National Care Service: Expert Legislative Advisory Group minutes - 30 May 2024

Attendees and apologies

The meeting was attended by:

• Scottish Government staff
• stakeholder organisations
• people with experience of community health, social work and social care services

Items and actions

The Chair introduced himself and thanked everyone for attending.

The Chair informed the group that the meeting would begin with a 45 minute question and answer session with the Minister for Social Care, Mental Wellbeing and Sport, Maree Todd. He explained that the focus of the second half of the session is Anne’s Law, Children’s services and Justice services.

The Chair welcomed some of the Social Covenant Steering Group who were attending for the first time.

The Chair reminded everyone of the group’s function as a sounding board and advice-giving body for the Scottish Government to contribute to development of the NCS Bill and Stage 2 amendments. A particular focus will be on what opportunities there are and how they can be enhanced, and how we can mitigate risk.

The Terms of Reference were noted, in particular that this is an expert advice group, not a co-design group. The Chair reminded everyone that if they are interested in co-design that they can sign up for the Lived Experience Expert Panel or join the stakeholder register.

The Chair indicated that we are committed to accessibility and asked members to let the Scottish Government know if there is anything else that can be done.

Actions

There were no new actions.

Terms of reference

These have been updated with new members.

Minute of the last meeting

There was one update to an outstanding action. 

• action: Scottish Government to circulate list of working groups and workstreams that exist around the NCS work and how they feed into each other. This was completed but members had asked for further information

In response to feedback, a column has been added to the spreadsheet with further detail on each group and a diagram has been issued.

The Chair introduced the Minister

Minister's opening remarks

The Minister thanked everyone for their time and contributions over the past two months and said how much she was looking forward to hearing from everyone and taking questions.

Ms Todd shared that the NCS Bill passed Stage 1 on Thursday 29 February, saying how delighted she is that we are getting closer to having a NCS which will benefit generations to come. This is a chance to make a difference to the social care system and it is crucial for people like members of ELAG to help shape the development of this.

The Minister went on to say that she firmly believes this is Scotland’s chance to make a real difference to the social care system in our country, and discussions and groups like this one are crucially important in ensuring the experience of experts can influence its design.

The development of the National Care Service (Scotland) Bill has already been significantly influenced by a wide range of stakeholders, and, in line with the Health, Social Care and Sport Committee (HSCSC) recommendation to establish a group of this nature, recognised the benefit to supplement the ongoing engagement and to bring specific focus to the process for development of Stage 2 amendments.

The Minister went on to reiterate her commitment to co-designing the details of the National Care Service and how the voice of people accessing health and social care support, and of the workforce, will be embedded in governance structures at both national and local level.

The National Care Service (Scotland) Bill, which will ensure greater transparency in the delivery of community health and social care, improve standards, strengthen the role of the workforce and provide better support for unpaid carers, is the biggest public sector reform since devolution.

People are at the heart of our reforms – ending the inconsistency of care provision across Scotland, ensuring those who need it have access to consistently high-quality care and support, and instilling Fair Work principles for our workforce to ensure they are valued for the work they do.

Striking the right balance between securing national consistency of service quality, while allowing flexibility to design services that reflect local circumstances, is a key priority of mine.

The NCS Bill is a real chance for us to develop a more ethical, human-rights based system that’s designed by the people who use or work within it.

The Scottish Government is working constructively with the Scottish Parliament and it is the Scottish Parliament who set the timetable for the Scottish Government to work to on this Bill.

The full text of amendments the Scottish Government intend to make will be sent to the Health, Social Care and Sport Committee, no later than June 2024.

There will therefore be sufficient time over the summer months for people to provide feedback to the Health, Social Care and Sport Committee when they call for evidence.

Question and answer session

Question

How much is the Scottish Government intending to invest into the implementation of the NCS to ensure it is a successful solution to the issues highlighted in the recommendations of the independent report into Adult Social Care in Scotland, that was led by Mr Derek Feeley in 2021?

Minister’s response

The most recent financial year that we have full figures for spending on social care in Scotland is from 2021 to 2022. In that year, £4.7 billion was spent on social care. There will be some extra costs in future years to make the NCS a reality. We expect costs for the development of the NCS to come to around £345 million over the 10 years from 2022 to 2032.

Investing in the NCS will mean we can make improvements in the areas highlighted in the 2021 report. For example, we must improve the experience of people who receive care and improving national standards and ensuring access to complaints processes is key to this. Supporting unpaid carers to protect their health and wellbeing is also important - this includes young carers. The NCS has the potential to lead to large benefits for people who access or deliver community health, social work or social care support including unpaid carers.

Question

How do we ensure that the third sector – a key provider of both preventative and formal services – is recognised, valued, respected and financially able to play its full part in health and social care? 

Minister’s response

We value the role third sector organisations play in providing social care services and in representing people who access social care support and carers. It is essential that their voice is embedded in our governance structures at both national and local level such as the National Board.

Voluntary and third sector organisations are a significant part of the social care market. In recognition of the essential role they play, the Bill contains provisions to extend the reserved procurement process to third sector organisations that meet the criteria as detailed in the Bill. This extension will only apply to health and social care contracts and the use of the process will be determined locally.

Our policy intent is to recognise the role of third sector organisations by providing for a procurement method which enables contracting authorities to limit the contracting opportunity to them.

This will not be the only route available to service providers and it will be up to local delivery partners to decide which procurement process best meets their population needs.

We have listened to feedback from third sector representatives regarding the criteria and definition used to extend the reserved process. We intend to introduce an amendment to the definitions. We will consult third sector representatives, to ensure the updated definition is fit for purpose and meets our policy intent.

Question

The next question included two points – one around the Verity House Agreement (VHA) and the feelings of those who feel their voices have been sidelined; the second was around how the values and principles of Self Directed Support (SDS) will influence the NCS.

Minister’s response

Ms Todd acknowledged that the values and ethos of SDS, such as human rights and autonomy, need to be built into the NCS. There is variable implementation of SDS throughout the country and this needs national oversight. Ms Todd has heard examples of how SDS has transformed young people’s lives when transitioning to adult services, but more recently has heard of instances where SDS has been used to prop up market failure – where statutory services have been unable to provide care at home and people have been given money to sort this out for themselves. SDS needs to be improved and the principles of it embedded in the NCS.

Regarding the VHA point, Ms Todd highlighted there are a number of ways for disabled organisations to feed into the NCS and gave examples of some groups who have fed in formally.

In terms of the VHA the Minister explained that a year ago we had reached a point where no-one had anything good to say and everyone opposed what had been proposed with regards to the NCS. I recognise and understand that people want ministers to be accountable. In the original proposal only ministers were responsible, but the reality of the situation is that we can’t do it alone and I have to work with various partners. Ministers, local authorities and the NHS have to work together to deliver care for Scotland and that is what that governance agreement gives us.

Question

The next contributor expressed disappointment with the way the NCS is going and wanted to discuss concerns around Anne’s Law. In a rural situation when partners are placed in care homes miles away with no door-to-door public transport, how can elderly spouses visit their partners? There were also additional concerns raised around access to SDS, with the contributor giving a personal example.

Minister’s response

Ms Todd said that officials will pick up the concerns regarding access to SDS. Ms Todd echoed the anger and emotion of the contributor and recognised the concerns related to the rural situation, due to both the constituency she represents and where she lives. It was acknowledged it is a brutal system which removes people from their communities and loved ones in the last years of their lives. Since this was a very personal and individual situation Ms Todd advised that the contributor discuss this with their local representative but said she will raise the broader issue of disabled access to cancer care in NHS Highland.

Question

The next question was in relation to social work and social care and the contributor asked whether, within the NCS, we are talking about all of social care or social work. Also, how can the NCS ensure that lived experience are represented? How can we do better?

Minister’s response

The NCS will ensure everyone is working to national standards. Consistency in education, training and working standards should help with the current variation in provision across the country.

Social care talks about the entirety of support although these are not all covered within the NCS, partly due to variation in delegation across the country. Places where things work well and cohesively tend to be where services are more integrated. Although local government want the decision around services to remain local, it’s difficult to see the argument for some services being left out of the NCS. The scope of what services will be within the NCS is not entirely settled but will be soon.

Question

Will additional costs for improvement fall under the cost of the Bill or social care costs overall?

How will the feedback from this group be implemented in the amendments?  

Minister’s response

Costs for improvement will have to come under wider costs since the Bill can’t mandate for this.

The comments about the feedback from this group have been echoed by most people involved since the beginning. The process of writing legislation has to be done by expert drafters but we are determined to include the voice of lived experience.

Question

The next question was around equitable involvement of people in decision making and the fact that the most vulnerable are the least empowered. In terms of front-line staff, many are unable to join unions due to low pay.

Minister’s response

Only 19% of people working in social care are in a union – increasing unionisation is part of the answer. The status of social care workers is important. A social care nurse feels more isolated and finds it more challenging to find support, compared to a NHS nurse. We need to increase the status of social care, which is a passionate, dedicated workforce committed to transforming lives.

The Chair thanked the Minister for attending and everyone for their questions. The Chair acknowledged this session was an important part of a broader evidence base for why we need to take a co-design approach.

Main meeting

Papers for discussion

The papers for discussion were introduced and key points summarised. The papers set out the proposed changes to Anne’s Law, Children’s services and Justice services. These are based on feedback and insights gathered from people with lived experience and stakeholders during the Stage 1 process.  

Breakout sessions

The Chair invited members to join breakout rooms for more in depth discussions on their chosen topic.

Closing remarks

The Chair thanked the group for their dedication, ongoing contributions, and considerable input over the past few weeks, acknowledging that the meetings have been hugely productive.

Draft amendments with be shared shortly after they have been sent to the Parliamentary committee who requested them. The Committee will then issue a call for written views, which ELAG members will be able to respond to.

The Chair invited questions and comments before closing the meeting.  

There were no questions or further discussion.