National Care Service: equality impact assessment

Screening

Policy Aim

Introduction

The establishment of a National Care Service (NCS) and new local care boards for social care and social work services which will be directly accountable to Scottish Ministers was introduced in the SNP's manifesto in 2021. Following the election, the Scottish Government committed to launching a public consultation within the first 100 days and to introducing the bill to the Scottish Parliament by the end of the first parliamentary session.

The NCS will be responsible for social work and social care support, including support for carers. It will also be responsible for planning and commissioning primary care and community health services, including mental health services. To ensure services are joined up, from a community healthcare context GPs, Nurse Directors and other clinical and healthcare leaders will engage in the development of locality plans.

While the details of the NCS will be developed in conjunction with people with lived and living experience, the overarching approach of the NCS will be to:

• Provide leadership, oversight, and accountability for community health and social care, including by providing strategic direction and planning at the national and regional levels;
• Uphold the NCS principles and develop and adhere to the charter of rights for people who access care and support and ensure human rights are embedded throughout its work;
• Develop and maintain a national system for effective complaints and redress for NCS services;
• Create, manage and promote national social care policies, setting national standards and developing practice standards, models and guidance to improve access to care;
• Create a framework for ethical commissioning and procurement to support the NCS principles and other important priorities, such as decarbonisation and the circular economy;
• Support fair work in social care, and carry out workforce planning;
• Include the National Social Work Agency to support and invest in the social work profession;
• Procure complex and specialist services at the national level;
• Plan and commission social work, social care support and community health services via geographically-based local care boards;
• Deliver social work and social care via geographically-based local care boards.

Background

In September 2020, the Scottish Government commissioned the Independent Review of Adult Social Care, chaired by Derek Feeley and supported by an Advisory panel of Scottish and international experts.

Taking a human-rights based approach, the review recommended improvements to adult social care, focussing on people who use social care support services, their carers and families, and the experiences of those who work in the social care sector.

The review recognised that in Scotland there is much to be proud of in the provision of social care and support but that we can still do better. It recommended three things that must change in order to secure better outcomes:

• A shift in the paradigm by challenging some of the prevailing narrative around social care support and underpinning a human-rights based approach.
• Strengthening the foundations that are already in place and closing the gap between policy and implementation. Nurturing and strengthening the social care workforce and supporting the contribution from unpaid carers.
• Redesigning the system to establish a National Care Service to provide a consistent service across the country, set national standards and drive national improvements, improve integration with the NHS and bring national oversight and accountability to social care and support.

The Independent Review of Adult Social Care report was published on 3 February 2021. Although it focussed on adult services most Integration Authorities have delegated authority for a wider remit that includes health, children and families, and justice delivery. The report recognised that adult social care support does not stand alone and has strong links to wider services, such as social work and children's services.

The report contained 53 recommendations, a key one of which was the establishment of the National Care Service.

The NCS Bill has been introduced to reform the way social care and social work is delivered in Scotland whilst strengthening the integration with community health services. The proposals contained in the bill are designed to put into practice the recommendations of the Independent Review of Adult Social Care, including that the Scottish Ministers should have statutory responsibility for social care, a National Care Service should be established, a person-centred and human-rights based approach should be taken to social care, and that Integration Joint Boards should be reformed to provide services as overseen by the National Care Service.

In addition to making recommendations, the Independent Review, along with other reports and audits, identified a number of challenges in the current approach to social care. These can be summarised as:

• Inconsistency of people's experience of social care ("postcode lottery")
• Complex and inconsistent governance arrangements
• Lack of national oversight and co-ordination
• Lack of collaborative and strategic leadership
• Non-integrated budgetary and financial planning

In developing the proposals for the NCS, officials have focused on addressing the above challenges.

Consultation

The public consultation on the proposals for the NCS ran from 9 August to 2 November 2021. The consultation sought views on a range of proposals, including:

• Scottish Ministers assume responsibility for social care across Scotland;
• A National Care Service that will oversee the delivery of care, improve standards, ensure enhanced pay and conditions for workers, and better support for unpaid carers;
• New local care boards that will deliver services and report to the National Care Service;
• The scope of the National Care Service includes adult social work and social care services, community healthcare provision, children's social work and social care services, thereby supporting an integrated and collaborative approach to support and care for people of all ages.

During the consultation period the Scottish Government held over 100 engagement events and meetings to gather views from as many partners, stakeholders, third sector organisations and members of the public as possible. Due to the restrictions in place to respond to the Covid-19 pandemic the majority of events were held virtually; however, a small number of face-to-face events were held in Troon, Aberdeen and Greenock. In total, around 3,000 people engaged with the Scottish Government at these sessions.

At the end of the consultation 1,291 responses were received: 703 from individuals and 575 from organisations.^[1] Of the individual respondents, the majority came from people who were a friend or a family member of someone who receives, or has received, social care or support. From the organisations, the biggest percentage of responses came from third sector organisations who provide care or support services, and organisations that classed themselves as "other".

The consultation analysis report was published on 10 February 2022.

Much will depend on the eventual scope of the NCS and whether services such as Justice Social Work and Children's Services are included. However, at a minimum it will affect adults accessing social work and social care support, their carers and families, and individuals providing social care in Scotland. By social work we mean the statutory role which involves assessing need, managing risk and promoting the wellbeing of individuals and communities. By social care support we mean services which directly support people to meet their personal outcomes. The Bill therefore will include adult social work services including adult support and protection, mental health and drug and alcohol services.

The Bill also enables the opportunity for children's services and Justice Social Work to be brought together alongside adult social work and social care and managed in a single framework with social work in prisons, alcohol and drugs services, mental health services and other non-acute, community, health care. This would be a significant change in the way that these services are organised, particularly in the case of children's services and justice social work.

The Bill will give the Scottish Ministers the power to transfer relevant responsibilities in relation to children's services and justice social work services from local authorities to themselves or to a local care board. Given that neither children's services nor justice social work were considered as part of IRASC, it is important that the risks and opportunities, costs and benefits are fully assessed before a decision is made to implement the transfer.

For children's services, establishment of the NCS will bring change to the landscape in which those services are currently delivered, in which they are integrated in some areas but not others. To fully consider the potential benefits and challenges of locating children's services in the NCS, a programme of work will be taken forward to gather evidence on the impact of integration of services. A crucial aspect of this will be to assess implementation of The Promise in both integrated and non-integrated areas and the impact on transition between children's and adult services.

The policy intention is that a preferred model of delivery will be co-designed with stakeholders, backed by relevant assessment of evidence, and be subject to consultation, parliamentary scrutiny and approval before any transfer takes place

National Performance Framework

The NCS programme will contribute to achieving the following national outcomes:

• We live in communities that are inclusive, empowered, resilient and safe
• We have a globally competitive, entrepreneurial, inclusive and sustainable economy
• We are well educated, skilled and able to contribute to society
• We have thriving and innovative businesses, with quality jobs and fair work for everyone
• We are healthy and active
• We respect, protect and fulfil human rights and live free from discrimination

As with any major change in policy, there is a risk that disruption to services may have a detrimental impact on people. The evidence in the EQIA shows that the protected characteristics of age, disability and sex are at risk of being disproportionately affected due to the over-representation of older people and people with disability who access social care support, and women working in the sector.

This paper shows how the Scottish Government aims to prevent negative impacts on protected characteristic groups by explaining how we will work closely with people most affected to ensure a smooth transition from the current process to the NCS. As policy continues to be developed, further impact assessments will be undertaken to ensure that their impact is understood.

The scope of the EQIA

As the establishment of the NCS has the potential to impact on a large section of the population, there has been engagement with a broad range of partners, stakeholders and members of the public during, and since the close of the consultation period. Further details are given in the 'Consultation' section of this paper.

We have carried out a full impact assessment on the following provisions of the NCS bill:

• National Structures
• Local Care Boards
• NCS Charter
• Complaints and Putting Things Right
• Right to Breaks from Caring
• Right to Visit Care Home Residents
• Ethical Commissioning and Procurement

We have also carried out an impact assessment on the objectives of the National Social Work Agency, as set out in the Policy Memorandum.

Although a decision regarding the inclusion of children's services has not yet been made, early consideration has been given to the equality matters impacting children's services in this EQIA.

The Scottish Government has also carried out the following full or partial impact assessments in respect of the NCS Bill:

• Business and Regulatory Impact Assessment
• Island Communities Impact Assessment
• Children's Rights and Wellbeing Impact Assessment
• Fairer Scotland Duty Assessment
• Data Protection Impact Assessment