National Care Service: consultation analysis

1. Introduction

The Scottish Government undertook a public consultation on its proposals for a National Care Service (NCS) to achieve changes to the system of community health and social care in Scotland. The proposals are intended to ensure that the Government: consistently delivers high quality services to every single person who needs them across Scotland; that there is better support for unpaid carers; and care workers are respected and valued. The consultation is a key step towards introducing primary legislation to the Scottish Parliament to achieve these changes. These proposed reforms represent one of the most significant pieces of public service reform to be proposed by the Scottish Government.

The Scottish Government views the implementation of the recommendations of the Independent Review of Adult Social Care (IRASC), and particularly the establishment of a National Care Service (NCS), as a key opportunity to address the challenges across social care highlighted before and during the Covid-19 pandemic. It views the creation of the NCS as a means of addressing these challenges in the long-term alongside its ongoing work to improve people's experiences of social care in the short to medium term. In the consultation document, it states that this is:

"An opportunity to change the way we deliver support and services - to place human rights at the centre of our decision making; shift our emphasis to prevention; empower people to engage positively with their own care; embed fair work and ethical commissioning; and strengthen our commitment to integrating social care with community healthcare, which we last legislated for in 2014." (Page 4 of the National Care Service consultation document)

The consultation was broad and wide-ranging: covering all aspects of a National Care Service, including, but not limited to, access to care and support, breaks from caring, using data to support care, recourse and remedies to problems, residential care charges, commissioning of services, regulation of social care, and supporting the social work and social care workforce. It was open from 9 August 2021 and closed on 2nd November 2021.

The Scottish Government has pledged that, following the consultation, there will be further opportunities for people to shape and design the details of how the reformed system will operate. The results of the consultation exercise will be used to shape and develop new legislation (a Bill) which is planned to be introduced in the Scottish Parliament in summer 2022.

As the Scottish Government reaches conclusions on the National Care Service, it will continue to consider how it will integrate with the National Health Service and any implications for the NHS. It has also stated that it will also consider the impact of its proposals for the NCS on equality groups and others, including businesses and island communities, and will carry out a suite of impact assessments before finalising the proposals.

The legislation is likely to be extensive and complex and is likely to take at least a year to be scrutinised by the Parliament. The Scottish Government will then need to establish the organisation and put the legislation into effect. Its intention is that the National Care Service will be functioning by the end of the Parliamentary term.

The policy context

In the consultation document on a National Care Service, the Scottish Government described social care as a service "there for people of any age who need help with day-to-day living because of illness, physical disability, learning disabilities or mental health conditions, or because of older age, frailty or dementia".

Social care also supports people with or recovering from alcohol or drug addictions, and those who are or have been homeless or are at risk of becoming homeless. Children's social care services also provide help for children and families who may need additional support, or where children are unable to live with their own families. Social care may be provided in people's own homes, including through remote care and technology enabled care, in residential accommodation and care homes or in the wider community, including many advice and support services.

The delivery of social care support is currently the statutory responsibility of local government under the 1968 Social Work (Scotland) Act. The Scottish Government sets out the policy and makes legislation on social care and therefore has a role in supporting improvement and ensuring positive outcomes for people across the country by having the right policy and legislation in place.

The Independent Review of Adult Social Care (IRASC) report was published in February 2021. It concluded that whilst there were strengths in Scotland's social care system, it needed revision and redesign to enable a step change in the outcomes for people in receipt of care. The review called for a fundamental shift in thinking and approach to social care to:

• Shift the paradigm of social care support to one underpinned by a human rights based approach
• Strengthen the foundations of the social care system to bridge the gap between policy intentions and the reality of people's experiences of social care – bridge the implementation gap
• Redesign the system by establishing a National Care Service to achieve national level accountability and consistency in social care and to transform the way social care support is planned, commissioned and procured.

Importantly, the Independent Review called for the voice of people with lived experience to be amplified at every level in the redesign of the system.

The review provided a number of high level areas of focus:

• Ensuring that care is person-centred, human rights-based, and is seen as an investment in society
• Making Scottish Ministers responsible for the delivery of social care support, with the establishment of a National Care Service to deliver and oversee integration, improvement and best practices across health and social care services
• Changing local Integration Joint Boards to be the delivery arm of the National Care Service, funded directly from the Scottish Government
• The nurturing and strengthening of the workforce
• Greater recognition and support for unpaid carers

The Scottish Government stated its commitment to implementing the recommendations of the IRASC in the National Care Service Consultation document. Before the pandemic began, it had been working with a wide range of partners, including people who use social care support, COSLA (the Convention of Scottish Local Authorities), unpaid carers, the social care sector and the workforce, to address many of the areas highlighted in the review.

The proposals outlined by the Scottish Government are wider than those suggested by the IRASC. It has stated that there is a need to use this opportunity to consider the scope, remit, inclusivity and delivery mechanisms of the National Care Service in its widest sense. The assumption is that, as a minimum, it will cover adult social care services. The Government notes, however, in the consultation document:

"If we want to build a community health and social care system to make sure that all people receive services that cluster round them to deliver the best possible outcomes, then we must consider the merits of extending the scope of a National Care Service to oversee all age groups and a wider range of needs including: children and young people; community justice; alcohol and drug services; and social work." (Page 6 of the National Care Service consultation document)

The consultation

The National Care Service Consultation opened on 9th August 2021 and closed on 2nd November 2021 as noted above. It consisted of a written consultation paper and wide ranging consultation events and other engagements over the 12 week period. This report focuses on the written responses to the consultation paper but also provides information on issues raised at 14 open consultation events and an number chaired discussions led by the Scottish Government.

The consultation paper asked 122 questions, of which 37 were closed, 30 were open, and 55 had both closed and open elements, for example multiple choice with a free text box for further comments.

The consultation was designed so that respondents could answer the sections of specific interest to them; for example, those with lived experience and specific area knowledge. Therefore, it was anticipated at the outset that not all respondents would answer all sections and the number of respondents varies therefore by question and section.

The Easy Read version of the consultation asked 25 questions, four open, seven closed and 14 both, making a total of 21 closed and 18 open elements. The Easy Read version covered all chapters of the consultation, with different wording of questions as appropriate. However, the Easy Read version did not cover all the detailed topics in the larger consultation paper or provide a translation of all of the questions as this would have made the Easy Read version excessively long. Easy Read responses have therefore been included separately under the appropriate headings.

The consultation was designed and delivered by the Scottish Government and PwC was subsequently appointed to conduct an analysis of the Consultation responses.

The report

This report is structured as follows:

• Chapter 2 presents information on the respondents to the consultation and the responses submitted, comments on the consultation process itself and the approach to the analysis
• Chapters 3 to 10 presents the results of the analysis of the responses to the consultation by question

There were a number of cross-cutting themes that emerged from the responses which were not explicitly addressed by the consultation directly. As a result, there is no quantitative data that can be attributed to these themes in terms of strength of the point of view. These issues raised in relation to the general concept of a National Care Service included the following:

• The need for more detail on the proposals in order to inform the debate
• The costs associated with a NCS and how it would be funded
• The existing local authority workforce
• Localism and local accountability
• Human rights and equality issues
• The extent of the NCS
• The delivery of services under the NCS

These cross-cutting themes are addressed in more detail in Chapter 4.