National Care Service consultation: discussion events summaries

2 November 2021

• Theme of discussion: all aspects of the consultation
• Time: 10:00- 1:30
• 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

• Self-employed carers are absent from the document.

• Self-employed carers are ‘black market’ workers – an important group who have left agency work because of conditions of service, poorly treated and not respected.
• There are major issues with low-paid self-employed staff who are earning below the minimum wage.
• There is a significant element of undercutting Local Authority input in the provision of services. The idea that one size fits all doesn’t fit all is a very fine nuance that a National Care Service (NCS) wouldn’t catch.
• An NCS will still have separate providers of care. I don’t think this will address actual performance issues. It doesn’t fundamentally address the unlevelled playing field of funding etc. and is still reliant on third sectors sharing practices. It doesn’t change the way care is provided.
• The focus of the NCS consultation is governance structures.
• People working in care homes leaving because they are not valued.
• Right to breaks is important even in the work place where it is not always recognised. It is a huge job to care for somebody and it is important that carers get breaks.
• The jobs that nurses would have previously done is now being done by carers who do not get paid. A lot of money should be put into supporting unpaid carers. Millions of people out there do not realise that they are carers. Work needs done to support their mental health.
• Resourcing – this is missing from consultation. When legislation goes through it needs financial schedule. Resourcing needs quantified to make the whole thing credible. Need to look at projections for over 75s. More money needs to go in to prepare for these projections. Need to think about how we will pay staff more, as that is the only way to attract staff.
• National Care Record – if we can get a good robust system everyone can access it would be fantastic and it will solve problems with duplicate working and recording. Safety aspect of data handling – right now lots of agencies hold lots of information on a person and this means information can get lost in the system.
• Carers would go above and beyond to keep family up to date, so a system where people could access information in one place would be helpful.
• Permissions – there might need to be some information that only certain people can see,  e.g. sensitive information
• Gap in proposal on complaints. People worry about making complaints about their carers – calling it a complaint put people off from doing it. Important to rephrase things as complaints and representations.
• If people done have access to advocacy, there is no point in changing the system. Access to advocacy is key.
• How we de-bar people? The complaints procedure isn’t understandable for a lot of people who use social care. Whether or not you are cognitively impaired you should have the right to raise a complaint.
• Can’t see anything in proposals which suggests that a national body running services would be better than the current system of Health and Social Care Partnerships, who have taken on massive work from two national organisations. In the past few years they have dealt with an extraordinary pandemic.
• NCS is probably not the best way to manage, direct and plan care. Different parts of the country have different issues – a national service would not address this. There would not be any benefit over a local system.
• The proposals negate the role of organisations in place; they refer to COSLA for complaints but COSLA can’t speak for private parts of social care.
• Integration Joint Boards (IJB) report to a central point. Quite a lot of the proposals could be within scope of existing organisations, and don’t need the creation of a new body.
• There has only 5 or 6 years of joint integration involving parts of health service and local authorities, so the timeframe for allowing it to bed in seems particularly short.
• There is a mix of health and social care and currently there are power dynamics between them; both sides feel that they will be subsumed especially if children’s and justice services are a big issue.
• It is important to learn lessons from Northern Ireland, where they have a set-up of 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 managerial ensures a balanced mix of people holding positions in health and social care and reinforces balance of power.
• We should give serious thought to the balance of health and social care. The Northern Ireland as good model of example.
• There is a lot of emphasis on hospital discharge in the consultation, which is a big issue that could become dominant, with social care suffering because of that.
• What would be the employment status of staff be if transferred from IJB and moved to this new body?
• Change is unsettling for the workforce when they don’t know what is going to happen, especially with the future of IJBs.

• There is nothing in the proposals for a marketplace type process for commissioning.
• An NCS would have funding increased by 25%.
• Anyone commissioning for services have always looked for high quality services within their budget.
• Demand for services outstrips supply. If we don’t have the variety and volume of support for people, then this is a moot point. How is NCS going to change that? How are we going to attract more people to deliver services in the sector.
• Commissioning can be compared to the gig economy. Commissioning needs to move away from this.  

• It is important that there is real alignment in terms of regulation, oversight groups from government and health protection. Nobody is working from same guidance or rules and there should be one regulator covering all aspects.
• The message around the NCS is about improvement. We need to determine how we start working in partnership with regulators and not moving the goal posts.
• We need one set of regulations and a joined-up message that we give to providers and people using service.
• The NCS should encompass all of these things. Operating within health and social care standards, the two parts should be joint and not have standalone guidance. We need to bring everything together with one framework and benchmark.

• Registration and values of different types of roles. Nurses often have to give up their registration when they move to social care. This can lead to a feeling of being excluded from entering into any integrated management strategic role.
• The current set-up can make nurses and social care staff feel undervalued.
• There is a big drive around protecting the title of nurse but nothing for people coming up through ranks of social care.
• People leave when they don’t feel valued, and they leave to train for other roles.
• There are successful models elsewhere, such as the Danish model of providing care services. Integrated and career pathways are set up from basic grade to health and care service. We should learn from other countries.
• Immigration – we are going to need 20,000 people for Scotland that we won’t get through current immigration policies. This is an issue post-Brexit and poses serious problems for health and social care.
• The level of pay and conditions is a problem, where independent sector agencies are earning below minimum wage after you take account of downtime, mileage costs, provision of smart phones, overtime payments and people not getting holidays.
• Self-employed carers not getting a day off throughout the year and can’t afford to take a day off. This can’t be fixed if pay and conditions are not right.
• Fife council spending £44m on private care providers.
• Councils are charging £18 per hour, and staff meant to be in two places at once.
• Companies being paid by the half hour by council but don’t spend 30 mins with service users.
• Why could we not have care villages? For example, sheltered housing has lots of care companies going in and out, have one team with shift type system. 
• It is important to value staff, make them feel supported, developed and pay them a decent wage.
• We need to double or treble salaries for social care. Staff are leaving in droves for not being valued and have standard training.
• Bring back enrolled nurses as giving up registration is not good. Have standards and training and value people in care homes.