National Care Service Forum 2022: ministerial speeches

The importance of ongoing communication with those who have lived and living experience of services and how this will help to shape the future National Care Service - Kevin Stewart, Social Care Minister.

Agenda theme: The NCS – what’s all this about then?

Introduction

Can I welcome all of the delegates here today and all of those watching on the webinar at home. We’ll do everything we can to ensure that the event runs smoothly. This is certainly a very ambitious hybrid event, the most ambitious hybrid one that I’ve been to so far. Please do bear with us if there are any technical issues.

I am absolutely delighted to be here today at the first National Care Service Forum. From the day I took up the role as Minister for Mental Wellbeing and Social Care I have been clear that the loudest voice on the future should come from those with living experience.  It is vital that we encourage that voice throughout the design stages of NCS.

The agenda today has been designed in a way that supports us to continue to have an honest conversation about the future.  I am incredibly grateful for all of the contributions and support that you have offered to date.  Three thousand of you joined last autumn’s consultation conversations and events.  And we received 1300 written responses to the consultation. 

I want to say thank you to all of you for all of that.  It has provided a huge evidence base.  However that was just the start. Now we must continue that level of dialogue over the next few years to ensure that we get all of this right for people. 

What is the National Care Service?

The establishment of the National Care Service will be the most ambitious reform of public services since the creation of the National Health Service.

The National Care Service as proposed in the Bill will bring together social work, social care and community health to strengthen health and social care integration for adult services.  By the end of this Parliament accountability for adult social work and care support will transfer from local government to Scottish Ministers.

A decision has not yet been taken on whether children’s services or justice social work will be included in the scope of the National Care Service. The Scottish Government are establishing a programme of gathering evidence and undertaking research to inform these future decisions.

However the aim is to ensure consistent, fair and high quality care for everyone in Scotland reducing the current variations across Scotland that many people have raised over recent years.

This is not about nationalisation of services. The Bill sets out that at a National level the functions are focused on consistency through national oversight.  Services will continue to be designed and delivered locally. That is right to support delivery with and for our communities and the people they serve.

National oversight will allow for better sharing of good practice and innovation, which we know is taking place across the country.

These changes will bring forward new power sharing arrangements at a national and local level. Delivering a mix of the clarity people want about ultimate accountability and crucially the flexibility to meet local needs - such as those of our island communities.

Change of this scale is necessary to deliver the consistency and quality of care and support across Scotland that people deserve.  It reinforces our wider commitment as a Government to take long term action to change our society and make it a fairer and more equal place to live.

The sooner we start, the sooner we will be able to deliver better support for everyone – and demand for these services will only increase in the future.

A service with human rights at its’ heart

Our ambition for the National Care Service is to establish a social care system that empowers people to thrive. Not one that just enables them to survive.

The principles of any new system should have people at its’ very heart, with human rights at the very centre of social care.

This means that the NCS will be delivered in a way that respects, protects and fulfils the human rights of people accessing care support and also their carers.  

We will work with you in the months ahead to develop a National Care Service Charter of Rights and Responsibilities to set all of this out.

Workforce

Our workforce is the lifeblood of care.

The National Care Service could not exist without the dedication and commitment of those who deliver services.   A key objective for the new body will be supporting and valuing our unique workforce.

By rewarding and valuing the workforce fairly, we deliver the best possible service for the people of our country. We will make the sector fit for the future and more attractive to people coming into the profession.

Why?

I want to take a bit of time this morning to reflect on why change of this scale is necessary.  Scotland’s community health and social care system has seen significant incremental change over the last 20 years.  Despite this people with experience of receiving care support and providing it have been clear that there remains some significant issues.

These were detailed in the 2021 Independent Review of Adult Social Care Services which set out a compelling care for change.  Including recommending reform of social care in Scotland and strengthening national accountability. And I am aware that many in this room will have contributed to that review. 

Why now?

We are not just changing to address the challenges of today.  We must ensure that we build a public service that’s fit for tomorrow. Today at least two hundred and thirty two thousand (232,000), or 1 in 25, people receive social care, social work and occupational health support in Scotland.

This demand is only going to grow. Recent (NRS) projections suggest that the number of people aged 65 and over will grow by nearly a third by mid-2045 to make up around a quarter of the Scottish population.

Whilst age is only one driver for social care demand, we need to recognise that the changing demographics of this scale will increase the pressures on an already fragile system. 

The population receiving social work and social care and support is diverse, with wide ranging needs and circumstances.

Data also shows us that the relationships between health and social care need are many, varied and often very complex. Many people need to access and transition between services – and often access multiple services at the same time – from across the health and social care spectrum.

In order to help this, we have committed to the introduction of a national integrated health and care record to ensure people only have to tell their story once and their information follows them throughout their social care journey.

To best serve people, the National Care Service must be able to influence the delivery of community health and social care together at a local level.

Together we must build a system that is sustainable, future-proofed and ready to respond to the needs of a changing population.

The importance of co-design

The Bill sets out the framework for change. The detail relies on us all, all of us here today and beyond to work together. 

We need to grasp the opportunity to deliver public service improvement together.  To ensure that we are getting the detail right for everyone.  And as a chance to include as many people across society in a conversation about their needs.

Such an approach requires trust and confidence, in each other and the process.  At this stage we all face the same level of uncertainty about the end project.  Let’s use the unique opportunity that we have today to start building all of that.

I have been honoured to have chaired the Social Covenant Steering Group over the last 12 months. They will be critical in holding us to account on the priority of the voices of lived experience as part of the design phase.  That they are heard, understood and listened to is extremely important.

Angela Constance will be on this stage later this morning to set out the scale of this partnership opportunity for us all.

Closing Remarks

I want to finish with some personal reflections on some of the experiences that I have heard to date. Examples that have, that I’ve heard that continue to give me the drive and the determination to deliver the change that is so necessary.

Tommy Whitelaw is someone who you will all know, I’m sure. He was a full- time carer for his mum who was diagnosed with vascular dementia, until she sadly passed away in September 2012.

Tommy’s experience of dementia and caring for his mum brought many struggles and of course moments of joy, love and inspiration.

The following is Tommy’s own words,

“My mum inspired me many times and amazingly at the most crucial moments when I was really struggling to cope and understand. My wee mum was facing all that dementia brought and over the last months nearing the end of her life, she was always able to comfort her son and get him through it.

“All too often on our journey we were lost, lonely and isolated but looking back my heart can sometimes smile and it this is thanks to the kindness of the special people that we dealt with.

“Like the District Nurse who put her arm around me one day when I was in tears and said “You’re doing ok Tom you’re doing OK ”. I can’t tell you how much I needed someone to do that as I was scared of what was happening and scared of letting my mum down.

“I absolutely believe that as a carer if I was propped up a little bit with the right help and support, I could have given my Mum the best care and support in the world.”

Marion Mcardle also shared her and her daughter’s story.

I’d like to read you Marion’s words:

“Since my daughter Laura began receiving Self Directed Support her life has transformed to a life where she has choice and control.

“Every day is about what Laura wants or needs to do. Her day is built around her needs and not the needs of a service. This has allowed her to become a happier and much healthier person. Her support is focused entirely on her and that ensures we can’t get it wrong. Despite Laura’s profound learning disabilities and complex health needs, she hardly ever needs to see a doctor and social services are hardly ever involved.

“If by getting it right for someone who has so many complex health and social care needs, means cost savings then surely there will be cost savings when we get it right for everyone?  

“Before getting Self Directed Support Laura’s day had to fit around the needs of services, timetables, staffing issues, transport issues etc. With all good intentions the bigger services or settings just couldn’t be as person centred as having her own wee team of support which have been handpicked by us to suit Laura best.”

The journey that we are embarking on and forming a National Care Service is all about people. It is about people like Tommy and his mum, it is about people like Marion and Laura. It is about people like you in this room today. And getting it right for people is what we aspire to do. You are the folk who can help us do that as we move forward. I hope that you get a lot out of today and I hope that you will tell us exactly what you think because that is what we need to do. I will continue to listen as we travel on this journey together. Thank you all very much.