National Care Service summer forums: supplementary report

Follow up events

Information sharing to improve social care support

We held an additional event in Edinburgh.

This event had a particular focus on the workforce.

At this session, several themes were discussed around information sharing for the workforce. These were:

• accessibility of information
• barriers to information sharing
• pressures on delivery of social care support

Discussions about the accessibility of information sharing for the workforce helped us understand that participants felt:

• the quality and accessibility of information sharing can impact on how social care support staff's performance is reviewed or judged, such as during an investigation
• the processes to capture and record information are not always accessible to all staff
• an Integrated Record needs to enable an efficient, practical, and secure way for relevant staff to update information
• information that is available about supported people is not always in an accessible format for frontline staff
• an Integrated Record needs to consider how information is displayed and presented. This would ensure social care support staff could access and understand what they need regardless of their profession, location, or the device they are using

Discussions about the barriers to information sharing for the workforce helped us understand that participants felt:

• there are too many people involved at different points in providing social care support, and therefore the information sharing chain is also long
• face-to-face information sharing and communication still play an important role in care and support services, both for communicating with supported people and between care and support staff
• it is important that the Integrated Record also supports face-to-face information sharing and provides a non-digital route to recording and reviewing information
• social care is a 7-day, 24-hour job but other health, social care and social work support professions do not always operate out of hours. This can make information sharing between professionals challenging during out of hours, especially in an emergency

Discussions about the pressure on delivery of social care support helped us understand that participants felt:

• staffing issues affect the quality of support delivered, and the continuity of social care support is not always achievable because of the pressure on the workforce. This can lead to information being missed as staff rush through their routines and procedures to get to their next supported person
• the struggles of staff on the frontline are not always well understood by management which adds to their feeling of being undervalued and fear that increasing information sharing can mean taking on additional work
• the system of social care support itself is not sufficient for supporting the number of people needing support
• staff have little time to complete all their tasks for the people they support, including information sharing, and communication with other professionals such as social work is also taking much longer due to their lack of availability
• social care support practices and processes have changed over the years and not always for the better. This can mean that staff now have less time to gather and record information from the people they support and that additional assessments are now needed for people to access support. This can also mean that new staff are given much less time for induction and training before they start their job

Making sure your voice is heard

We held an additional in-person event in Hawick and two online events.

We worked with Partners for Integration and Scottish Care to raise awareness of the event in Hawick. There were participants representing the workforce from each of the sectors, unpaid carers and people accessing services.

One of the online events mostly involved representatives from the workforce, including local authority social workers. The other was attended by carers.

At the sessions, we spoke about these topics:

• complaints and redress
• independent advocacy
• eligibility criteria
• support planning

Discussions around complaints and redress helped us understand that participants felt:

• strongly about the importance of people being supported to provide feedback and make a complaint – particularly those who may be, or feel, less able to do so
• more could be done to record and recognise positive feedback from people who are accessing services. This was reflected strongly in feedback from those delivering social care support
• good conversations and building trust are key when responding to complaints, instead of giving people generic answers or 'reading from a script'
• it would be better to have dedicated complaints-handling staff to be more independent and reduce the time pressure on those delivering social care support
• it is important to be realistic and manage people's expectations about what outcomes might be possible from their complaint
• people want to be told what will happen as a result of their complaint and how this will inform improvement within services
• that services need to be more accessible for people living in rural communities. This includes the ability to access services where transport options are limited

Discussions about independent advocacy helped us understand that participants felt:

• it would be helpful to raise awareness of and provide information about independent advocacy earlier to enable people to access services before they reach crisis point
• there is concern some social care professionals are reluctant to involve independent advocates. Some feel professionals could have better awareness of independent advocacy services and would like them to actively connect people to support earlier if that is what they want
• some people feel the focus on independent advocacy in the National Care Service Bill is too narrow and other types of advocacy and brokerage services should be considered
• it is important to have agreed standards in place, particularly as people think that not all advocacy services are of good quality
• there are gaps in independent advocacy service provision for children in some areas. People feel there is a lack of information and awareness of support available within schools and among parents, guardians or carers
• people want a clear and consistent definition of independent advocacy using plain English so it is understood by everyone

Discussions about eligibility criteria helped us understand that participants felt:

• people either do not understand what eligibility criteria mean or they had to ask lots of questions of professionals before they understood
• it should be up to social workers to explain what eligibility criteria mean and help them understand it, rather than people having to find out for themselves.

Discussions around support planning helped us understand that participants felt:

• there can be a lack of information and communication provided about the support planning process and the decisions made about a person's social care support. This includes limited access to care reports and plans
• more and better communication would also help some people to feel like they have a better relationship with their social worker
• unpaid carers found it difficult to be heard during the assessment and support planning process. They said they felt they were excluded from the process or that their own experiences and opinions were overlooked if they conflict with the experience of the person being assessed

Valuing the workforce

We held additional events in Edinburgh and online. These sessions included:

• an in-person session with people with lived experience of delivering community health and social care support
• an in-person session with trade unions members with lived experience of delivering social care support
• two online sessions with people who have lived experience of delivering community health and social care support

At the sessions, we spoke about these topics:

• training for skills and development
• integration of services
• trust
• career pathways
• communications

Discussions around training for skills and development helped us understand that participants felt there is a need for more entry level training for those new to the social care workforce.

Discussions around integration of services for effective multi-agency and multi-team working helped us understand that participants felt:

• there are limitations on the training received by people employed by private sector agencies, which limits their ability to provide social care support to their full ability
• there is a need for increased understanding and knowledge of social care roles and responsibilities across health and social care. This would support collaboration of support for people accessing social care support
• it is important to have integration of services between adult and children services. Disjointed services make it challenging for those providing and receiving social care support

Discussions around trust helped us understand that participants felt:

• the workforce needs to know they are trusted to do the right thing when being inspected
• there needs to be at least minimum staffing levels to provide a sense of safety and wellbeing

Discussions around career, profession and career pathways helped us understand that participants felt:

• there is need to consider how apprenticeship opportunities can support people through recognised qualifications whilst supporting recruitment pressures

• the social care workforce should have routes for career progression in order to specialise in certain areas of their discipline. They value having the option to choose if they want to progress in their career as specialists or as people managers

Discussions around communication for setting and managing expectations helped us understand that participants felt:

• there needs to be better communication with people accessing and receiving social care support in relation to the NCS to help them understand what social care does and what the workforce can or cannot do. This will help the workforce feel valued for the work they do and the effort they put in supporting people
• it is important for the workforce to help people receiving social care support to understand their rights. For example, clearly understanding what help they can access, and how they can access social care support

Realising rights and responsibilities

We held an additional event in Hawick.

This event had a particular focus on the NCS Charter of Rights and Responsibilities ('the Charter'). We asked people at the event to provide feedback on the draft Charter. We worked with Partners for Integration and Scottish Care to raise awareness of this event. There were participants representing the workforce from each of the sectors, unpaid carers and people who access services.

Discussions around the Charter helped us understand that participants felt:

• positive about the rights in the Charter and welcome the focus on rights, equality, support networks, involvement, and choice
• worried that the rights in the Charter are not deliverable and would be disappointed if the NCS did not meet the expectations set out in the Charter
• the draft Charter may be too focussed on adult social care support and in particular residential care. People made suggestions for how the Charter could make it clear that it applies across a broader range of services
• they needed more information on what we mean by 'support networks' in the Charter and more information on how they can support decision making
• they wanted more information on the health and social care standards in the Charter and suggested that the Charter provides a link for those that might want further information on them
• they did not like that the Charter said the NCS would 'respond quickly' to complaints and suggested that we include timelines for when people should expect to get a response to their complaint

Keeping care support local

We held an additional event in Aberdeen.

This event had a particular focus on the workforce and people accessing services.

At this session, people reinforced the findings from the other summer events. Discussions helped us further understand that participants felt:

• more inclusive communication is needed. We heard that easy read should be used more widely and proactively, and that all communication should be in plain English
• information should be shared more effectively between workers, and between workers and supported people
• they wanted choice and control when receiving services. We heard that the same self-directed support options should be available nationally, but weren't right for everyone
• the services available to people should not depend on where they lived
• the system must be flexible and enable services to adapt to local needs
• transitions between local authorities, even for relatively short hospital stays, can disrupt care packages
• more voices need to be heard and lived experience representatives should have a wider group to report back to or seek views from
• concerned about understaffing, high turnover of staff, and some staff not having the right training or attitude for their roles