National Care Service: questions and answers - engagement sessions

Accountability and the role of Scottish Ministers

Will Scottish Ministers personally ensure needs are met and direct care boards, or will it be civil servants doing this job?

• By establishing a National Care Service, Scottish Ministers will hold ultimate accountability for the provision of social care and will have oversight of the whole system.

Social care in the Highlands is already managed by NHS Highland and therefore under more direct ministerial direction than with Integration Joint Board's. Is there any evidence that social care delivery is better in the highlands?

• In developing the National Care Service we want to make sure that we build on and don't undermine good practice/progress with integration and improving the quality of care for people.
• The co-design approach will help.
• The lead agency model adopted in Highland is not directly comparable to what we are proposing through the National Care Service. Under our proposals, there will be national level support and oversight for the local care boards. The national level part of the National Care Service will produce standards and guidance, help drive improvement at national level, oversee performance locally; establish and maintain a framework for ethical commissioning; implement a complaints and redress system; and support the social work and social care workforce at national level as well as carrying out national level workforce planning. This extra support should lead to social care that is high quality, consistent and fair and meets people's individual needs in their communities.

If ministers are going to oversee care boards, will they be going out into the care sector to shadow different roles in different settings?

• Scottish Ministers frequently visit and engage directly with people accessing care and support and providing care. Such visits will continue as we establish the National Care Service. They are committed to involving people with lived experience in the design and development of the National Care Service.
• The local care boards of the National Care Service will also engage directly with people who use services and provide them. Our vision for the National Care Service is that local care services will be planned on a co-design basis, ensuring that those with the experience of the system are involved in the decision-making to deliver it.

How can we ensure that the National Care Service will be run better than the NHS, which is currently a shambles?

• The years since the Covid pandemic have been immensely challenging for our NHS and social care system, which has continued to deliver services in the face of both increased and pent-up demand, and the impact of multiples waves of Covid infection and hospitalisation.
• Through this unprecedented period, the Scottish Government and NHS staff have worked hard to continue to deliver services and ensure that people can access the care they need.
• Guiding the recovery from the pandemic, the Scottish Government's NHS Recovery plan sets out our plans for health and care over the next five years. Backed by over £1bn of funding, the plan supports inpatient, day case, and outpatient activity and the implementation of sustainable improvements and new models of care.
• We are currently developing our proposals for how the National Care Service will function. Where possible, we are doing that on a co-design basis with people who use services and deliver them, whilst also working closely with delivery partners to draw on their expertise.
• We are taking this approach to make sure that the people with the direct experience of care services are able to have their say and contribute to the design of the National Care Service, so we ensure that the system is designed with their needs in mind.

Who will become the providers of last resort if thing go wrong and services are moved out of local authority control?

• We are co-designing the National Care Service to ensure that there are robust mechanisms in place in case things go wrong. If a voluntary sector or private provider fails, local care boards will be empowered to step in and take over the running of a service, as local authorities can do now.
• The National Care Service Bill provides powers for the Scottish Ministers to intervene in emergency situations or where there is service failure in order to appoint another organisation or public authority to provide that service or to transfer it to another local care board.
• The National Care Service Bill also provides for the Scottish Ministers to apply for an emergency intervention order if they believe that a service provider is not achieving an appropriate standard.

Will Scottish Ministers be able to purchase local authority buildings to continue services? What is the justification for the Bill giving ministers power to remove staff, buildings etc from councils?

• The details of how services will be delivered at local level will be co-designed.
• The National Care Service Bill provides for the transfer of staff and buildings to the National Care Service, should they need to be. Any transition to do that would be undertaken carefully and fairly to minimise the potential for any disruption on those receiving and providing services.
• Local government will be a key partner in this co-design process.

Centralisation hasn't been a success in Police and Fire. Will this centralisation be different and if so, how?

• The aim is not centralisation.
• We are designing a system that will see local care boards, working with people with lived experience, to plan and deliver care services.
• National guidance and frameworks will drive improvement across Scotland so that there are consistent, equitable and fair, high-quality community health and social care services across Scotland that meet people's needs.
• At the national level, this will establish and maintain: a framework for ethical commissioning; implement a complaints and redress system; and support the social work and social care workforce at national level. Their priority will be to work with and support local care boards and ensure that good practice is identified and shared across Scotland in an effective way.
• We intend to co-design and consult extensively with stakeholders on how best to provide an National Care Service that delivers both national consistency and local flexibility.
• Local government is an important partner in delivering social care currently and will remain so as we develop new ways to deliver improved care across the country.