National Care Service Forum 2022: summary report

Summary of discussions

Vision for the National Care Service

There was widespread support from attendees for a National Care Service. There was general agreement that a National Care Service should deliver a consistent service for everyone across Scotland, while allowing for variations to meet the needs of people locally.

Human Rights and Independent Living

There was widespread agreement that human rights should be at the heart of the NCS. This chimes with the Scottish Government's vision of continuing to develop a forward-thinking, inclusive Scotland. Feedback highlighted that this should involve listening to people and enabling people to live the best quality lives possible, as determined by them. This could result in independent living becoming a reality for more people. The new system should be one from which bureaucracy is removed. It should be more agile and responsive (rather than reactive) leading to more efficient decision-making.

Partnerships and collaboration

Building on the work of the Integration Joint Boards, attendees wanted to see the NCS deliver joined up services and strong partnerships that work for everyone and are consistent across Scotland. This should be supported by information-sharing, where workforce and care providers are equally represented, suitably trained and fully supported.

The NCS provides an opportunity for better collaboration between social care services, social care services and the NHS, and for linking up with education, housing, prisons and other services.

Integrated Health and Social Care Record

The NCS and NHS should be two strong pillars of support working together. An integrated health and social care record would mean that people would not have to retell their stories to different parts of the system and would give them confidence that they have been seen, heard and are known to those who are looking after them.

Early Intervention

The NCS should focus on early interventions, which are more effective and less costly than crisis interventions. This should include support for tackling loneliness, including befriending individuals. However lifelong care needs, funding and resource for conditions that are not preventable also need to be taken into account

Eligibility and Assessments

Some attendees suggested that removing eligibility criteria would support a more preventative approach. Any eligibility criteria should be regulated, transparent and consistent across Scotland. Attendees agreed this should also be extended to care at home assessments, with a formalised system put in place.

Workforce development and training

There were calls for national level career development and training for the social care workforce.

Attendees wanted careers in social care to be seen as desirable and structured. It was suggested that engaging young people in schools and highlighting social care as an appealing career option might be a helpful way to bring more talent into the sector. There were also calls to recognise the value of specialist skills in areas such as dementia and autism.

The role of unpaid carers should also be fully recognised and valued and more support and respite should be available.

Current recruitment and staffing issues would need to be tackled and it was recognised that these are often the cause of the current tendency towards crisis intervention.

Funding

Attendees agreed that ensuring the NCS is properly funded is essential and wanted more information about financing and budget for the NCS. There was consensus that NCS finance systems will need to be flexible and agile in order to achieve individualised and personalised care.

There were calls for responsive commissioning and procurement in every local authority, which should be transparent, accountable and coordinated with strategic working at national level to identify solutions. Funding should not be linked to population size or driven by budget management, but instead be driven by people and need.

Attendees agreed that long term investment to the NCS is needed, stressing that funding should not be year to year, but that longer term financial security should be delivered where possible.

How we communicate and listen to people

Communication

There is a need for the Scottish Government to be accessible and inclusive in how it engages with people, understands their expectations and seeks feedback in a way that's suited to the individual. Attendees suggested that the people with the greatest understanding of the support people required are often those with the quietest voice.

Attendees discussed the need for a clear and coordinated approach to communications, recognising that people have varied preferences and accessibility needs. There were also discussions on the importance of regular feedback and engagement, in simple, straightforward language.

Co-design

When thinking about co-design, several attendees flagged that measures should be taken to address the power imbalance when national and local government co-design with people with lived experience. There was a recognition that some people need support in order to design services for themselves and that seldom heard or 'quiet voices' need to be included.

Language is important when we are talking about working in partnership with people with lived experience. Co-design and co-production are often used interchangeably and there has been some confusion expressed about these differences. Co-design and other ways of involving people using services in the design of services mean that the planning of services is done jointly, but this doesn't always lead to involving people using services, families and communities in the delivery of the service, i.e. actually making it happen. It is vital to be clear with people about the difference between co-design and co-production and to set and manage their expectations appropriately.

Creating Communities

Attendees suggested a way to address co-design might be through creating communities of 'common interest' so that people with lived experience can support and learn from each other. There was a suggestion that meetings with people with lived experience in their own communities would enable better access to those 'quiet voices' who are not able to input through events such as the Forum.

There was widespread agreement on the importance of hearing the experience and expertise of people with lived experience of receiving and delivering social care support as part of the process to inform the design of services.

Potential risks or unintended consequences

Managing expectations

While there was widespread agreement about the priorities identified in the consultation, people felt that the NCS should work in stages to ensure the organisation was rolled out effectively and in a way that ensures we can retain trust and confidence. Some attendees felt that negative media reporting and articles circulated had contributed to an atmosphere of mistrust in the proposed new system, along with a fear of change. They felt that this was stopping some people from engaging with the principles, although some of these concerns were alleviated by attending the Forum.

Accessible Communication and Inclusivity

Attendees commented that it was crucial the human rights approach was properly implemented. Others commented that the co-design aspects need careful considering to ensure the Bill does not develop in a 'top down' way. Some concerns were expressed around the availability of funding and the limited time available to co-design the NCS with people.

Some people highlighted the importance of ensuring all voices, including for example those of homeless people and prisoners, were properly represented, in order to ensure the NCS was fully inclusive. It was suggested that to combat the risk of poor communication, accessible communication should be enshrined in legislation.

Impact on current work/need/transitions

There was acknowledgement that the NCS programme had to ensure they had a good grip of current 'on the ground' issues, alongside considering structural changes, to ensure the gap between health and social care doesn't widen. Attendees highlighted that careful consideration needs to be given to the transition of services. It was noted that not including children's services in the NCS from the start could create a harmful divergence between children's and adult services. Potential risks were also flagged around the challenge of sharing data efficiently and effectively between agencies.

Funding

It was not clear to some attendees how current resource issues within the health and social care sector would improve under the NCS. Much work and funding would be required to ensure everyone in the workforce feels valued and properly rewarded for the work they do and have the training they need to deliver for service users. Clarity was needed on employment security, career progression and pensions. Some people felt that transferring staff to the NCS might worsen the existing recruitment gaps.

Timing

Some attendees questioned whether the timing of the NCS posed a risk, at a time when staff, stakeholders and those with lived experience are already exhausted following the pandemic. Linked to this was a risk of consultation fatigue – many organisations do not have capacity to engage fully due to workload pressures, and people with lived experience may not have capacity due to other external factors such as the increasing cost of living.

Variations in Terms and Conditions

Some people felt that there is a missed opportunity in not nationalising social care through the NCS and were concerned that maintaining a system with private and third party providers would mean that addressing things like terms and conditions would be difficult. This was linked to a concern about a 'postcode lottery' for staff, with pay varying between different areas and that this would only be prevented by standardisation, similar to the NHS. More clarity was needed around how employers are to evidence that they are a Fair Work employer.

Local flexibility

There was some uncertainty about whether the NCS would end the current 'postcode lottery' given that local differences in service delivery would continue.

Concerns were also raised about the loss of local decision-making and tailored, local solutions that reflect individual circumstances.

Ensuring preventative support

Another theme which emerged from discussions was around the need for the NCS to pivot more towards a more preventative approach. This would mean sufficient support might be available for non-urgent cases, resulting in reduced spending at crisis stages.

Gaps in the consultation?

Monitoring

Many attendees felt consistent and collaborative commissioning needs extended to both the private and public sector. There needs to be clear expectations around timescales such as in A&E where there are service level agreements in place. A question was raised on how we will demonstrate that NCS milestones have been achieved – how can people map progress and see change happening? Some gaps also identified around allocating resources – what do people need to reach their full potential and live the life they want to live?

Prevention

The theme of a rehabilitative, preventative approach was raised repeatedly. There was a focus around the need for a cultural change in this area. People suggested that service users should have regular opportunities to check in rather than only raising things when they reach crisis stages. It was suggested that a useful piece of research would be to look into the potential savings from applying more resources in the present rather than further down the line, to evidence long-term savings and favour early interventions.

Lifelong and ongoing need

On a similar theme, attendees suggested that resources for low-risk patients are currently lacking and that, at the same time as developing a more preventative approach, we must make sure that those who need ongoing support are not excluded or disadvantaged. To achieve this, there was some support for children's and justice services being included in the NCS from the start and to consider including services such as audiology.

Local Government scrutiny

The need was identified for more clarity around democratic scrutiny and the role of local government, funding and eligibility criteria, which services are to be included within the NCS, and around routes to redress. A 'no wrong door' policy was discussed when accessing social care and making complaints.

Improving Quality

People also wanted more clarity when talking about 'best value', with concerns that it alludes to the cheapest options. People should have the right to help determine what good looks like to them. Clear principles and governance is needed to understand where the balance between cost and quality sits. It was suggested that 'best value' could be rephrased as 'improving quality above costs'.

Language

Attendees also discussed the stigma around the word 'care' itself and suggested more exploration of alternative terminology is needed.

Trauma Informed

Some attendees highlighted the importance of trauma-informed practice as part of the human rights-based approach and that everyone in the NCS should have basic trauma training. This should be explicitly referenced.

Event feedback and reflections

What went well

• A strong programme with representation from a variety of sectors and people with lived experience
• A range of facilitators across the discussion groups, including Social Covenant Steering Group members, ensured that people with lived experience were prioritised in round table discussions
• Mixed discussion groups meant that people heard a range of perspectives which led to thought-provoking conversations
• People appreciated the space to input into discussions and several reported feeling heard in a way they hadn't expected or previously experienced
• Speeches were described as powerful, compelling and demonstrated good understanding of the issues
• The inclusion of people with lived experience including a workforce representative in the panel discussion was welcomed
• A good mix of attendees and a positive atmosphere in the venue – people were genuinely engaged
• The event was relatively accessible to a wide range of people – many attendees appreciated the efforts made on accessibility
• Positive comments received on comfort breaks, refreshments, directions and overall good organisation

What issues were highlighted

Technical

• some people didn't receive the agenda ahead of the event due to individual email address issues
• the online experience could be a more interactive experience and it would be helpful for participants to know in advance how this would work

Administrative

• more time for the panel discussion would be welcomed
• some of the accommodation that was booked for attendees was not as accessible as claimed by providers.

Looking ahead to the NCS Forum 2023

We will consider all feedback from the event and as we look ahead to the next Forum, and, working with members of the Social Covenant Steering Group, we will focus on improving the event in the following areas:

Pre-event

• The SG will publish the programme on our SG website well in advance of the event and in various formats, as well as on our social media channels and share with stakeholders.
• The SG will also email the programme to everyone who has registered to take part, and advise participants to double-check the email they provided when registering to ensure they receive this in advance.
• The SG will encourage pre-Forum questions during a dedicated period of time in the week prior to the event via accessible channels.

Digital and hybrid accessibility

• We recognise the importance of including digital/hybrid options to allow everyone who wishes, to take part.
• We are investigating other platforms that will provide a smoother online experience subject to resource, so that online participants can take part in group discussions.
• We will explore the possibility of holding facilitated break-out groups for online attendees and including their feedback, in real time, alongside that of in-person participants.
• We will also consider more creative and inclusive ways for all participants to feedback - for example the inclusion of both a virtual and real-life comments wall, so that any issues, technical or otherwise, can be dealt with quickly to improve the experiences of the Forum for everyone.

Access to Ministers

Some participants of the Forum noted that they would have liked more time to hear from the panel on their views on issues raised within the group discussions, in particular the Ministers.

They also expressed the importance of having contact with Scottish Government Ministers and officials, and felt the Forum was an ideal opportunity to realise this ambition, either in person or online.

In future Forums, we will give further thought to :

• the optimum amount of time for the panel section of the programme (in addition to Ministers taking part in table discussions)
• a Q&A with Ministers only and whether this should be part of the next Forum programme or a separate event at another time of the year.

Barriers to attendance and location of event

Participants were keen to see events similar to the Forum happening on a smaller scale, on a more local level, throughout the year, to compliment the National Care Service forum annual event. Perth Concert Hall proved to be accessible in many ways for participants, but for some, it was too far to travel and they were unable to attend in person.

• We will work with our stakeholder groups and people with lived experience, to identify suitable venues for events in different geographical areas across Scotland, including linking in with existing stakeholder events, to provide a variety of opportunities to hear people's views on the National Care Service.
• Where possible, we will book train tickets for participants in advance so they are not financially excluded from participating and we will again book and pre-pay for suitable accommodation close to the venue for individuals with lived experience and their personal assistants where required.
• We will work with local stakeholders to identify opportunities to engage with local people, in particular 'seldom heard' groups, to develop useful and accessible ways of reporting progress and listening to hopes and concerns for the National Care Service.
• We will also consider hosting online webinars out-with the business day for those who are unable to access or attend events during that time.
• We will continue to look for ways to make the event as accessible as possible.