The Scottish Government’s 2021-22 Programme for Government (PfG) committed to bringing forward legislation to establish a National Care Service (NCS). In her statement on the PfG, the First Minister described the NCS as:
“arguably the most significant public service reform since the creation of the National Health Service”.
The Independent Review of Adult Social Care
The proposals for the NCS followed the Independent Review of Adult Social Care, (the Feeley Review), which recommended the establishment of a National Care Service to bring together all adult social care support delivered in Scotland. It said that:
“A National Care Service must ensure that people have equity of access to social care supports, and experience a similarly high quality of care, wherever they live in Scotland”.
Prevention was also key:
“There should be a consistent, national focus on preventative, early intervention and anticipatory forms of support that shift the emphasis, and experience of care, away from crisis intervention and towards better quality of life”.
The review set out that:
“Statutory responsibility for adult social care support should be set out in law along similar lines to those already established for health services, to establish parity of esteem and clarify mutual dependencies between health and social care support, and to establish equity in terms of reporting arrangements”.
Scottish Government consultation
The Scottish Government launched a consultation on the National Care Service on 9 August 2021. The proposals in the consultation went wider than the policy areas covered in the Feeley Review, which focused on adult social care, to include children’s social work and social care services. The consultation document states that not including them within the NCS:
“risks fragmenting the current system of care and assessment and further adding to complexity for services users.”
The consultation notes that at a minimum the NCS will cover adult social care services but it also seeks to consider extending its scope to oversee all age groups and a wider range of needs including:
- children and young people
- community justice
- alcohol and drug services
- social work.
The consultation on the NCS closed on 02 November 2021. Online engagement events were held between August and November 2021.
The responses to the consultation have been published along with an analysis of stakeholders’ responses to the consultation on a National Care Service.
The analysis found that most respondents believed that the main benefit of the NCS taking responsibility for improvement across community health and care services would be more consistent outcomes for people accessing care and support across Scotland.
A number of potential risks were also identified by respondents. These included:
- the potential loss of the voices of people accessing care and support and care workers; the impact on local services
- the loss of an understanding of local needs and local accountability
- the variation of needs across Scotland especially where more rural and remote areas such as the Islands are concerned
- staffing concerns with regards to retention and morale.
The analysis also discusses responses on the possible scope of the NCS. Most respondents agreed that children’s services, justice social work, social care in prisons, alcohol and drug services and mental health services (as outlined in the consultation) should be included in the NCS. However, it is worth noting that a number of key stakeholders did express concerns about the proposals to include children’s services.
The majority of respondents were in support of the NCS and Community Health and Social Care Boards (CHSCBs) commissioning, procuring and managing community health care services.
Other areas of work
In a letter to the Health, Social Care and Sport Committee the Minister for Mental Wellbeing and Social Care noted that as part of the development of the NCS there is a need for a consistent approach to data and effective information infrastructure. The Scottish Government has commissioned work on:
- the digital approaches, services and products that have enabled similar services outside Scotland
- how people experience interacting with services in Scotland – with a focus on what data is important to them
- a review of the technology, service and digital architectural landscape across the public, private and third sector organisations involved in the delivery of social care services.
The Scottish Government has said that legislation will be introduced in the Scottish Parliament in summer 2022, most likely June, and it intends to establish a NCS by the end of the Parliamentary term.
You can find out how the Scottish Parliament makes law in this video and on the Scottish Parliament website.
SPICe has published a briefing on Adult Social Care and Support and one on Scotland’s Care System for Children and Young People.
We have also published some relevant blogs including:
- More money or more reform? How are the UK and Scottish Governments thinking differently about health and care reform
- Health and social care: who pays and who decides
- Could a National Care Service work like the National Health Service
Once the NCS Bill has been introduced SPICe will publish a range of detailed briefing material to support parliamentary scrutiny and inform public debate on the Bill.
Lizzy Burgess, Senior Researcher, Health and Social Care
Feature image from Age UK