The Scottish Government has committed to bringing forward legislation to set up a National Care Service (NCS), with the aim of improving the way social care is delivered in Scotland. It is likely that the establishment of an NCS will bring big changes to the way social work is organised and delivered in Scotland. The 2021-22 Programme for Government says that the NCS will be the
Biggest reform of health and social care since the founding of the NHS
Social work delivers a variety of services of care and support to adults, children and people in the criminal justice system, and the NCS Bill may propose that some or all aspects of social work are included in the NCS. You can read more about social work in Scotland in our briefing, and find more SPICe resources on the NCS at the NCS hub
What is the National Care Service?
The National Care Service (NCS) is the Scottish Government’s proposed new system for delivering social care services in Scotland.
Establishing an NCS was a key recommendation from the Independent Review of Adult Social Care (Feeley review) published in 2020. The review recommended a national system to bring together adult care services, so that people would have equity of access to support and that quality of care was consistent across the country.
In response to the recommendation, the Scottish Government ran a consultation on proposals for an NCS in 2021. The consultation received over 1,200 responses from organisations and individuals, giving their views on the potential benefits and risks of the NCS.
What is the case for a National Care Service?
The social care system is under strain and demand for services is growing. An ageing population and declining healthy life expectancy in Scotland has created a growing demand for health and care services.
There are a number of other challenges across social care highlighted in the Feeley review, including:
- a focus on high tariff instead of preventative work
- complicated systems for accessing care
- inconsistent services
- a workforce who feel undervalued.
To address these challenges, the Feeley review recommended reforming social care and setting up a nationally controlled system, with Ministers accountable for care support instead of local authorities and integration authorities.
An analysis of consultation responses reported that most respondents (72%) agreed that Scottish Ministers should be responsible for social care. Among individual respondents, social workers were less likely to agree with the concept of the NCS (64%) than others. As the consultation was a self-selecting survey, the views of respondents cannot be taken to represent the views of the wider population, just of those who have chosen to respond.
How would the NCS be organised?
The Feeley review identified self-directed support, the Independent Living Fund, and integration of health and social care as strengths in the current system that should be built upon. It also reiterated the importance of prevention and early intervention to ensure the shift away from care as crisis intervention.
The consultation proposed that the NCS would be a national body responsible for the strategic direction of care, workforce planning, commissioning, and research to support improvement. Community Health and Social Care Boards would replace integration authorities and be responsible for service delivery.
What services are going to be included in the National Care Service?
The NCS was proposed following recommendations in the review of adult social care, but the consultation sought views on including other aspects of social work: children’s services, justice social work, alcohol and drug services and mental health services. The consultation paper said that
Not including all social work and children’s social care within the National Care Service (NCS) risks fragmenting the current system of care and assessment and further adding to complexity for services users
Most responses to the consultation were in favour of the wide scope and considered that keeping all aspects of social work together would lead to better consistency and joined up working. Most respondents supported the inclusion of children’s services (76%), criminal justice social work (62%), prison care services (72%), alcohol and drug services (81%) and mental health services (75%).
Some key stakeholders expressed concern about a wide scope, including the Convention of Scottish Local Authorities (COSLA) and Social Work Scotland. They said there was a lack of evidence that including other services would be beneficial, given that they were not considered in the Feeley review. Respondents suggested that there needed to be more evidence of the benefits to including these services, what should be kept from the current delivery, and more consultation with relevant service users.
What about the workforce in a National Care Service?
The Feeley review identified a need for a national organisation to provide oversight of the training, professional development, and recruitment and retention of the workforce.
A National Social Work Agency (NSWA) to provide leadership of the profession was proposed in the consultation. It would take leadership of qualifications, training, improvement, workforce planning as well as pay and grading for social work staff and seek to address many of the workforce issues and challenges currently facing the sector.
The consultation responses showed there was agreement for the benefits of an NSWA, with 86% agreeing a social work agency would improve training and professional development, and 77% agreeing it would help raise the status of social work.
What was the response to the NCS been?
Many respondents to the consultation agreed that the benefits of the NCS would be more consistent outcomes for people accessing services (77%), and potentially improved coordination of work across different organisations (72%).
Broader concerns were raised about the NCS. The loss of local needs, local knowledge, and local accountability was one of the biggest concerns. Some respondents felt that the risk of an NCS being a large and centralised body risks losing the ability to adapt to local requirements of care. This was a particular concern for Highland and Island communities.
We need to ensure that central control does not affect the localised delivery of service that is able to adapt to the unique circumstances and needs of the different areas of Scotland.Consultation response from a person accessing care and support
There was also concern that this centralisation and loss of local context would also risk losing the local links that are important to social work, like to education, leisure, or housing in local authorities, affecting the integration of services and joined up working.
Responses also raised the risk that social work in the NCS could be overshadowed by other services.
What is happening next?
The 2021-22 Programme for Government laid out plans to introduce the legislation by June 2022. The legislation is likely to be complex and will take some time to scrutinise. If passed, the Scottish Government will then need to implement the legislation. The NCS will therefore take a while to fully implement. The consultation says that it hopes to have the NCS functioning by the end of the Parliamentary term (2026).
Sam Harrison, Researcher