National Care Service consultation: discussion events summaries

16 August 2021

• Theme of discussion: all aspects of the consultation
• Time: 10:00-12:00
• Discussions leader(s): Anna Kynaston

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

• More support needs to be available to allow people to die at home.

• Carer - only get into care system if deemed critical.  Too many people have to fight for assistance.
• IJB representative  said that finance in the social care system is a significant issue due to cuts to budgets and cuts being continuously demanded. Finances may be an issue with new NCS .
• Due to Pandemic – some services have not re-started. Recognise impact on service users and carers. Far less support than pre-Pandemic.
• Equality of care for those with dementia. Currently those with terminal illnesses can receive a fully funded package of care while a service user with dementia using Self Directed Support is required to make financial contributions to their care.
• Sight Scotland - Disparity between the funding for children and adults. The level of funding/provision changes significantly when an individual transitions from a child to adult but care needs do not change or maybe increase. Person centred approach needed – transition between ages and areas needs consistency.
• GCVS Transparency and accountability needed in the system. The Third Sector absorbed a lot of the slack from LAs when the pandemic happened and they need to be part of any future discussion about social care. What can we deliver now?
• Retaining eligibility criteria for care provision and how this squares with cash limited budgets.   
• The relationship between the NHS and NCS was not explained in the Consultation paper. Also lack of acknowledgement of GP and Health Board work not being referenced.
• Care at Home owner said that a national care plan would be a good idea.  Care at home organisations are not second class and need to be acknowledged as a something which is more pre-emptive and not a crisis management tool.
• Qualification basis and training across the sector needs to be nationally delivered, recognised and “transportable”.  Currently liability lies with the employer.  Internal training is not always recognised elsewhere. 
• National Care Record considered important. Personal records should also encompass NHS records. Huge issue of sharing information across systems and ensuring information available at point of care. National Care Record could address this.
• Challenging decisions has resulted in a defensive reaction from providers. Governance and accountability need to be central to the NCS. Lessons should be learned from Police Scotland and how it was set up to avoid the mistakes which were made.
• Who assesses individual needs? Those who assess needs should not be those who provide the budget. In addition, the Social Covenant Steering Group should get independent support separate from Scottish Government to access meetings.
• People Led Policy Panel.  Assessments.  Need different grades.  Eg. Grade 1 need 24 hour care.  Grade 2 – night care.  Grade 3  - cleaning and food. The system of assessment should be separate from finances and assessments should be carried out in collaboration with the service user.
• No Independent Advocacy for those with mental health needs, and that there was very little content in the consultation about mental health and no reference to the UNCRights or disability.
• HSE - no mention of H&SatWork Act or HSE in care premises. Need to integrate regulatory landscape as they work closely with Care Inspectorate, Public Health Scotland and Environmental Health Departments on care home regulation.
• What role for housing and independent living, aids adaptations etc.  How does the care service link with housing support? 
• EL H&SCP – any consideration of patient access to records.  Are there any specific plans to reach out to consult the BME groups? Voices of individuals who receive care and their families should be heard at all stages of the journey.
• RCN – proposals appear not to include acute care.
• The question of the GP contract and the relationship between GP’s and Health Boards. Will there be a move away from Centralised contract? Clarity for the GP contract is needed. The consolation pack suggests that there is potential for the new boards to take over this. The relationship between GP’s and the new boards are unclear.
• A contributor asked about Social Workers and the issue of users affordability, and are Ministers willing to find funding for this
• Another issue was that of the Living Wage and gender pay gap. They noted that there was no debate about affordability in NHS.
• Common Weal – Concern about centralising things further and making services accountable to ministers. There should be opportunity to challenge this and suggest that local authorities should be revitalised to do this role.  End postcode lottery across country.
• If social workers / care workers can work collaboratively with service users to assess needs etc, will Ministers ensure budget is available? Never have debate about affordability in NHS. Need to challenge what matters in social care as their lives matter. Social care as infrastructure spend. No public discussions about affordability of NHS seen as a need.
• Contributor asked if there would be opportunities to tidy up the existing legislation through an updated Social Work Act? 1968 Act should be reflected on. Social Work has more legislation than any other devolved area.  The current legislation is looking to shut the paradigm and provision of care services, and this should not be restricted to one client group.
• Third sector provider said a change is needed in Regulation, and there needs to be a  better balance between the volume of duplicated information reported to different bodies. This results in a financial cost, but also a cost in terms of the time staff are unable to provide day to day support.
• A contributor asked what is the relationship between the NCS and the “Promise” AK described that we worked closely with Promise colleagues and GIRFEC, these are seen as complimentary flagship commitments.
• A Private sector provider of care discussed the Feeley Report talks about removing profit margins and potential issues connected with this. Nothing in consultation on this.
• Another person mentioned the use of SDS, and how will NCS affect direct payments.
• A contributor asked about the role of social enterprises and if they could assist in providing services to users.
• Contributor made reference to drugs and alcohol, and one of the criticisms of Feeley was that there was no reference to homelessness, but noted that was mentioned in consultation. Provision of homelessness services should be seen as a health service and accorded equal importance.
• A question was asked about information systems, and whether the NCS will have one national system
• Member of health board and chair IJB – what do you mean by delivery through health and social care boards? Do you want HSC board be operational delivery for NCS in community?
• A carer representative on an IJB said that the systems can be hampered by finance, but works quite well on the whole but lacks business improvement skills. What is required is a countrywide governance system, as the experience they have is that the voting system on IJB blocks free voting as the composition frequently vote on political lines. The system should be reformed so that political interference is no longer an issue. Public and 3rd sector representative do not have a vote on IJBs.
• Strategic Planning Groups have the ability to step in and support. But to include in new board would create a huge board.
• Another carer argued that it is difficult to attract carer’s to IJB’s as they are not paid as they are in the NHS system. This creates a barrier to representation.
• The National Care Service would be responsible for developing and managing a Structure of Standards and Processes for ethical and collaborative commissioning and procurement
• Another contributor raised the point that if the profitability of providing services is taken away by the NCS, who will plug gap if providing services is no longer profitable for private sector?
• Residential care currently policed by Care Inspectorate.  No method of ensuring poorly performing homes progress through grade system. CI need more teeth.
• Social care qualifications need to be placed on a higher footing. COSLA regulations are a barrier to the workforce. It is a poorly paid profession and those working in the profession need career advancement opportunities and recognition for the work they do.  
• Some aspects of the consultation are definitive, but the questions on Fair Work are less definitive than those in the Feeley Report. There was also a feeling that the consultation document was not clear on the role of collective bargaining.
• A Social Care Org representative observed a 2 tier system for workers in commissioned sector and Local Authorities exists. There is a need to attract, and retain, provide career progression, and a better recognition of the value of the work carried out. The pay should reflect the greater complexity of work they carry out.  The existing National Care Home Contract should be reformed to allow better pay to be made to staff.  Look at Pensions as well.
• Another contribution reflected on the need for the workforce to be valued, and the need to address issues such as those relating to travel time, especially in the Highlands, where staff are often not paid for their time.
• A point made was about Third Sector organisations which are hostile to Trade Union’s and this should be addressed in the NCS. 60% of workers are in Unions.
• Another person said that we should not wait until the NCS is established to improve pay and conditions for the workforce.
• A contributor from a third sector organisation mentioned that there should be portability of qualifications. Employer’s liability means that training and qualifications  cannot be standardised in areas like Health and Safety and Food hygiene, There is an issue that how do you promote portability of qualifications without risking the liability of individual providers.
• Fight for 15 campaign – this doesn’t need to wait for a NCS to be established. There are things that don’t have to wait and the pay of social care workers is one of these things that SG should do now.