Future of Social Care: What does a National Care Service mean for mental health services?

VOX reflects on opportunities and challenges for those with lived experience of mental ill-health within the NCS Consultation.

Of the 245,000 people in Scotland receiving social care, around 1 in 6 receive social care support due to mental health issues (this link will take you away from our website). With the Scottish Government now consulting on a proposed National Care Service, Paula Fraser, VOX’s Development Officer has been working with our members to understand their perspectives and ensure their voices are heard in the consultation process.

VOX Scotland is run by and for its members. Our members have lived experience of accessing mental health support and fundamentally want to see a marked improvement to the quality and availability of services. This must be the overarching priority in the development of a National Care Service.

In particular, members want an end to the ‘postcode lottery’ of service provision in different areas of the country. A system that is more equitably coordinated across Scotland could see improvement for some people in this regard, with members emphasising the need for services to be ‘levelled up’ in the process.

They told us they want to see more accessible community hubs for mental health to help maintain their wellbeing, better integration of services, and to be able to access support whenever they need it – not just when they are in crisis. Members stressed the importance of care that is personalised and responsive to their needs at an earlier stage, and that there must be significant investment in, and support for, the workforce to ensure this is available to all.

Members said they need an National Care Service that is flexible and adaptable – one which recognises that levels of support needed, even for one individual, are likely to fluctuate over time. As found within the Independent Review of Adult Social Care, commissioning using generic frameworks based on hourly rates does not work well for people in this context (this link will take you away from our website)

It is worth noting, however, that many proposals in the consultation document extend beyond the Review, and would likely usher in a major re-organisation of services. Crucially, the resources and attention that will be concentrated on this re-organisation must not be to the immediate detriment of service delivery. Set-up must be underpinned by an ambition to achieve the best possible system for all who access it, with the resources made available to implement it.

Key to making such a system a reality is ensuring that those receiving support are at the heart of designing and influencing services. Proposals for people with lived and living experience to be voting members of ‘Community Health and Social Care Boards’ are welcome, but further detail is needed on how this will ensure authentic, non-tokenistic, participation – what support will be provided for all board members to fully engage?

Indeed, the consultation process itself has elicited concerns from VOX members. They told us that many questions require far more of the basic scope and principles to be established first before they could provide meaningful answers, and feel the consultation period is too rushed for those it will impact to meaningfully engage. We heard that example ‘case studies’ of what proposals could end up looking like in practice would have benefited their engagement with the consultation.

Fundamentally, social care should be rights-based and it should be empowering. In order for this to become a reality for all we need a significant boost in investment and support for the workforce, provision of additional services that provide support pre-crisis, and meaningful involvement of those with lived experience to co-produce solutions. These must be core tenets of a National Care Service if it is to truly deliver what our members have ultimately called for: a system where everyone can get the care and support they need, when they need it, wherever they are in Scotland.

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