National Care Service consultation: discussion events summaries

13 September 2021

• Theme of discussion: scope of the National Care Service
• Time: 14:00-16:00
• Discussions leader(s): Ingrid Roberts

Introduction

This is a summary of the key points raised by attendees at this session.  None of the points have been attributed to individuals as the purpose was to encourage broad and open discussion.  The summaries for all the national events will be provided to the independent contractor undertaking the consultation analysis.

Points raised at event

Children’s Services

• Is there scope to complete an additional review beyond this consultation period into the advisability or not of including children's services?  What can we learn from the current integration, or not, of children's services within IJBs? What is the involvement of the Directorate for Children and Families with the consultation and service redesign process? Would be keen to know that officials with children's social work/child protection expertise are embedded in this work, as well as the Minister for Children and Young People
• Can we hear what Education's views are on this? Education are often joint funders of children's residential places and sole funders for day placements at schools that are more specialised. 
• 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.  Actions that are being taken now ahead of consultation, aware that there are unprepared services. The focus on social care are being weighed towards the elderly.
• When you look at what FM committed to, about lived experience and being at the heart. Feely review – specifically said about service provision. Uncomfortable about participation.  Has the Gov got an evaluation of HSC partnerships forming – where the structures aren’t working well.   Lacks detail about detail included and what the structures inside NCS could look like. So little detail, difficult to engage

Healthcare

• Given the wide-ranging remit of the Promise and that fact that it is at an early stage - is there a possibility that it is somehow diluted or lost as this new and much larger agenda take precedence ?

• If this proposal is person centred then a more holistic care service must include both Education Services from nursery to secondary and recognise the part that Housing plays in an individual's lived experience.

• Patient journey has to be seamless and holistic.  Unless you involve the acute sector you’re always going to have problems and people will feel left out. Hospital and community care must be the part of the person's journey and in my view more integrated from the individual point of view.

• I struggle with the term National Care Service. Implies service delivery. Given the local approach sitting with partnerships to ‘deliver’. Is the NCS not more of an Agency to oversee, provide governance and set standards?

• There’s nothing in consultation around where health improvement would sit. Needs wider context in terms of public health and where PH in Scotland has gone. Issue about public health, what said isn’t clear from the consultation. Working round whole system approaches. That has to be front of what we’re trying to do here.

• Title of consultation itself doesn’t deal with the scope that were talking about. A care service is misleading. Drawing most on the Feely review, talk majority on care. Be clearer about what we mean. Concern is that we need an ambition to do things differently than we did before.

Social Work and Social Care

• What do you mean by social work and social care – it shouldn’t need to be a different point for feedback. Complexity about what we are talking about IN the NCS. It’s unclear what being in or out actually means. Presents risk of parts of SWSC in what will be left behind.  Social Care pathway is not well understood. Nobody has end to end ownership of pathway and its finding so accountabilities and responsibilities are blurred.

• It’s not just about care. The whole ethos of SDS is ‘support’ to live the life people want. Care implies doing to people. The whole ethos of the report is empowering people to live lives that matter to people. National Care and Support Agency reflects all of the intentions of the Feeley report.  Interface with housing and education is vital.

• To attempt to bring together such a wide ranging range of public and 3rd Sector organisations under an umbrella is complex enough - where do private providers sit for example? It appears to be more about governance and standards. Each organisation will still have their own T's and C's - that cannot be brought into one neat package.

• We need to be very careful about the perfect storm. A total lack of social care staff due to poor pay and conditions. This is particularly in Adult social care. The same issues are not as great in Children's services for a variety of reasons - we cannot be complacent. A lack of staff brings pressures/burnout and can accelerate the potential for neglect and abuse within the system

• Personal Assistants are also part of our Social Care workforce providing personalised support directed by the individual. Home care services – deliver thousands of care. Recruitment potential and their skills, how we value their skills. Seem to value health care skills rather than social care skills. So undervalued that the home care services do a fantastic job. Merge them together and it will be a true NCS.

Nursing

• Important that nurses are not responsible for something they cannot control. Clarification about the elements of nursing to be included would be helpful

• Governance aspect of document is confused – the questions being asked aren’t necessarily the right ones. Needs to be proper thinking of governance structures in relation to nursing.  Support points about nurses should also widen to include school nurses, health visitors, diabetic nurses etc.

Justice Social Work

• Do we take all of social work together or do things become separate. For majority of people in justice the majority of their needs is around social support and some social care. For those who keep emerging in the criminal system, social care and support has failed them. Social work is a whole system activity – needs to maintained as an integrated service

• There is a huge risk that youth justice gets lost if Justice gets drawn into the NCS and Children's Services stays outside. These young people are some of Scotland's most vulnerable/under supported and they run the risk of being further excluded and faced more difficult transitions on entering the adult 'system'. I agree that the consultation does not cover the complexity of the system and youth justice is a good example of this.

• People in prison require a high level of support – adult support services within prisons are hard to get a hold of – not an effective support system

• Criminal Justice and Mental Health are invariable linked for a majority of individuals, these must be linked to prison services and the areas that Jean Waddie has raised including housing.

• Social Care not just delivered within prisons. Prison Visitor Centres are an important interface between prisoners, their families and the statutory social work services. They pick up family challenges when someone enters prison and when they are discharged

Alcohol and Drug Services

• All of these topics link with one another. Services should be integrated as part of a whole system approach. Separating them out is not progress.  Children exist within families where there is drug and alcohol problems which may also escalate to the need for justice social care. These services must be integrated and should not be artificially set out.

• One member asked if rehabilitation programmes could be offered through a national care service instead of locally.

Mental Health Services

• Can’t understand why mental health would be seen as separate. Mental health and physical health should both be healthcare overall. The mental health landscape is extremely complex. There are different workers that treat mental health to other health issues.

• Of all the sections on this document – mental health is shortest and it’s a bit remiss that it is so short.

• We have been guilty it seems of asking third party providers to take on complex care cases way beyond their skills and capabilities and for the same cost - so another opportunity to do these properly at a nationally designed NCS yet locally delivered level with suitability skilled and rewarded staff

• Our Self-directed Support legislation intends to support and protect human rights and ensure choice and control

National Social Work Agency

• Whatever the future looks like, implementation is key. The risk to people during the transition phase is increased with any significant change. Having a body that has an overview across the country looking at Ts&Cs, training, improvement etc. is welcome. No downsides.  This has been needed for some time however where does it leave the SSSC.

• Through pandemic people have lost their social care packages and they are not being reinstated.

• Perhaps an increase in training around supporting complexity will increase the availability of complex support across all council areas. Pooling training resources, identifying training need and ensuring training services are properly evaluated and are providing adequate training may make a positive difference in this area.

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

• Working with our LA we now have a Core and Cluster facility more locally enabling repatriation from England - and we can build on that for staff, management and service users alike in an NCS and deliver at least at regional level surely?

• It's impossible to work from the same set of rules when finance drives so much in terms of what actually happens on the ground regarding values and delivery. Despite the challenges and the complexity, it's why many thousands of disabled people feel strongly that we need a National Care Service

• Learning from Police Scotland demonstrated the benefits of having a national approach to IT, Governance and infrastructure, Terms and Conditions and pay scales for staff. With tweaks to policies and procedures to fit local needs

• SG rock and hard place, how but where is the detail but wanted to leave open to get contributions. Huge challenge sin getting everyone to work form same set of rules but agree we should be. 32LA with different systems and processes is challenging.