National Care Service: statement of benefits

Annex: How social care currently works

Social care support is delivered by a wide range of partners. This includes organisations in public, private and third sectors. Social care is provided in people's homes, including through remote care and technology-enabled care, in residential accommodation and care homes or the wider community, and involves much advice and support services.

Currently, local authorities are responsible for social work and social care support, and local health boards are responsible for health services. They work together as integration authorities to assess the needs of their area and plan and commission local community-based health and social care services, using funding contributed by the local authority and health board. These are complex arrangements and mean it can be unclear for people to know where to go when they need support. The services people receive can also vary across the country.

Health and social care partnerships (HSCPs) in each local area are responsible for delivering local community-based health and social care services on behalf of the integration authority, including adult social work and adult social care support, primary care and community health services for adults. Some local areas also have responsibility for children's health, children and families social work and social care, justice social work, and homelessness and housing support.

The IRASC identified problems with this. As a joint organisation between the local authority and the health board, HSCPs do not employ staff. Their budgets are agreed upon and allocated by the NHS Board and the local authority rather than through direct funding. The Chief Officer is accountable to both bodies. These complex arrangements have not always resulted in the quality and well-integrated service that was intended, although it is recognised that success rates vary across Scotland.

For example, the implementation of the duties of the Social Care (Self-directed Support) (Scotland) Act 2013, which came into force in 2014, shows variation across Scotland. The Act places a duty on local authorities to offer people how much control they want over their support and the budget. Since the Act came in, there have been several reviews of Self Directed Support (SDS), including by Audit Scotland and the Care Inspectorate, which have highlighted inconsistencies in SDS implementation across Scotland. These include:

• Inconsistency of Interpretation and Implementation – Variation in the level of use of the four different options across the country. Variation too in usage across other service user groups.
• Information and Advice – There is an inconsistency of advice and information, leading to a lack of understanding and confidence for service users.
• Workforce – The workforce can feel conflicted between focusing on outcome-based assessment and care planning based on what matters to the individual and the existing eligibility criteria.