National Care Service: island communities impact assessment

Consultation

The NCS consultation ran from 9 August to 2 November 2021 and received almost 1,300 responses. 54% of responses were from individuals and 45% were from organisations. These responses included 298 detailed responses that did not follow the structure of the consultation, most of which were in a report style. Over 100 engagement events and meetings were also held, in which around 3,000 people participated. The consultation contained 96 questions, split into chapters covering improving care, the National Care Service, the scope of the National Care Service, reforms to Integration Joint Boards, commissioning of services, regulation, and valuing people who work in social care.

An Easy Read version of the consultation was also produced. The Easy Read version contained 24 questions based on the full version of the consultation and covering all chapters. Additional Easy Read material to explain key concepts of the NCS was also produced to assist people to understand the proposals. 50 Easy Read responses were received.

The consultation engagement events included 3 public engagement sessions aimed specifically at island communities and 2 meetings with local authorities that encompass island communities. Since the close of the consultation, engagement with stakeholders has continued. Further engagement has included meetings with the Island Assessment Impact Group, which was formed to specifically consider the impact on islands, and engagement with the National Islands Delivery Plan Group and the Islands Strategic Group. This further engagement will continue as policy is developed on the basis of the powers introduced by the Bill.

The analysis of the NCS consultation was undertaken by an independent contractor and published on 10 February. The analysis report discussed key themes and opinions expressed in the consultation responses alongside numerical analysis of the closed questions. Where applicable, it highlighted differences in views between different kinds of respondent. It also included quotes to illustrate the spread of views received. The analysis of the consultation responses found broad agreements with the proposals for the NCS and also highlighted a number of island-specific concerns that had been raised.

Concerns which were specific to island communities included:

• the general need for flexibility to account for specific island and rural communities when developing a national approach to social care;
• barriers to accessing social care for island communities such as transport limitations and small and dispersed populations;
• barriers to portability of care packages between urban and rural/island areas;
• barriers to social worker and social care recruitment due to working age population decline and the need to attract workers to the islands;
• potential disruption to existing mature integration arrangements that have developed to account for island settings;
• economic and demographic constraints on establishing new public bodies due to small size of island communities;
• impact of any disruption on local authority provision of social care due to local authorities delivering a far greater share of social care on islands compared to mainland Scotland; and
• ensuring funding models for social care accurately reflect additional costs associated with delivery on islands.

During discussions at the Island Assessment Impact Group between November '21 and April '22 the above themes were explored further with attendees. This resulted in the following additional island specific considerations:

1. Increasing the numbers of public authorities or agencies will add to already cluttered governance landscape.

2. Distinctive challenges in relation to the availability of workforce for any new local care boards, as well as the social work and social care workforce more generally.

3. Housing availability is an issue in remote areas which exacerbates workface pressures.

4. Enhanced sense of local democratic accountability in island communities which is considered a strong feature of current system.

As the Bill sets out the groundwork on which the NCS will be established, the above issues are not addressed in full. Further development is being undertaken on the basis of the powers introduced by the bill and it is through that process that these issues will be addressed in detail. For the purpose of the bill, officials have ensured that it contains the flexibility necessary to address the above issue as the details of the NCS and its policies are developed.

A separate public consultation was held on Anne's Law. It sought views on the Scottish Government's proposals to ensure that people who live in adult care homes have rights to see and spend time with the people who are important to them. The consultation was in two parts. Part 1, on strengthening the Health and Social Care Standards, was launched on 16 September and closed on 2 November 2021. This was followed by a consultation on delivering Anne's Law itself which launched on 24 September and closed on 5 November 2021. Part 1 received 157 responses and part 2 received 284 responses. There were also 8 events held in September and October 2021.

There was virtually unanimous support for the overall aim of both parts of the Anne's Law consultation, i.e. that people living in adult care homes should have the right to see and spend time with those who are important to them to support their health and wellbeing. Updated Health and Social Care Standards were published on 31 March 2022.