National Care Service - National Forum 2023: speeches

Introduction  

Good morning and welcome to our second National Care Service National Forum. It is wonderful to see so many of you here today in person. I know we have quite a lot of people who were here last year, thank you very much for coming back. Thank you for taking the time to travel and join us in Glasgow.  

A big hello as well to the hundreds of people joining us online from across Scotland. We will do our best to ensure the event runs smoothly for everyone, but please do bear with us if we experience any technical difficulties, and please let us know if those are happening.  

Following the introduction of the National Care Service (Scotland) Bill to the Scottish Parliament in June 2022, we held our first National Forum in Perth in October last year. This built on what we learned from the Independent Review of Adult Social Care and kicked off our collective conversation on how community health and social care should be delivered in Scotland.  

In the past 12 months we have deepened these discussions, learning from people with lived and living experience of receiving or delivering community health and social care. That has been a hugely beneficial process, and I will talk a bit more about that later on.  

Since the last forum, we have had a new First Minister and wider Ministerial team. We are lucky to have Ms Todd and Ms Whitham with us today, alongside the other esteemed members of the panel it is great to have such good representation here today. As you know, The First Minister introduced the NCS Bill in his previous post of Cabinet Secretary for Health and Social Care and remains committed to delivering the National Care Service.  

Given the range of views expressed in the past year, we requested an extension to Stage One of the NCS Bill to take further time to consult with the wider public and key partners. That was the right thing to do – it is absolutely crucial that we get this right. 

We have used this extra time to meet with hundreds of people who use and deliver community health and social care. We have had regular conversations with trade unions to ensure workers voices are represented throughout the reforms. 

We have also been meeting regularly with colleagues from COSLA and wider local government. We reached a shared accountability agreement, where Ministers, local authorities and the NHS will share responsibility for delivering community health and social care in Scotland.  

Co-design 

Our biggest piece of work over the last year has been co-design.  

When we talk about co-design, it means working with people with lived and living experience to ensure reforms take account of their experience and better meets their needs. Lorraine and Shea gave a really good illustration of how important that is earlier on. 

This summer we travelled across Scotland to meet with people in their communities, learning about their experiences and what they would like to see from a National Care Service.  

We spoke with more than 600 people from Stranraer to Shetland to understand what is working well across community health and social care just now, and what can be improved. We saw some amazing examples of how care is delivered in different communities.  

At the end of last month we published six reports from our summer of co-design.  

If you haven’t had a chance to look at them yet, I would really encourage you to read them. They are available to read online.  

The reports show the real need for change that we are proposing. Although many of the issues highlighted may not be new, people are saying it feels different and like a real opportunity to make the changes that are needed. Also as a collective we are listening to each other and empowering each other to make the change.  

This need for change has only deepened in recent years, particularly in the new fiscal environment we are all working in and the pressures on people as well as public services.  

The reports reaffirm our commitment to delivering improvements which meet the needs of everyone in Scotland. 

We have identified groups and communities we know we need to get better at engaging with. We have some plans for that, we will hold dedicated co-design sessions with a range of additional communities to ensure their voices are heard and listened to whilst we develop the NCS. There are lots of people in this room who will contribute to that, we know we do not have the monopoly on the knowledge. We would like you to tell us if there are groups of people who you think we need to engage with. We want to be inclusive of everyone. We will work with our third sector colleagues who we have funded for this work to ensure these experiences are incorporated into plans. Again, we want to hear from people if you think there is more that we could be doing.  

The learnings from this summer has informed the programme for today, so we can further deepen understanding and use this to develop the National Care Service.  

It’s important to say that Co-design will continue on an ongoing basis. This is not going to be a time limited exercise. This is a different way of working and will inform proposals and plans as the NCS develops. At a national level, we are hearing a lot of but we are keen to see how this is embedded at a local level. Work just now is focussed on making sure that the framework design of the NCS and the corresponding legislation is fit for the future. We need to make sure that we have the right foundations in place, while at the same time, the flexibility to adapt as we need to. But this is just the start and people must continue to be involved in shaping the support and services they need.  

Progress 

We have made significant progress over the last year, developing plans for national oversight, whilst also retaining local flexibility. 

Our shared accountability agreement with local government and the NHS is a significant milestone from the last year to ensure we agree a way forward on what national accountability with local delivery will look like.  

We have already agreed we will have a National Board to ensure consistent, fair, human rights-based social care support and community health services.  

This will be underpinned by clear national standards, improved data and planning, a framework to support improvement where it is needed, effective complaints mechanisms and advocacy services. At the same time, it will support communities in order to maximise the benefits of reformed local delivery of services.  

We will continue to develop what our shared accountability agreement will look like in practice, and I look forward to hearing your ideas on that today.  

We have also made significant progress with the Charter of Rights and Responsibilities. We have developed a draft Charter which people across Scotland have given feedback on during our co-design sessions this summer.  

One of the key aspects of the Charter is that it will set out the rights and responsibilities of people accessing NCS support. It will also provide channels to help them raise issues if rights are not met.  

One piece of work I would really like to highlight is the work we are doing to embed Getting It Right For Everyone, also known as GIRFE, across the National Care Service development. GIRFE is a multi-agency approach of support and services from young adulthood to end of life care and is loosely based on the Getting It Right For Every Child model. We have eleven pathfinders across the country just now which is testing that approach.  

We have also made significant progress on plans for the proposed National Social Work Agency.  

Through the agency we are aiming to improve the quality and consistency of support for people across our communities and invest in our workforce.  

We have heard from social workers and people who receive support on what the Agency needs to address including social work education, workforce planning, standards and improvement. We envisage an agency, built on partnership, that will create a national vision for social work and lead the social work profession in Scotland. 

We have also commissioned the Centre for Excellence for Children’s Care and Protection (CELCIS) to carry out independent research on whether children’s services should be included in the National Care Service.  

Three reports have already been produced from this research and are giving us a good idea of how we can ensure children and young adults get the help they need, when they need it.  

We have also worked very hard to ensure Fair Work principles will be embedded across the National Care Service and have progressed several workstreams over the last year to ensure this happens in partnership with workers and stakeholders.  

These are just some of the areas we have made progress in over the last year as we have moved forward with plans for a National Care Service.  

Next steps 

As I look ahead to the next 12 months and beyond, there is still lots to do.  

Some of this is really difficult and really hard as it is a massive change, and I think our collective approach is really important. As I mentioned previously, we know there are still gaps in our work to date, namely hearing from the voices of those who are often seldom heard in our community. There are other areas where we have identified gaps but again I would encourage everyone in the room to tell us if you think we are not engaging with certain people.  

Only by hearing from everyone, can we develop the reforms needed to improve everyone’s experience of community health and social care.  

We will continue our collaborative working with key partners and stakeholders, testing our thinking and reforms to make sure they are fully fit for purpose.  

We are using all of this learning to design a National Care Service that meets everyone’s needs and will continue to do so. This is not just about today, this is a legacy question for all of us. How we want community health and social care to be in Scotland for future generations.  

Thank you again for your continued investment into this reform, I am excited to see what we will achieve over the next year and beyond. I look forward to hearing from you all today on what the National Care Service should become.  

I am now delighted to welcome our panellists and will hand back to Lorraine who is going to lead the discussion.