National Care Service consultation: discussion events summaries

4 October 2021

• Theme of discussion: all aspects of the consultation
• Time: 14:00-16:00
• 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

• Aspire to see when NCS is up and running that people having routine overnight care which is crucial if you want people to stay in their own homes. 
• Self-directed support, encouraging choice, control, personalisation etc. - social workers tend to not make people aware of all the SDS options - along with a lack of training around SDS in health and social care overall
• Where are social care and social care research is going to sit as  consultation doesn’t mention this. It’s also unclear social care research is going to be governed and who by. Evidence informed run services is important where that research commissioned.
• The consultation process isn’t long enough as organisations were not aware of this and isn’t in organisational business plans. Wanted to know when will a timeline be published as this would be useful for her and colleagues.
• Contributor mentioned that SG at the moment relies on political power in Scotland and has yearning for devolution and independence. NCS is biggest attack on devolution.
• Local Authorities have faced 13 years of austerity and cut in budgets and the demographic changes mean a larger demand for services. NCS generally and colleagues as seen biggest kicking for everything they have done over the years and last year during pandemic. This is demoralising and will lose experienced staff. There will be major issues with national standards and lose innovation. Lose local services for housing, integration and children’s services.
• Budgets are already stretched and staffing is always a problem. How will the NCS enable us to recruit the right people to provide the right support when person centred support usually costs more than standard block funded services. Tailored support sometimes means 24/7 services because that is what families need, and often don’t get - there is a clear lack of respite in Scotland and as our learning disabled population grows older there are less places for them to live as mainstream care homes do not usually have the staff to care for adults with learning disabilities and dementia combined.
• Mentioned democratic accountability, Local Authorities are accountable organisations and delivering these services. Some concerns about jumping gun about details before dealing with big picture stuff. Entitlements, rights, talk of procurement and commissioning outsourcing of public services and further opportunities for input. Fundamental questions about how this will affect existing efforts and achieve integrated children’s services. Publicly delivered services rather than outsourcing. A lot of services that were delivered publicly are now outsourced and children’s services are included in that.
• Important that the Government take their time and don’t the rush this process. It’s really important that the structure is fit for purpose and doesn't become a big white elephant that needs reform after ten years of failing.
• One problem is that HSCPs currently do not listen, do not communicate effectively and are patronising 
• Possibly some lessons can be learnt from Wales social care system as that seems to be the best social care system in the UK
• Recognises a lot of what Derek Feeley said is correct but is yet to be convinced that proposals set out will take us there. Is NCS not really a misnomer and a National Health and Community care service which would be better. Wonder whether creating an NCS and NHS is best was to integrate something and consideration giving to one National health and social care service.
• Where there is change there is threat or loss. This is an opportunity to make a positive change for people across Scotland. Things don’t link in together and both need to function and in conjunction with each other. Need to think about accountability for NHS and NCS, bureaucracy and additional level of bureaucracy, joint outcomes and better focus. Spending money better and same terms and conditions for staff. Care Inspectorate has a job to do and easy to apportion blame, equalise terms and conditions, looking at quality standards that have to be met, investment and fair assessment. Be confident in taking a leap of faith as this is an exciting opportunity. Need to do something different as current system doesn’t work.
• How much is NCS team looking at new Human Right Bill?  Including UNCRPD.  Important to be clear how that will fit together – hope to see huge cultural change resulting from it.  Would be good to set that in the establishment of the NCS, not have to bolt it on later.  Eg independent living, right to information, independent advocacy etc.
• Governance of clinicians – medical professionals in the public sector have pretty good system of clinical governance.  If large sections are moved to the new organisation, how do we avoid dangers of fragmenting governance.
• Welcome 3rd sector reps getting voting rights on local boards.  Difficult for a single rep to adequately represent the whole of the sector locally, need to consider how that can work.  Welcome direct budgeting – current delegated budgets are not genuinely integrated.  GIRFE approach and language in consultation seems very positive, but how to make it real on the ground?  Biggest challenge currently is access and different models of assessment, need to repeat stories etc.  Document sounds positive, but how to make it work.  Also how can 3rd sector be meaningfully involved in commissioning and service design and procurement.  Want more outcomes based support plans and commissioning, to help people with independent living rather than task-based.
• Still a postcode lottery in NHS, so why would NCS remove it?  Local authorities are restricted in spending, NHS isn’t, wastes lots of money and does badly (discharge into care homes with Covid).  Consider NCS is likely to make things much worse, no evidence that it won’t.
• Removal of services would have huge impact on role, scope and structure of local authorities.  Was told changes would impact negatively on other services such as education etc., what would happen to funding.  Need to not lose local knowledge of community.
• Was involved in a lot of Feeley conversations.  Discussion of structures misses the need to rebalance power.  3rd sector understands, need to build from that.  Mental Health and social care systems particularly don’t work well together, people can’t get support unless they are taking the drugs they are told. Need people with lived experience to be involved in service design and delivery.  Engagement is getting slightly better in HSCPs, not so good in health. System needs to listen to people and not be driven by professional groups.
• A language has been developed over time around independent living and this should apply to the National Care Service. Structural change is not necessarily recommended but there is a feeling that national accountability is needed.
• The NCS should avoid the imbalance of power in the NHS. It should not be about replicating the NHS. Mental Health and Addiction services are not dealt with well currently. This who receive treatment are dehumanised and have little say in their treatment. Third sector involvement has assisted, people are treated more on a human level. Lived experience needs to be part of design and delivery of the NCS. Too much credence is paid to professional interests.
• Feeley said that there needed to be a culture change to allow the care sector to attract suitable numbers of young people to the profession. Workforce is getting older, as are unpaid carers. Carer centres need to be fully resourced.
• There is a reduced pool of  social care workers, and fair proportion of workforce are at retirement age. Young people ned to be made aware of opportunities in the sector and work is needed to take place with Universities, Colleges and schools. Work is happening on the ground. Attainment at University and colleges high, but we need to target those in less successful avenues.
• There is a lack of information for parents who care for children. Everyone should receive the same quality of service. There were good services provided many years ago through Social Work departments, and there is a difficulty in accessing services where there is a transition from child to adult services today.
• Unpaid carers need far greater access to respite services. Mental Health provision currently imbalanced as focus is on those in crisis and not those who perhaps have a longer term illness that needs to be treated. More investment is needed in mental health services.
• There are good proposals for the NCS, but there is a workforce crisis in social care across all employers. It won’t matter how professionalised the workforce becomes it won’t resolve this The current system is inflexible to local need. NCS must ensure this does not take place, New Boards need to be creative and flexible in delivering services and the disconnect of local need not being met needs to be addressed with communities. Carer’s have a big role across society but undervalued.
• Island communities have unique challenges, often difficult to access services. A top down structure means that it does not permit localised decision making. What will be the accountability of new boards.
• We want to understand the role of carer’s and be more supportive, We should focus