Considering mental health within the National Care Service

Craig Smith reflects on the need for change and the importance of including input from people living with mental health problems in the NCS.

The National Care Service has the potential to embed a truly human rights based approach to the organisation and delivery of social and community health care. But to achieve this it must empower people – including people living with mental health problems – to be full partners in decisions about their care.

Unsurprisingly much of the political debate on the National Care Service has focused on structure and political accountability. These discussions include where responsibility for social care will sit, and how the national service will be structured locally. Important as this is, we urgently need to ensure attention is shifted to the much needed culture change in social and health care design, procurement and delivery. This to ensure the National Care Service is genuinely built on a foundation of lived experience involvement with the promotion of independent living at its heart. This will require genuine co-production with people who will be supported by the NCS and recognition of the third sector as equal partners in social care design and delivery.

So how do the current Scottish Governments proposals stack up?

There is much to welcome in the Government’s proposals. In particular, we at SAMH warmly welcome the proposed “Getting It Right For Everyone” (GIRFE) approach to support planning. The focus on personalised support built around desired outcomes for people receiving care is the right one. We hope this approach will lead to people having much more genuine choice and control over decisions about their care – something we know can positively improve people’s mental health. While in a health care context, our research on the experience of treatment for depression, Decisions Were Made About Me Not With Me (this link will take you away from our website), found that research participants who were happier with their level of involvement in decision making about their treatment and support were more likely to be satisfied with their treatment. We are pleased that proposals on support planning will be aimed at greater coordination of care, and portability of care plans. This should make a real difference where someone is supported by various organisations, or moving to a new area, reducing the stress of people having to retell their story.

But making this approach a reality requires adequate staffing and resourcing of social care and community services, not just legislative action. As the development of the NCS moves forward we urgently need to see more details about how it will be adequately funded, both in the short and long term – something that to date has been missing.

Despite welcome proposals such as the GIRFE approach we are concerned that in some areas the plans don’t go far enough or have too little detail. We warmly welcomed the Independent Review of Adult Social Care (this link will take you away from our website), which provided the framework for the proposed reforms; but as they stand, these proposals don’t fully implement the recommendations of the review. For example, we welcome a commitment to ”human rights based”, “ethical commissioning” of services. Yet there is little in the detail of the Scottish Government’s proposals that gives us confidence that services won’t – as is too often the case today – still be designed and commissioned around local budgetary constraints.

As the independent review set out, to ensure person centred and human rights based services, we need a fundamental break with the current model of competition. Cost-driven procurement processes must change to a culture of collaboration. It is crucial that the power in-balance between people receiving care, social care providers and commissioning bodies is addressed.

For example, to ensure genuine compliance with the UN Convention on the Rights of Persons with Disabilities and a human rights approach more generally, it is crucial that the model of commissioning and procurement adopted by the National Care Service, particularly at a local level, moves away from a reliance on generic frameworks for adult social care. Access to specialist, personalised services built around someone’s individual needs is critical to promoting recovery and independent living. While the emphasis on national minimum quality standards and an outcomes-focused approach to care in the Government’s proposals on commissioning are welcome they do not give us confidence that a framework approach will end. It is essential that people with mental health problems can access specialist mental health social care support, delivered by practitioners with specialist training in mental health. Our experience with social care services commissioned through local generic frameworks has too often resulted in people with mental health problems not being supported by practitioners and services that can cater to their needs.

As the development of the National Care Service moves into the next stages, SAMH will continue to champion the importance of lived experience involvement and the specific needs of people living with mental health problems. This is a once in a generation opportunity to radically improve social care in Scotland, and it must be grasped.

This opinion is part of the ALLIANCE’s Future of Social Care series. You can find other entries in the series here.

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