National Care Service Forum 2023: report

Next steps for the NCS

Making improvements to social care support now

We have been examining the findings from co-design activity that has taken place over 2023. We will use them to help us meet our commitment to improving community health and social care.

This means delivering a NCS that works for everyone who needs it. In the meantime, we are working on improving the system as it is right now. This includes improvements for the workforce.

Here’s an update on how the findings have helped us develop our work and how they are supporting our plans for 2024.

We have continued to progress several key projects to improve Fair Work principles. These will lead to better terms and conditions and more rewarding roles for the adult social care workforce. This will improve the experience of the current workforce and help to attract and retain new staff.

Increased funding and pay

When compared to 2021-2022, funding for social care support has increased by over £1 billion in 2024-25, delivering on our Programme for Government commitment to increase social care support spending by 25% over this Parliament two years ahead of our original target.

The 2024-25 budget provides an additional £230 million to support delivery of the pay uplift to a minimum of £12 per hour for adult social care workers delivering direct care in the third, private and independent sectors from April 2024. This represents a 10.1% increase for all eligible workers.

Recruitment and staff development

We are working with the Scottish Social Services Council (SSSC) and other partners to promote career opportunities, upskill and develop the workforce. Our aim is to address recruitment and retention issues. We also want to attract new people to the sector to ensure the sustainability of services in the future.

We are working with the Department of Work and Pensions (DWP) to achieve this. We are helping their work coaches to support people who may have previously received social care support into careers in adult social care. This includes:

• developing materials to help identify appropriate candidates and showcasing career pathways in social care
• supporting large-scale sector-specific recruitment events
• promoting their Care+ Academy, which supports local employers to recruit by reducing some of the recruitment and onboarding burdens

To support international recruitment efforts, we have worked with NHS Education for Scotland (NES) and COSLA to create the NES Centre for Workforce Supply: Social Care. We launched a pilot project in summer 2023 to:

• gather information on how we can best support providers and the workforce through the visa sponsorship process
• develop supporting materials to be shared across Scotland

To increase sustainability in the workforce, we have been working with partners and using our marketing campaign to engage with more young people and showcase opportunities in the sector to them. This includes delivering a careers event with Developing the Young Workforce Forth Valley and supporting ongoing work with The Prince’s Trust.

Effective Voice Project

Effective Voice is a way for the workforce to have access to a safe environment where dialogue and challenge are dealt with constructively. It means employee views are sought out, listened to and can make a difference in a meaningful way. Examples of Effective Voice mechanisms include regular one-to-ones, staff forums, and an openness in workplaces to allow Trade Union access.

We have been working with sector stakeholders to embed the principles of Effective Voice in social care. This will help promote fair working conditions, develop best practice, and help deliver high quality care through listening to the views of the workforce.

The Effective Voice Framework has been developed alongside key Social Care stakeholder organisations. It has also been informed by the lived experience of social care staff. The Framework will support employers and employees to assess the standard of Effective Voice in their workplace and take steps to improve it, if needed.

The first phase of Effective Voice delivery is due to launch in early 2024 and is expected to last 12-18 months. It will test the Effective Voice Framework with a representative sample of Social Care Providers.

An independent project delivery lead, based in Inspiring Scotland, has been in post since late April 2023. Work in 2023 included:

• engaging with potential participant providers
• developing the evaluation of the project with the University of Strathclyde
• developing tools to support providers to improve Effective Voice within their organisation

The findings of this work will inform a future national rollout of Effective Voice policy. This will make resources and guidance available to the entire sector.

The National Improvement Steering Group and The National Improvement Framework

IRASC and Joint Statement of Intent

One of the recommendations from the Independent Review of Adult Social Care (IRASC), was to create a new approach to improving outcomes. The Joint Statement of Intent 2022 to 2023 also sets out joint commitments by the Scottish Government and COSLA to improve the social care support system.

The National Improvement Steering Group was set up in October 2022. It has members from across the social care support and community health sectors. It is jointly chaired by COSLA, SOLACE and the Scottish Government.

The steering group is overseeing the development of a National Improvement Framework. The framework is being developed collaboratively. The Scottish Government has led some but not all of this work.

The Framework will provide focus and structure for efforts to make improvements within the sector. It will give flexibility for local areas to plan how to deliver and will be used at a national level to track progress.

Independent Review of Inspection, Scrutiny and Regulation of Social Care in Scotland (IRISR)

The Independent Review of Inspection, Scrutiny, and Regulation of Social Care in Scotland (IRISR) resulted in the IRISR recommendation report. This was published on 27 September 2023. Work is continuing to consider the 38 recommendations within it.

The Minister for Social Care, Mental Wellbeing and Sport will provide a published response in due course.

Any future changes to inspection, scrutiny, and regulation will be subject to consultation and will be done in partnership with the sector.

NCS Board

There will be a NCS Board to operate and manage shared accountability for NCS services.

Aims

The NCS Board will ensure there are consistent, fair, and human rights-based social care support and community health services in place.

The board will deliver improvements across the system. It will do this by supporting joint leadership and greater collaboration between partners. It will also seek to improve quality and consistency of services. It will also ensure services are sustainable and person-centred by undertaking new functions at a national level.

It will support communities in order to maximise the benefits of reformed local delivery of services.

It will have an effective complaints and advocacy service for people. The voice of people accessing health and social care support and of the workforce will be embedded in governance structures. This will apply at both national and local level.

Membership

Board membership will be informed by co-design. However, we expect the board to include representatives from:

• Scottish Government and local government
• NHS Board
• people who access community health and social care support
• the workforce and unpaid carers

We value the role third sector organisations play in providing services and in representing people. Their voice will be embedded in our governance structures at both national and local level.

Scope

We propose that that the board will:

• set national strategic direction
• develop standards, guidance and operating frameworks
• oversee and seek delivery assurance on local strategic plans and ethical commissioning strategies
• monitor system performance
• maintain a support and improvement framework which will aim to provide support to local areas when monitoring indicates that standards are not being met with powers of intervention, when required, as a last resort
• ensure visibility of data, information, and analysis about social care support, social work and primary and community health services through reporting on delivery
• carry out national commissioning and procurement by agreement for complex and specialist social care services, which will include prison social care
• seek assurance on public protection arrangements
• provide support to local delivery partners

NCS Board co-design

The co-design work on the NCS Board began at the end of 2023. We shared our proposal for future co-design engagement with our stakeholders for review and feedback. This has refined our approach and we will continue with engagements with Lived Experience Experts Panel (LEEP) members and Stakeholder Register members. We will then begin a series of co-design activities, starting in spring 2024 and running through to autumn.

We will co-design the detail of how the board will operate. This will include how it will secure and support meaningful representation from those with lived experience. Groups involved in this co-design will include:

• people with lived experience of accessing community health
• social work and social care support services
• unpaid carers
• care providers
• workforce and organisational stakeholders

Co-design work since summer 2023

Co-design themes

Co-design work has continued to focus on the five current design themes of the NCS Programme.

These themes offer a useful focus but still allow for broad discussion during co-design activities.

We will keep the current themes under review, with the option of introducing more themes if needed, or adjusting the focus.

We review insights from co-design sessions and then use them to build a knowledge bank of co-design feedback. This allows us to easily access the feedback we're getting from a range of communities and individuals.

Working with seldom heard voices

The summer forums of 2023 and the NCS National Forum offered a way for members of the public to get involved in co-designing the National Care Service. However, we know that we must continue to do more to engage a diversity of views and experiences. To support this, we have been working closely with organisations who have close ties to communities who have had less opportunity to engage in the co-design work to date. We are referring to this as work with ‘seldom heard voices’ groups. It will continue into Spring 2024.

The communities we are engaging with in this phase of work are:

• people with experience of justice social work
• people with experience of homelessness
• the LGBT community
• the Gypsy/Traveller community
• people with experience of (or providing support to people with) dementia
• people with a disability

In 2024, we plan to broaden this out to also include:

• people with a learning disability
• children and families
• black and ethnic minority communities

This more targeted work will remain under review in terms of which groups we engage with.

We have a budget of up to £50,000 for this work. We already have grant funding arrangements in place with several organisations to create opportunities for the communities they represent to get involved in co-design. The main focus of the work is around the themes of ‘information sharing’ and ‘making sure your voice is heard’.

These seldom heard organisations will provide reports as part of the grant funding. We will share these reports later in the spring.

Workforce Charter co-design

The 'Valuing the workforce' team ran a series of co-design sessions over November and December 2023 to inform the development of a Workforce Charter. These sessions included internal Scottish Government stakeholders, professional advisors and members of the workforce. To recruit for these sessions we used LEEP and we also selected organisations directly.

The goal of the sessions was to understand the need and purpose of a Workforce Charter and to gain feedback on a draft. The Workforce Charter draft is currently being developed and sense checked against the findings from these sessions.