The National Care Service – an investment in our future

The Health and Sports Committee call for views marks further progress in realising the ambitions for a National Care Service.

The ALLIANCE welcomes the long-needed focus to improve social care. Focussing on positively transforming it into an investment in citizenship. For too long, social care has been an afterthought. The reforms being brought in by the introduction of the National Care Service Bill and associated work programmes are a positive move by Scottish Government in response to the Independent Review of Adult Social Care (IRASC).

Today the ALLIANCE published our response to the Health, Social Care and Sport Committees request for views ahead of the stage 1 Bill process. There is much we welcome in the broad framework Bill. However, we must learn from other pieces of legislation introduced in Scotland which did not realise the transformational change it set to achieve. The Self-directed Support (Scotland) (Act) 2016 being one recent example of this.

IRASC was clear in its recommendations – the changes must ensure consistent implementation of improvements to social care across the country. The ALLIANCE proposes this legislation should fully integrate a human rights-based approach to enable its ultimate end goal to realise social care as an investment in society. It must ensure people have the right to access appropriate, enabling, high quality, compassionate, and timely support. Robust accountability mechanisms need to be included in the legislation with sufficient checks and balances to guarantee we are monitoring if the changes are leading to improvements and – where failings exist – people have recourse to quick and efficient routes to have this remedied.

There are areas where improvements could be made
Turning to some specific areas highlighted in our response where we feel amendments would strengthen the legislation:

The charter is a welcome development, but it must go further to be framed in terms of the rights people have which the National Care Service is there to respect, protect and fulfil.

The impact of not providing rights based, person centred social care can be devastating and can result in a deterioration in people’s health and life chances.

The ALLIANCE feels that the Bill should make explicit reference to people’s right to independent living and inclusion in the community. Further, that the right to habilitation and rehabilitation, as set out in article 26 of the UN Convention of the Rights of Disabled People, is an explicit right which needs to be enshrined in the legislation.

It is essential that we understand the right to communication as a fundamental right and how it is integral to social care support. For example the current system does not have a universal understanding of the communication support needs of people living with sensory loss, people who have communication support needs, or people accessing social care where English is not their first language.

The role of people with lived experience must be strengthened in the legislation. We would advocate for stronger reference to be made to co-production so the involvement of people with lived experience is meaningful. Choice and control is an integral and equal part of the service design and delivery process. We would welcome transparency of process in how decisions are made and in how co-production is achieved in practice.

Embedding accountability throughout
While much of the proposed content of Section 1 of the Bill (the National Care Service principles) is welcome, there is insufficient articulation of how their implementation will be monitored and nothing in the legislation to indicate consequences if those principles are not fulfilled. If we are to see meaningful implementation of the principles, and of human rights based approaches to the National Care Service more broadly, the accountability processes must be clear, with effective redress available if systems fail.

We don’t currently measure the impact of social care in ways which would tell us whether changes made are leading to changes needed for by individuals. We often measure waiting times, sometimes workload and typically costs. Yet we don’t measure what good these budgets are doing. Having robust data is going to be a cornerstone of the National Care Service to ensure we are able to respond to the signals about the changes being made, to measure the impact, and hopefully pick up when things go wrong early.

Implementation
Whilst getting the legislation right is of utmost importance and will guide its implementation, it is equally essential that we spend the necessary time, attention and resource on the implementation process. The reason why implementation has not been successful under previous reform agendas is that we don’t consider the infrastructure support which is needed to facilitate systems change. Some of this could be addressed in the legislation and the accompanying financial memorandum by ensuring that care boards must, rather than may, deliver training. Without investment to build capacity amongst the workforce, implementation of human rights based approaches is unlikely to be realised in practice.

In addition, the proposals which will involve new processes and systems – data collection, care records, a national complaints system, evaluation measures, training facilities – must be properly and sustainably resourced to ensure its success and effectiveness.

Without attention on the accompanying system change to be implemented – teams can be left feeling unable to navigate the issues which can arise when they try to implement changes. We must have a shared commitment to follow this through for the long term to ensure that people, including the workforce, can realise the vision of social care which so many of us are calling for.

The ALLIANCE are committed to influencing this work and welcome this unique opportunity to radically transform our social care system. We must get it right for the people of Scotland now, and in the future.

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