National health and social care workforce plan: part two

Chapter 2: Setting The Context: The Vision For Social Care In Scotland

7. This chapter provides the context for our future thinking about the workforce by highlighting the key policy and strategic drivers that shape our shared priorities and will influence the kind of workforce we need in the future.

8. Through national outcomes, policies and legislation, Scottish Ministers, local government and third and independent sector providers are implementing the transformation of care through a partnership approach which focuses on empowering people to be equal partners in their care and supports decisions which enable them to participate fully in social and economic life and be supported in choices about how they live their lives. To achieve this alongside better health and wellbeing, better care and better value, requires public service transformation. The 2011 Christie Commission set the underpinning framework for this.

9. Our shared priorities across the spectrum of Social Care and the drivers that shape these are set out in a range of policies and strategies including:

• COSLA’s 2017-18 priorities for Health and Social Care, which are supporting local government and Integration Joint Boards ( IJBs) to address demographic and financial challenges, enabling communities to live healthy, independent lives and promoting an outcomes and prevention culture;
• Current work on reform of Adult Social Care, which will consider workforce issues and new models of care and support;
• Implementation of Integration of Health and Social Care with an increased emphasis on community-based and preventive care, support for people living with complex needs and on responsive, person-centred services;
• Implementation of the Social Care (Self-directed Support) (Scotland) Act 2013, allowing people, their carers and families more choice in their support and how it is delivered;
• Getting it Right for Every Child, the national approach in Scotland that puts the wellbeing and rights of children and young people at the heart of services that support them;
• The expansion of Early Learning and Child Care. Due to the proposed expansion of early learning and childcare there is currently a strong focus on this specific workforce;
• The Mental Health Strategy 2017-2027 which aims to achieve parity of esteem between physical and mental health, working across service boundaries to enable people to get the right help at the right time;
• The Health and Social Care Standards, effective from April 2018. These outcome-based standards seek to ensure that individuals are treated with dignity and respect and are involved in decisions about their care;
• Implementation of the Carers (Scotland) Act 2016, from April 2018. The Act is designed to support carers’ health and wellbeing and help make caring more sustainable;
• The National Strategy for Community Justice, which is underpinned by principles that include preventive intervention and high-quality, person-centred, collaborative services;

• The Digital Health and Social Care Strategy in development that will set out how outcomes will be improved through enabling those who use services to use digital information and tools to maintain their own wellbeing and improve data use in service improvement and planning; and

• The Health and Social Care Delivery Plan (December 2016) that promotes greater joint working between IJBs, local authorities, NHS Boards and other partners, including at regional level.

This social care–focused part of the National Health and Social Care Workforce Plan should, therefore, be read in the context of the wide range of ambition for improving the lives of people in Scotland which has been informed and is shared by all the delivery partners in social care.

10. Our shared ambition is that social care supports people at all stages of their lives to live as independently as possible and achieve meaningful personal outcomes. Some of the common themes that emerge from the policies and strategies outlined above include:

• The need to recognise the individual assets of those who use services, and those of their family and wider community;
• The need to work with people, ensuring they are treated with dignity and respect and where possible, can direct their own support and achieve their personal outcomes;
• An increased focus on prevention and early intervention;
• The need for collaboration and integration between services and professional disciplines, with an increase in multidisciplinary team working, so that support is integrated from the point of view of the person; and
• The need for greater innovation, flexibility and creativity in service design and delivery, making full use of the potential of technology.

11. Delivering this vision of how services support and enable people at all stages in their lives when they need it will require new ways of working, redesign of services, new models of care and innovative and flexible approaches to responding to changing demand. One new model of care designed around people and communities is the Buurtzorg model of neighbourhood care which has been successful in the Netherlands. Several areas in Scotland are testing the Buurtzorg principles of self-help, independence, continuity of support and empowering staff teams, using the learning to accelerate progress with integration as well as the development of the community health and social care workforce. We need to look across the whole landscape for the opportunities which will help to deliver the changes sought. For example, the regulation of services and the workforce plays an important role in acting as a quality gateway for social care. The legislative framework for regulators was established prior to the integration of health and social care and we need to ensure that they can continue to play an enabling role in supporting new models of care and providing public assurance. A further example comes from current work to explore the concept of a Teaching/Research Care Home for frail older people in Lothian. This would bring together doctors, nurses, allied health and social care professionals with involvement of local communities and multidisciplinary training for students, to determine what benefits this would have on outcomes.

12. The integration of health and social care and Self-directed Support together provide the opportunity and expectation for reforming how social care for adults is delivered. This links with the transformation agenda across the whole of social care as well as that for wider public services. We also need to explore further the opportunities afforded by all kinds of technologies, and the work to develop and implement a Digital Health and Social Care Strategy is well underway. New approaches in these areas are being introduced and developed in many localities; these will need to keep pace with further change and to adjust to continuing growth in demand for health and social care services.

13. This has significant implications for the workforce we need now and for the future; implications not only for workforce numbers but also for the roles, skill sets and career pathways across the health and social care workforce. The changes we have embarked upon are occurring within a wider context of financial constraint, historically low levels of unemployment and the uncertainty created by the outcome of the referendum on the UK’s membership of the EU. Given Scotland’s geography, rural areas face particular challenges, such as a restricted number of service providers and geographic remoteness. It is therefore both timely and necessary to work together in more consistent and effective ways to develop improved approaches to workforce planning across the health and social care sector.

14. Part 2 recognises the complexity of the social care landscape and the size and diversity of the workforce, which is described further in Chapter 3. It recognises the need to improve the evidence base for workforce planning and makes recommendations to improve the data, tools and guidance available to the diverse partners who play a role in planning the workforce ( Chapters 3 and 4). In order to make progress towards our vision for social care there are both current and future challenges for the workforce, described further in Chapter 5. The recommendations in that chapter identify a number of current challenges that are priorities for action.

15. The recommendations set out in this Plan will establish initial work streams in seven priority areas, which seek to enable progress in workforce planning for social care in an increasingly integrated landscape, with the purpose of improving outcomes for those who use services.