible respite care.

Complaints process

There was a view across some of the meetings that the complaints process was quite "defensive" and that the terminology surrounding the processes could be improved. It was thought that the complaints procedure is not always understandable or easy to navigate for many people who use social care. It was said that everyone should have the right to raise a complaint, regardless of cognitive ability. As a result, there was a view that people need access to advocacy to support them in the complaints process.

Technology and data (including a National Care Record)

There was a general agreement that there is now an opportunity to make data sharing arrangements around care more seamless, safer, efficient and pragmatic. It was recognised that at the moment there are too many separate assessments for individual people accessing care and support and that there is a need for IT systems that "speak to each other" to allow information to be available at the point of care. There was a general consensus that integrated IT would save a great deal of time and allow health and social care staff to focus on helping and supporting people accessing care and support. Data and systems need to work together to save people re-telling their needs to different services. There was a general agreement that a National Care Record would be important.

Some participants suggested that personal records should also encompass NHS records. Issues around confidentiality and data security and how sensitive information would be shared were also raised.

A National Care Service

There was a general recognition in the engagement events of the need for change, but participants did voice concerns about disruption caused by restructuring and whether improvements could be made within the existing system. There was also caution around the level of detail provided around the reforms and some concerns that more information was required. Some participants stated that there is a need to be clear about the problem that needs to be solved in order to offer a clear strategic response. It was also thought that a phased approach to the construction of the NCS is needed. Some participants also noted that the progress made on integration should not be lost in this reform.

Accountability and responsibilities were key concerns with many participants noting the need for clarity around lines of responsibility. There was a view that the NCS needs to be responsive to local priorities and circumstances. Many highlighted that "one size fits all" will not work. The need to learn from Police Scotland was mentioned in several meetings. Some suggested that Police Scotland demonstrated the benefits of having a national approach to IT, Governance and infrastructure, terms and conditions and pay scales for staff with some tweaks to policies and procedures to fit local needs.

Funding the new system was also raised as an issue, with some seeking clarity on how the new service would be resourced. Participants welcomed the fact that care will be considered on the basis of need and not budget. Some participants commented that finance drives what actually happens on the ground regarding values and delivery. Despite the challenges and the complexity, it was said that this is why many thousands of disabled people feel strongly a National Care Service is needed. It was also noted in this regard that prevention is preferable to crisis care management.

Some commented that demand currently outstrips supply and unless this gap is addressed, the new structures are a "moot point". Many participants noted that budgets were already stretched and that social care had experienced reductions in funding over a number of years. It was noted that person-centred support usually costs more than standard block funded services and that there is a lack of respite care in Scotland. Several participants noted that there is "never a debate about affordability in the NHS".

It was also suggested that resourcing is missing from the consultation. When the legislation goes through, it will need a financial schedule. It was suggested that resourcing needs to be quantified to make the proposals credible. There was also a need identified to look at population projections for older age groups and changing demographics in general. Staff pay, and recruitment and retention were also raised in the context of funding for the new system.

Other comments related to the need for cooperation between NHS and NCS and that, at the same time, the Scottish Government should ensure the social model approach is protected and there is not a move back to a medical model. It was thought that the interface with the NHS will be a challenge for the NCS, given its more medical model.

Parity between health and social care was raised as an issue: it was stated that currently there are "power dynamics between them"; there was a sense that both sides feel that they will be subsumed especially if children's and justice services are included. Some respondents suggested that clear and strong leadership across the workforce would remove some of the barriers to cultural change and avoid competing with conflicting organisational interests. There was also a clear view in many of the meetings that people with lived experience of social care need to be part of the design and delivery of the NCS.

It was noted that the social care needs of young people are often overlooked and that there is a need to revisit what social care means to different groups. It was also mentioned that a missing piece is education: some suggested it needs to be connected with young carers and children with additional support needs.

There was also a strong view from meetings with the Scottish Islands that the proposed NCS would not meet their needs and would have a detrimental impact on the economic and demographic profile of the islands. Other respondents also noted the importance of responding to local needs.

Some participants across the meetings thought that the system did not need disruption at the current time. It was thought that the proposed changes were likely to be disruptive and unsettling to many people, and may have a negative effect on people's support and care. The opinion was that thought must also be given to social care staff who are "tired and worn out", with "no end in sight" from ongoing pressures from the pandemic and Brexit, amongst other things. The system requires a cultural shift with staff an important part of this; 'The People's Service'.

Concerns were raised with regards to additional bureaucracy and "empire building" and it was suggested by some that more evidence was needed to demonstrate the case for change, highlighting the role of the Health and Social Care Partnerships during the pandemic.

Others thought that the NCS proposals were not addressing all the issues in the system. It was suggested that an NCS will still have separate providers of care and may not address any performance issues and differences in funding across sectors. Some thought the proposals will not change the way care is provided. It was noted that if there is a move towards a more regional approach, it may cause further problems with the interface with the NHS.

Overall, it was thought that it is important that the Government takes due time to consider the proposals and does not rush the process. Some stated that the focus should be on ensuring the structure is fit for purpose and does not become a "big white elephant" that needs reform in ten years time.

Lived experience

The importance of including people with lived experience in design, implementation and day-to-day decision-making was emphasised throughout the engagement events. This should include involvement at the earliest stages and the participation of people with lived experience should be facilitated and be meaningful (ie with voting rights etc). "Critical friends are very helpful to challenge what is happening in the system, particularly those who have lived experience". Overall, there was a clear view that the new structure and services should be person-centred.

Scope of the National Care Service

There was a general and recurring theme in several engagement events that there is a lack of clarity and detail for people trying to get a sense of what the proposals mean in reality. Participants asked whether there would be further consultations and opportunities to shape things going forward. It was also stated that co-design with people with lived experience will be important (as noted above).

Some participants noted that there is a significant element of "undercutting" local authority input in the provision of services and highlighted that "one size doesn't fit all". Some also commented that here is very little mention of the CSWO role in the consultation document despite their specific statutory role in relation to social work and social care.

It was also thought that more information was required about the basis and logic for including children and families, justice services etc. in the scope of the NCS and how that will improve the current service. Some stated that more background around the proposals to what was originally an Adult Services Review would be welcome.

It was noted that structural change does not always make a difference to the provision and quality of service, with several participants noting that implementation will be key.

Some suggested that an oversight body across the country with a remit including terms and conditions, training, and improvement and so on would be welcome. There were comments that this has been needed for some time but a question arose about the future role of the Scottish Social Services Council. It was thought that an increase in training around supporting complexity will increase the availability of complex support across all council areas. Some suggested that pooling training resources, identifying training needs and ensuring training services are properly evaluated and providing adequate training may make a positive difference in this area.

Specific elements of the scope of the NCS are considered below.

Children's services

Some participants stated that there is a need to address the transition between children's and adult services and there were also some concerns about the unmet needs in children under 18 years of age. There was a view that if children's and justice (and other elements) are not included, the focus and investment in improvement and workforce capacity risks being skewed toward those services which are in the NCS. The focus on social care would therefore be weighed towards the elderly.

There was also a question around the role of The Promise in relation to the proposed NCS. It was thought that, given the wide-ranging remit of the Promise and the fact that it is at an early stage, there may be a possibility that it is diluted or lost as this new and much larger agenda takes precedence.

Several respondents noted the need to consider education services being linked to health and care for children and young people with disabilities.

There were a lot of questions raised with regards to children's services and its inclusion in the NCS. Questions were raised with regards to there being scope to complete an additional review beyond this consultation period into the advisability or not of including children's services.

Participants asked what can be learnt from the current integration, or not, of children's services within IJBs? It was noted that education is often joint funders of children's residential places and sole funders for day placements at schools that are more specialised and so participants were interested to hear the views of education stakeholders on the proposals. Some thought that children's services should be incorporated into the NCS but that there was a need to think about the relationship with education and housing so that the links between these services do not break.

There was also a view that if these proposals are person-centred then a more holistic care service must include both education services from nursery to secondary level and recognise the part that housing plays in an individual's lived experience.

Healthcare

When it came to healthcare, it was thought that the patient journey has to be seamless and holistic. It was felt that unless the acute sector was involved there would always be problems and people would feel left out.

An area of concern was with the perceived lack of content with regards to mental health within the consultation, with no reference to the UN Convention on the Rights of the Child or disability or independent Advocacy for those with mental health needs. It was also noted that Mental Health and Addiction services are not dealt with well currently. It was thought that those who receive treatment are dehumanised and have little say in their treatment. It was thought that third sector involvement has assisted in this, and people are treated more on a human level in these settings.

Another contentious area was with regards to hospital discharge in the consultation, which is a significant issue that could become dominant, with social care suffering because of that.

It was noted that there is no reference in the consultation on where health improvement would sit in the news structure. There was a suggestion that it needs wider context in terms of public health and where PH in Scotland has gone. The NCS should avoid the imbalance of power in the NHS. It should not be about replicating the NHS.

Alcohol and drugs

A common theme that came up throughout the engagement events was that of person-centred services. It was thought that at the minute, it was substance-centred instead of person-centred services – this needs to change and people need to be at the heart of these services. As noted above, in the discussion on healthcare, it was stated that mental health and addiction services are not dealt with well currently.

Alcohol and drugs services should be integrated as part of a whole system approach. Some stated that separating them out "is not progress". It was also noted that many children are in families where there are drug and alcohol problems which may also escalate the need for justice social work if these problems result in offending behaviours.

Justice

It was thought that there is a lack of information and detail of how justice social work (JSW) would look within a wider service, including how the legislation would change. Links to sentencing and policing, which are distinct and separate from other parts of social work and social care, were noted including the fact that individuals are mandated to work with JSW. Potential tension between care and justice aspects is a factor to consider.

It was agreed that social work is a whole system activity: it needs to be maintained as an integrated service. It needs to include the children's and justice sector in what is now part of proposals. As in other areas of the consultation, it was challenged as to how to ensure lived experience across the whole system is properly involved. There is a risk that youth justice gets lost if justice gets drawn into the NCS and children's services stay outside. The consultation does not cover the complexity of the system and youth justice is a good example of this.

It was noted that people in prison require a high level of support. Adult support services within prisons are hard to access which is not an effective support system. It was noted that social care is not just delivered within prisons. Prison Visitor Centres are an important interface between prisoners, their families and the statutory social work services. As above, it was reiterated that criminal justice and mental health are strongly linked for a majority of individuals, services must be linked to prison services and other areas including housing.

Some expressed a view that maintaining JSW professional identity is important. Concern was raised about JSW becoming a small part of NCS and a consequent erosion of professional identity. Professional autonomy and trust in the profession was thought to be a really important point.

Concerns were raised about potential loss of ring-fenced funding if JSW was part of NCS and the ability of JSW to operate in a wider NCS if funding is not protected. It was also acknowledged that ring-fenced funding can at times limit leverage of additional funding.

Some thought that the risks associated with JSW services meant it would be better to allow adult services to transition first, and then take the learnings on board before integrating JSW. However, others felt it would be better for JSW to be involved from the outset to have a say in its development.

Reformed Integration Joint Boards

There were various concerns raised in relation to the concept of the reformed Integration Joint Boards (IJB). IJBs report to a central point. Some thought that quite a lot of the proposals could be within scope of existing organisations, and do not need the creation of a new body. There is a need to explore current arrangements and see what is possible to deliver within that rather than seek to resolve issues in new arrangements.

There were some concerns that social care is an inverted pyramid and that the IJBs will create more bureaucracy. Inhibitors for IJBs to work effectively are the levels of funding and control in hands of Chief Officers. Many questions were raised on these issues:

Would a shift to the new Boards make governance more effective?

• In relation to the relationship with acute services: a helpful aspiration of IJBs has been to have influence over acute care delivery – how will the proposals affect this?
• How will the new boards connect to existing structures e.g. housing, education, community planning? It was noted that IJBs are connected to a much broader system.
• With all members having voting rights how will representatives act effectively as advocates for their sector when having to take accountability for decisions?

Overall, there was agreement that there is a definite need for change but there is a fear that the new structure will not solve the perceived current core issue of poor joint working between LAs and health boards.

Voting and board membership

The subject of voting and board membership of IJBs raised many questions as to how best to position this. It was suggested that what is required is a countrywide governance system, as the experience of many participants is that the voting system on IJBs blocks free voting as the membership frequently votes on political lines. The system should be reformed so that political interference is no longer an issue. Public and third sector representatives do not have a vote on IJBs currently. Will the third sector have membership on the boards and, if so, how do we decide who should be represented?

There is a need for caution about differences in roles currently. Some have votes and others do not. It was thought by some that members should feed-in in another way rather than sitting on the board and being accountable. It was also thought that Boards must be more transparent about how people "get a seat at the table".

There is a balance needed but "a lot to think about" in terms of how best to represent all on the Boards. It was suggested less breadth of representation is not desirable but more information on whether CHSCBs will include some/all/how much of health and social care services is needed. This would mean that consideration needs to be given to the extent to which elected members should be involved as they are democratically elected and represent the community.

It was reiterated that people with lived experience should be included in an open and transparent manner and front line staff and people accessing care and support need to be part of the new Boards. It was also thought that non-voting members "currently feel like they are a token gesture" i.e. their inclusion looks good but they have no influence on final decisions. There was a concern that the involvement of those with lived experience can end up being inaccessible and tokenistic.

There is also the risk that equal votes means that the needs of the majority are addressed, but the needs of the more complex cases do not get the attention, support and service needed. There was a fear that the professionals and support organisations with the knowledge would be voted down. There were also concerns about local accountability if the role of the local authority is diminished

Commissioning of services

There were a range of issues raised in relation to commissioning of care:

• How can Scotland aim for high-value, outcome-based commissioning?
• The balance between budgets and meeting needs
• It is difficult to have flexibility because of the procurement rules
• Commissioners need training and many don't use the Light Touch Regime
• How can the third sector be meaningfully involved in commissioning and service design and procurement?
• Commissioning cannot be separated from other streams, including Fair Work. There needs to be a commitment to a cessation of hourly-based non-committal and parity of esteem.
• If the profitability of providing services is taken away by the NCS, who will plug the gap if providing services is no longer profitable for the private sector?
• Scotland Excel: there are issues with Scot Excel frameworks and frameworks in general – they are generic and so force bidding against unknowns. In discussions with LA commissioning and procurement officers cost is the dominant topic and quality often feels like an afterthought
• Profit appears in the GP model: it is not as simple as profit is bad. Commissioning for case-load work well in community nursing. Weighted capitation works well at a local level.
• It is difficult to commission for a group service but some things have to be done that way - advice lines etc. only work if they're funded as a resource for the whole community. The current model supports crisis but not low-level needs that are not crisis and that are not necessarily very visible. Outcomes-focused commissioning sounds good but it is difficult to "put a pound sign on that". Aberdeenshire Council is an example of some good work.
• The key thing is getting the balance right for local and national commissioning. National commission freeing up people, knowing what to do nationally and how much to leave locally.

Regulation

It was noted that it is important that there is real alignment in terms of regulation, oversight groups from government and health protection. It was thought that no one is working from the same guidance or rules and there should be one regulator covering all aspects.

The message around the NCS is about improvement. There is a need to determine how we start working in partnership with regulators and we need one set of regulations and a joined-up message that we give to providers and people using the service.

In relation to the governance of clinicians, it was thought that medical professionals in the public sector have a good system of clinical governance. If large sections are moved to the new organisation, how do we avoid dangers of fragmenting governance? Where HSE is concerned, there is no mention of Health and Safety at Work Act or HSE in care premises. There is a need to integrate the regulatory landscape as HSE works closely with the Care Inspectorate, Public Health Scotland and Environmental Health Departments on care home regulation.

There is also a need for clarity that all principles of human rights should apply in all settings e.g. on an individual person accessing care and support and on a service provider level. Currently accountability is missing in the care sector at a local level. Protections against discriminations must include people accessing care and support with mental health issues or ailments. "Equity is as important as equality". Whilst human rights are included, health and safety and securing justice should be included as part of scrutiny and assurance. There must be clear governance in place. Reporting of Adverse Events should also be included and consideration given to how these are treated.

Valuing people who work in social care

In relation to valuing the people who work in social care, there was a lot of concern across the meetings about the current state of the workforce, with many saying the sector is "in crisis". It was often stated that care home staff are leaving the profession because they are not valued. Some of the possible reasons discussed included: a need for standards and training; more value given to people working in care homes and the sector in general, and in particular pay and conditions. Many thought that these are critical issues.

The level of pay and conditions was viewed as a particular problem: independent sector agencies earn below the minimum wage after downtime, mileage costs, provision of smartphones, overtime payments and lack of holidays are taken into account.

There was a widespread acceptance of the need to attract, and retain social care workforce, provide career progression, and give better recognition of the value of social care in general . There was a view that the existing National Care Home Contract should be reformed to allow better pay to be made to staff and address pensions. The terms and conditions mismatch between NHS and Council employed staff was seen as a significant issue to be addressed in some way, whether via direct employment by the new boards or via another mechanism. It was thought that pay should reflect the greater complexity of the work undertaken.

Time blocking was also raised as an area of concern as carers are not automatically paid for the time they spend with a client if it goes over the window of time initially allocated. Some participants thought that travel time should be included; and that there should be national pay rates and adherence to recommended mileage rates. There was a comment that social care staff are asked to do jobs that the NHS would supply a Band 7 nurse to do but without the same accreditation of learning and comparable pay.

Risk factors identified included immigration. It was estimated that 20,000 people will be required for Scotland that will not be able to enter the country under current immigration policies. This is an issue post-Brexit and poses serious problems for health and social care.

It was also noted that self-employed carers are not mentioned in the document. These are "black market carers" who have left because of conditions of service, and perceptions that they are poorly treated and not respected. Many of these carers are paid below the minimum wage. The IRASC stated that there needed to be a culture change to allow the care sector to attract suitable numbers of young people to the profession. There was a view that the workforce is getting older, as are unpaid carers.

There was an agreement that care services need to be fully resourced. Local Authorities have faced 13 years of austerity and cuts in budgets and the demographic changes mean a larger demand for services. There is a risk that NCS generally is demoralising for local authority staff "for everything they have done over the years and particularly last year during the pandemic".

The theme of empowering people in the IRASC was viewed as particularly important. There was also a feeling that the consultation document was not clear on the role of collective bargaining.

Overall, it was thought that the attempt to bring together such a wide range of public and third sector organisations under one umbrella would be very complex. Questions were asked about the role of private providers for example. It was noted that each organisation will still have their own terms and conditions "that cannot be brought into one neat package".

Nursing

It was said that it is important that nurses are not responsible for something they cannot control. Clarification about the elements of nursing to be included would be helpful. Some thought that the governance aspect of the document is confusing: "the questions being asked aren't necessarily the right ones". There needs to be proper thinking about the governance structures in relation to nursing. The points about nurses should also widen to include school nurses, health visitors, diabetic nurses etc.

It was noted that nurses often have to give up their registration when they move to social care and that this can lead to a feeling of being excluded from entering into any integrated management strategic role.^[6] There was a suggestion that enrolled nurses should be brought back as giving up registration is not a positive. The current set-up can make nurses and social care staff feel undervalued. It was also thought that there is a drive around protecting the title of nurse but nothing for people coming up through ranks of social care.

Personal assistants

Comments in relation to personal assistants referenced that they are also part of the social care workforce providing personalised support directed by the individual. Home care services deliver thousands of [hours of] care. "We seem to value health care skills rather than social care skills." It was thought that home care services are undervalued and that merging them together will mean a true NCS.

GPs

Some expressed concerns about the move of the GP contract. There was a view that aligning GPs to the NCS would not add value or act as an incentive to recruit GPs. In relation to the GP contract and the relationship between GPs and Health Boards, it was questioned whether there will be a move away from the centralised contract. Clarity for the GP contract is needed. The consultation pack suggests that there is potential for the new Boards to take over this. The relationship between GPs and the new Boards are unclear.

Issues with GP service in a village community and looking at that becoming a hub for local services was raised. How would NCS proposals and a national service affect that and where would a GP service lie in the NCS? The consultation does not provide enough detail. It was noted that there were a lot of good things in the paper i.e. the aspirations for local working. There was a view that the aim of having a stronger GP voice in the system is good but that this is not the way to go about it. The grass roots up approach is missing.

It was also stated that bodies needed time to develop and although it is a significant organisational change, it felt to some like a series of changes instead of letting the system mature and develop: "there is a lot about integration and very little about the everyday integration that we need." There were also worries about retention and recruitment.

There is a need to attract and keep as manyGPs as possible in the system. "A lot of GPs would feel like this is the final straw". The role of GP clusters and the need for coterminosity was also mentioned. Challenges were posed on why there is the suggestion of change to GP contracts: "who steps in if a GP fails?"

Moving staff

It was thought that there were no clear benefits of moving employers and that there would be a protracted process to transfer staff and harmonise terms and conditions. The energy, time and cost of that process could be better spent on delivering services. The people running the services are in a thousand employers in the private, third and public sectors. Some stated that what is being discussed here is the commissioning and procurement staff moving from NHS and Council to a third body, each losing the connection and knowledge of their current teams and networks. There has to be a better way of doing it but one option is if they had one employer: but this would mean we do not need a third organisation (i.e. CHSCBs). There was agreement that one (existing) group/body should employ everybody.

Some suggested that it cannot be pretended that CHSCBs are delivery arms unless they employ the staff. Challenges were raised around how the Scottish Government sees it working with three chief executives, all with vested interests; some holding staff; others finance etc. It was noted that more detail is required on how the Scottish Government thinks it will work to enable further discussion.

Lessons from elsewhere

Participants in the engagement events noted the importance of learning from other countries. Some suggested that it would be important to learn lessons from Northern Ireland, where there are two senior level posts – Chief Executive or Chief Officer. The requirement is that if one is from health care, the other is from social care. A joint or controlling senior manager ensures a balanced mix of people holding positions in health and social care and reinforces balance of power. Serious thought to the balance of health and social care is required.

Participants also noted the Danish model of providing care services. Integrated and career pathways are set up from basic grade to health and care service. The example of New Zealand was also cited. New Zealand integrated services 10 years ago: key to success was the training of the staff, helping them understand the meaning of integration and involvement of people accessing care and support and that change was made from the bottom up, not top down. It was also thought that some lessons could be learnt from the Welsh social care system as that was perceived as the best social care system in the UK.

Other issues raised included the role of the third sector and the need for more clarity around the links between care and housing.

The consultation process

There were a range of issues raised in relation to the consultation process. It was thought that the consultation document was difficult to digest in relation to its scope and length and the consultation process was not long enough in terms of time, meaning organisations were not able to plan for their approach.

A significant problem with the tight consultation period is that people who use/need social care services of all kinds were unable to engage fully.

Concerns were also raised about the lack of detail in the proposal and more information and greater clarity was requested. It was thought that further details would help engagement and reduce workforce anxiety and therefore turnover. It was noted that there is a workforce and capacity issue in a sector which is still recovering from the pandemic.

Suggestions were made by attendees that there needs to be more public engagement and more involvement from people accessing care and support: there was a particular concern about the accessibility of the Easy Read documentation. It was suggested that more notice is required in future of ongoing NCS consultation and legislative work, and next steps and a view that the assumptions in the document need to be tested through an impact assessment, particularly in relation to the Islands.

There were also concerns raised about the speed at which the Government is planning to bring in legislation as well as a challenge around the timing of the consultation in the midst of the pandemic, Brexit, the current stresses on the workforce and the forthcoming local government elections which will impact on the ability of local authorities to respond.