The pandemic has exposed deep cracks in the UK’s creaking health and care systems. In England, in an attempt to fix the system, Prime Minister Boris Johnson took the unprecedented step of implementing a Health and Social Care Levy, which will be paid for by increasing National Insurance contributions.
North of the border too, where I live and work, changes are afoot. The wheels were set in motion in early February when Derek Feeley, a former Scottish Government Director General of Health and Social Care, published a landmark report. The 107-page study, entitled ‘Independent Review of Adult Social Care in Scotland’ made a number of key recommendations, including setting out the case for a National Care Service to be established.
Since the report was published, the Scottish Government launched a consultation in August in which it published a set of proposals for a National Care Service. The consultation period will end on 18 October 2021. If the proposals are accepted, the National Care Service will come into being sometime in 2026.
Is the National Care Service the answer?
The big question is will a National Care Service address the major challenges that the Scottish care system faces? And, most crucially, will the seismic reforms being proposed, deliver a social care sector that supports frontline workers to provide the best possible care to those they look after?
It’s an exceptionally complex question to answer as details of Holyrood’s plan lack detail. What we do know is that the proposal is centred on the recommendations that Derek Feeley made in his ‘Independent Review of Adult Social Care in Scotland’.
The Feeley Report
So, what were they? Perhaps the BBC ‘s Douglas Fraser offers the most succinct summary of Feeley’s findings, when he wrote in May, that Mr Feeley “reflected views that legislation is good but the implementation is not”.
But, what does this mean? In the report foreword, Mr Feeley touches on the consequences of poor implementation, while outlining his vision for a National Care Service. He said, “We need a new narrative for adult social care support that replaces crisis with prevention and wellbeing, burden with investment, competition with collaboration and variation with fairness and equity. We need a culture shift that values human rights, lived experience, co-production, mutuality and the common good.”
Short-term and long-term recommendations
In the short term the report, however, outlines that adult social care workers be paid a fair wage, that health and care services work together more closely and that end-user charges be ended for non-residential care.
But, in the long term, if a National Care Service is realised, Holyrood’s ambitions for it seem far bolder than Mr Feeley’s. The Scottish Government, it seems, is not content to simply encompass adult social care. It also wants the National Care Service to cover the full gamut of services including children’s social care services, alcohol and drug services, community justice and all community health services.
Is the National Care Service biting off more than it can chew?
Some worry that in placing a comprehensive raft of services under the umbrella of the National Care Service, Holyrood is biting off more than it can chew, and according to some this could have a negative impact on social care. Writing in the Local Government Chronicle in August, Andrew Cozens, an independent health and care specialist, said, “Putting hard pressed services – care, primary care, and community health – together in a single service does not guarantee better funding or outcomes. Instead, it could be a fresh Cinderella.”
Arguably, it is the proposed change to standards and commissioning of services that are causing most anxiety.
Plans for National Care Service bewildering
Working for QCS, the UK’s leading provider of content, guidance and standards for the social care sector, Scotland’s First Minister, Nicola Sturgeon’s recent announcement that a new set of standards would be developed for care homes in Scotland, has left many, including me, somewhat bewildered.
We already have a robust set of Health and Social Care standards and an effective regulatory body in the Care Inspectorate that sets standards for the sector. So, what would a new set of protocols look like? Who would be responsible for administering them and how will this impact on care providers?
Looking at the Feeney report, it does not seem to call for a new set of standards to be created, Instead, it points to the inconsistency in the way that standards are sometimes delivered and embedded by social care partnerships and local authorities. The question, therefore, is if the guidelines and standards are sound, why re-invent the wheel?
Making sense of the consultation
QCS is currently working with its partners – including Scottish Care, the representative body for independent social care services in Scotland, to make sense of issues raised in the consultation so it can provide customers in Scotland with absolute clarity as to how to best interpret and prepare for any future changes in regulation.
Karen Hedge, the National Director of Scottish Care, also has “significant concerns” about the commissioning of services. She says that a culture of “siloed thinking” has prevailed instead of the “cross-sectorial conversations” that should have taken place in the foundational stages.
Mrs Hedge explains, “Astonishingly, we find ourselves at the consultation stage when actually what we really needed to be doing was to work collaboratively using coproduction across the system to design what the National Care Service should look like based upon Mr Feeley’s recommendations.”
Community Health and Social Care Boards
Scottish Care reports that the lack of clarity in the consultation has led to confusion regarding the proposed changes to local commissioning of care services. Currently, commissioning is carried out by Integrated Joint Boards (IJBs), which came into being five years ago. However, under the new proposals, IJBs will be replaced by Community Health and Social Care Boards.
Mrs Hedge says, “Many are asking, what are Community Health and Social Care Boards, how will they function, and most importantly, how will they differ from Integrated Joint Boards in their ability to ensure that people get the right services in the right place at the right time? Despite these new boards being mentioned in the National Care Service consultation, there is very little detail explaining what the vision is for these boards. The consultation, for example, doesn’t answer questions as to why Integrated Joint Boards (IJBs) have taken so long to be effective.
She continues, “Fundamentally, if IJBs are to be replaced, the consultation should set out clearly and transparently what the changes are set to achieve and how they will do this. In not doing so, there is a niggling worry that the National Care Service is creating the same service under a different name. The greatest irony, however, is that many of the IJBs, which are set to be replaced, are finally beginning to function well. The learning from these areas is crucial in any future developments and should have been taken account in the proposals outlined in the consultation.”
Lived experience vital
It is a view that I share and it also serves as a powerful reminder that the consultation must be driven by people with ‘lived experience’. Essentially, that means staff, who work on the frontlines every day, service users who receive person centred care and their families who see first-hand the profound difference that a package of excellent personalised care makes to their lives.
There is a risk, however, that the National Care Service morphs into a health-led model. To view it through that lens, and not via the prism of people who are receiving person-led care, would be to let a once in a generation opportunity slip through our fingers.
Whatever happens, care services can rest assured that Quality Compliance Systems will support providers and service users through any period of significant change.
To find out more about the QCS or to purchase a subscription, please contact QCS’s team of advisors on 0333-405-3333 or email: [email protected].
The article was first published in The Care Home Professional
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