The future of social care in Scotland

"Current care systems aren’t working for people they serve and need radical change."

10 years ago, the ALLIANCE initiated a debate about social care, based on a commissioned piece of work, 12 Propositions for Social Care, with a set of briefing papers and a national dialogue seminar of interested organisations.

The centrality of commissioning, coproduction, personalisation, human rights, improvement, culture change and governance for change was at the heart of the 12 Propositions.

Now, a decade on, health and social care integration, self-directed support and carers rights legislation behind us, the Scottish Government’s consultation on the creation of a National Care Service has provoked a debate about which public bodies should control what elements of health and social care.

What we knew a decade ago, however, and what the Independent Review reminded us was that imperative changes to social care are shaped by the views of people who know best what change is needed – people who access social care support.

From the ALLIANCE’s own work with people with lived experience, including the largest study to date of people’s experiences of Self-directed Support (SDS), ‘My Support, My Choice’, and engagement for the Independent Review of Adult Social Care, it’s clear that the current systems aren’t working for the people they serve and are badly in need of radical change.

Change must come; purposeful, person-centred change must come before another decade slips by.

Eight years ago, SDS was introduced – a world leading, human rights based piece of legislation that guarantees people the right to exercise choice and control over their social care. Frustratingly, however, these principles are far too often not reflected in people’s experiences, and the reality is a far cry from choice and control, a prime example of the ‘implementation gap’ between what the law says people should expect, and what the reality is in practice.

Change must come.

It must come for many groups; disabled people, people living with long term conditions, unpaid carers, families living on the edge, people in recovery, those working through mental health challenges and people with sensory loss (supported by the Scottish Sensory Hub in the ALLIANCE)

Take the experiences of Deafblind people. We asked them about their experiences of SDS, as part of our ‘My Support, My Choice’ project. While the majority indicated that SDS has improved their experiences of vital communication more broadly, many said they did not get enough information about their options, leaving many Deafblind people unable to make informed choices about their care and support.

However, these experiences demonstrate just some of the many problems that the current social care system doesn’t adequately deal with and raises a number of additional issues; unpaid carers left without any right to breaks or respite and excluded from decision making, an undervalued and underpaid workforce, outmoded competitive tendering processes that hinder partnership working and people excluded by stigmatising, paternalistic attitudes and systems, unable to fully and equally enjoy their human rights.

This is a system that needs far more than tinkering at the margins.

Change must come, cultural change of the highest order, a uniquely Scottish service driven by kindness, inclusion, empowerment and capacity-building.

Investment is clearly important to making this a reality. There’s no doubt social care has been chronically under-funded for years – the Independent Review estimated the cost of fully implementing its recommendations at a necessary £660 million. This is urgently needed, to achieve a rights based system and ensure fair pay for the social care workforce. But this needs to go hand in hand with changes to current structures, rather than throwing money on top of systems that don’t work.

The proposals for a National Care Service will be hotly debated in the months ahead.

However, regardless of any future structure for social care in Scotland, it is essential that necessary, transformational change is delivered.

Most importantly, the National Care Service needs to put people at the centre consciously designed by the rights and wishes of people who access receive social care. It should be a gift to the Scottish people, a compassionate social convenant for the 21st century.

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