Plans to transform the way social care is delivered are being progressed as part of the Scottish Government’s commitment to improve the experience of everyone who accesses social care, social work and community health services.
Ahead of Stage 2 proceedings of the National Care Service Bill later this month, a number of amendments have been lodged, all of which are subject to Parliament’s agreement.
As the National Care Service will now be established through both legislative and non-legislative means, with reform of social care at the centre it is proposed the Bill will be known as the “Care Reform (Scotland) Bill”.
If agreed by Parliament, as amended, the Bill will also bring forward significant reforms to social care, including:
Anne’s Law being enshrined into legislation to uphold the rights of people living in adult care homes to see loved ones and identify an essential care supporter
ensuring all those working in or supplying services to the health and social care sector follow the same information standards allowing easier communication
the creation of a National Chief Social Work Advisor post, in statute, to bring strategic leadership at a national level.
The Bill will also retain measures to establish a legal right to breaks for unpaid carers. Ahead of the legislation, the Scottish Government has identified an additional £5 million in the draft 2025-26 Budget to support 15,000 carers to take short breaks from their caring responsibilities.
Ministers announced in January that legislation to set up a new public body to oversee national improvements would no longer go ahead. However, work to establish a National Care Service Advisory Board is progressing and it is due to meet for the first time in March.
Social Care Minister Maree Todd said: ”Social care has the power to transform people lives, that is why it is so important that those accessing services receive the highest quality care, delivered consistently across Scotland.
“The amendments lodged in Parliament offer us the best opportunity to urgently get to work to reform the system and have a transformative impact on people’s lives.
“Positive progress is being made on establishing an advisory board that puts people with experience of the social care system at the heart of it, helping deliver the changes we all want to see.”
An essential care supporter is someone, for example close relatives or friends, who plays a vital role in providing their loved ones with regular care and support alongside staff. This includes companionship, personal support and advocacy.
As part of our ongoing work on the lives of people with learning disabilities, we continue to track the latest research, policy developments, and data shaping their experiences (writes Fraser of Allander Institute’s DAVID JACK).
In previous round-ups, we’ve explored topics ranging from employment and social care to education and healthcare access. For this edition, we turn our attention to the rollout of annual health checks for people with learning disabilities in Scotland.
What are Annual Health Checks?
An Annual Health Check is a yearly check-up offered to individuals with learning disabilities to help identify and manage their health needs. It typically includes a review of medical history, physical health measurements (such as weight and blood pressure), checks on long-term conditions, discussions about mental health and lifestyle, assessment of healthcare access difficulties, medication reviews, and the development of a health action plan if required. The goal is to detect potential health issues early and support overall well-being.
Why Annual Health Checks Matter
Annual health checks are seen as a vital tool in addressing health inequalities. Many people with learning disabilities face challenges in communicating their symptoms, making proactive health assessments essential. Research consistently highlights the poorer health outcomes this group experiences, including higher rates of undiagnosed conditions, preventable illnesses, and premature mortality.
Just this week, researchers at the University of Glasgow released new findings revealing that young adults (aged 25-34) with learning disabilities are nine times more likely to die from treatable causes than their peers in the general population. The study, led by the Scottish Learning Disabilities Observatory, underlined the severe health inequalities faced by this group—particularly young women, who were found to be at disproportionately higher risk of premature death from treatable conditions.
Scotland’s Commitment and the Reality of Implementation
In May 2022, the Scottish Government pledged to offer annual health checks to all adults (aged 16+) with learning disabilities by 31st March 2023. To support this, NHS Boards were allocated £2 million annually. However, implementation struggles led to a revised deadline of 31st March 2024.
The first official data on Scotland’s progress has now been released by the Scottish Government. The 2023/24 figures reveal that despite identifying 23,758 eligible individuals, only 1,405 (6%) health checks were offered, with just 1,128 completed. This means fewer than 5% of eligible individuals have received a health check—highlighting that the rollout remains far from comprehensive. Notably, while 80% of those offered a check went on to complete it, the vast majority of eligible adults have yet to be given the opportunity.
The failure to fully implement the annual health check programme points to deeper systemic challenges within Scotland’s healthcare system. While the Scottish Government has made reassurances that health checks remain a priority, the delay of the Learning Disabilities, Autism, and Neurodivergence (LDAN) Bill has raised concerns about long-term commitment.
In a letter to the Health, Social Care, and Sport Committee, Minister Maree Todd reaffirmed the Scottish Government’s dedication to expanding health checks, including exploring new settings such as the State Hospital and prisons. However, these recent figures suggest that rather than expanding, the programme is struggling at a foundational level. The challenge appears not to be a lack of policy ambition but a failure in execution, which risks slowing or even obstructing progress in reducing health inequalities in Scotland.
A Troubling Lack of Progress
While 2024 marks the first year of formal reporting, and some allowances can be made for scaling-up challenges, the level of delivery remains lower than expected, particularly given the dedicated £2 million in annual funding. The current data does not include a breakdown of uptake by NHS Board—an important detail that should be incorporated into future reporting. The next set of figures, due in June 2025, will be key in providing greater transparency on regional disparities, and we also encourage the publication of more detailed demographic data when appropriate.
Back in November 2024, media reports stated that none of Scotland’s NHS Boards had fully met the target of offering health checks to all eligible individuals. In some areas, such as NHS Lanarkshire and NHS Shetland, there were indications that not a single eligible patient had received a health check. Greater clarity on this is needed through more detailed official statistical reporting to ensure timely, accurate and transparent data on progress.
Encouraging NHS Boards to report on how they are utilising the allocated £2 million per annum could provide valuable insights and help address delivery challenges. Additionally, assessing the effectiveness of public awareness campaigns would help identify what has worked well and what could be improved to ensure that people with learning disabilities and their families are fully informed about their right to an annual health check.
Varied Approaches
The Scottish Government provided directives outlining the framework for annual health checks, while allowing flexibility in local implementation. This flexibility has resulted in varied delivery models across NHS Boards, reflecting differences in workforce capacity, healthcare structures, and local resources. Some Boards will conduct checks primarily through GP practices, while others may incorporate community-based assessments, specialist learning disability health teams, or partnerships with third-sector organisations.
For example, NHS Lothian recommended a model where Community Learning Disability Nurses work closely with GP practices. Other Boards are integrating health checks into community services or collaborating with third-sector organisations to improve outreach. However, these varied approaches risk creating inconsistencies in data recording, as different systems are likely being used.
The Scottish Government has emphasised the need for standardised data collection across all Health Boards. A uniform approach is essential for assessing the effectiveness of health checks and ensuring equitable service delivery. The Annual Health Checks National Implementation Group aims to assist NHS Boards in aligning practices and reporting methods, with members expected to share real-time delivery data to collaboratively address challenges, overcome barriers, and provide peer support.
Beyond the Census: How Health Checks Could Bridge the Data Gap
If Scotland’s annual health checks for individuals with learning disabilities had been fully implemented as intended, they could have provided a valuable and reliable dataset on the number of people with learning disabilities in the country. Interestingly, the number of adults (23,758) identified through the Annual Health Check Survey Return to the Scottish Government already exceeds the number of adults reporting a learning disability in Scotland’s 2011 Census (21,115) by 12.5%.
This first set of published data for the Annual Health Check Survey states, “The method by which eligible people are identified varies by Health Board – the numbers identified only represent people with learning disabilities who are known to services.” Coupled with the fact that these checks are not yet being delivered at full capacity, this suggests that the true number of adults with learning disabilities in Scotland is likely to be higher than 23,758.
Scotland’s 2022 Census faced significant challenges in identifying the learning disability population. Instead of reporting learning disabilities separately, the published data currently combines them with learning difficulties and developmental disorder—a disappointing step backward compared to 2011.
The National Records of Scotland (NRS) identified learning disability as the primary category of concern, noting an “unrealistically large increase” in the number of people selecting this category compared to the previous census. As we previously explained, quality assurance efforts primarily relied on triangulating data with Scotland’s Pupil Census, which only captures those in school education and does not account for the broader adult population.
A fully functioning health check system could have served as an essential alternative data source, refining population estimates, improving census accuracy, and informing future data collection. Crucially, it could have also helped assess discrepancies in reported numbers—and given the challenges with learning disability recording in the 2022 Census, it still could—helping to clarify the scale of potential misrepresentation and ensuring that individuals with learning disabilities are properly represented in National Statistics and policy planning.
Policy Changes in England: A Warning for Scotland?
Recent developments in England signal changes to the NHS’s approach to annual health checks for individuals with learning disabilities. In an effort to prioritise reducing waiting times, Health Secretary Wes Streeting has announced a reduction in the number of NHS targets from 32 to 18.
This streamlining includes the removal of the specific target to provide annual health checks to 75% of people with learning disabilities across England. It is worth noting that unlike England’s previous approach, Scotland’s current policy is to offer a health check to all eligible individuals, without a set percentage target for delivery.
The Health Secretary’s recent decision has raised concerns that removing these targets could also lead to the loss of ring-fenced funding in England. Historically, funding has been directly tied to national targets to support their delivery, and without this financial safeguard, there is a risk that annual health checks could be deprioritised.
Mencap has warned that removing this target could have “deadly consequences,” as people with learning disabilities already face a life expectancy up to 23 years shorter than the general population.
While healthcare policy in Scotland is devolved, pressures on workforce capacity and financial resources remain significant challenges. If services continue to be overstretched, there is a risk that learning disability healthcare may receive less focus. This could make it more difficult to address health inequalities, potentially leaving those already at high risk of poor health outcomes further marginalised.
Conclusion: Turning Commitment into Action
The rollout of annual health checks for people with learning disabilities in Scotland remains a work in progress, with ongoing challenges still to be addressed. Despite the Scottish Government’s assurances that expanding access remains a priority, the reality is that progress has been slow, and only a small percentage of eligible individuals have received a health check so far.
Beyond improving individual health outcomes, a fully implemented programme could play a crucial role in shaping policy by providing more accurate data on Scotland’s learning disability population—particularly given the shortcomings of the 2022 Census.
As concerns over widening health inequalities grow and policy shifts in England raise further questions about long-term commitments, Scotland must ensure that these health checks move beyond ambition and become a fully embedded, effective service.
A Third Sector Response to the Draft EIJB Strategic Plan for 2025-28
In response to the EIJB consultation inviting people and organisations to have a say on the draft Strategic Plan for 2025 – 28, the Third Sector Reference Group is working on a contribution on behalf of our sector.
This is another in a series of actions in light of the future funding crisis third sector organisations are facing across the city.
Your input to this response is vital and we would ask any and all third sector groups and organisations to share your hopes, fears and priorities, by answering the 9 questions in this short survey.
You are also encouraged to submit a separate response individually, feeding back on the identified priorities, planned actions and measures of success.
You can find out more and submit a response to the consultation here.
Please be aware that the deadline for the consultation submission is extremely tight – Sunday 23rd Feb 2025.
This is strongly influencing the actions we are focusing on to deliver the best outcome for the sector.
The Reference Group has pulled together several resources that you might find useful:
Yesterday COSLA and the Scottish Government convened a roundtable discussion to consider immediate challenges facing the delivery of social care services:
COSLA Health and Social Care Spokesperson Councillor Paul Kelly, reflected on the meeting: “I was very grateful for the representation from across the care sector, including our partners in the third and independent sectors, involved in this critical discussion.
“We all have a shared responsibility to improve outcomes for people using health and social care services in Scotland, and I am acutely aware of how much more challenging this becomes when confronted with significant budget gaps for Local Government and Integrated Joint Boards.
“Of course, I know that it’s a similarly challenging financial context for our partner providers who deliver vital care and support for people.
“The reality is that the current financial challenges will have a very real impact on services and it’s for this reason I thought it was crucial to bring together key partners to highlight the impact this has been having – and will continue to have – on the system.
“The changes to employer National Insurance contributions, coupled with continued financial constraints and uncertainties, are a significant risk felt by Local Government which will impact upon the delivery, commissioning and procurement of services.
“There are no easy solutions to the challenges that were aired but I was encouraged by the frank and open contributions from attendees, and the consensus that it’s more important than ever that we work collaboratively to ensure continued delivery of social care for all those who need it.
“As COSLA’s Health and Social Care Spokesperson, I want to reiterate that we are doing everything we can to address the challenges the sector collectively faces, and that COSLA remains absolutely committed to engaging with the Scottish and UK Governments on these matters.”
People across Scotland will have better access to NHS treatment through increased capacity, expanded primary care services, enhanced use of digital innovations and a range of other measures, First Minister John Swinney announced yesterday.
Speaking to representatives from across the health and social care sector, the First Minister set out action to drive down waiting times and reduce pressure on frontline services.
The First Minister was joined by Health Secretary Neil Gray and announced a range of actions including:
A substantial increase in capacity, with 150,000 additional appointments and procedures per year
Increased investment in primary care, making it easier for people to get appointments with their GP
Improved use of data and new digital innovations including the roll-out of a Scottish health and social care app – a ‘Digital Front Door’ to the NHS for patients
The First Minister said: “Protecting, strengthening, renewing our National Health Service – that is a goal I think we can all get behind. A real focus of common purpose.
“That requires action from me, as First Minister, from my Health Secretary Neil Gray, and from my Government. We can offer the leadership and direction – as the measures outlined today seek to do.
“So, today, we commit to a substantial increase in capacity in order to significantly reduce people’s waits.
“Our plan will ensure that a greater proportion of new NHS funding goes to primary and community care. GPs and services in the community will have the resources they need to play a greater role in our health system.
“This increased investment will result in GP services that are easier for people to access. That is important in terms of people’s confidence in the health service – but equally, it will make it more likely that health issues are picked up quickly and dealt with earlier.
“Our National Health Service is there when we need it. No other public institution supports us with so much care through life’s biggest moments. We must support it in return.
“The approach I set out today charts our course to do that. It addresses both the challenges and the opportunities. It sets the NHS on a path of modernisation and renewal.”
LAST WEEK the Scottish government confirmed that plans for a National Care Service (NCS) in Scotland have been scrapped in favour of an advisory board and smaller, more targeted reforms (write FRASER of ALLANDER INSTITUTE’s MAIRI SPOWAGE and EMMA CONGREVE).
The decision came after months of declining support from key organizations and stakeholders including COSLA, key trade unions and representative bodies for social care providers in Scotland.
Beyond the wavering support for the NCS plans, there is clear support for social care reform, particularly in enhancing access to and the quality of services.
Our interest in the National Care Service, and wider social care reform stems back to 2022, in which we conducted analysis of the NCS bill published in June of that year. Following this work, published in August 2022, we engaged with a number of stakeholders across the private, public and third sector.
Among concerns around governance and funding of the NCS, one of the key concerns from stakeholders we engaged with was the lack of good quality and timely data that is crucial to ensuring that any reforms to social care are well informed. In particular, the need to better understand what future levels of social care demand might be, the workforce requirements to accommodate this, and the associated expenditure on social care.
Our concerns about the lack of investment in social care research were highlighted in our response to the Wave 2 consultation. The Scottish Government has not commissioned any work in this area, and we have not been able to find independent funders willing to fund work of this nature in Scotland.
It is our view that projections of demand and cost of the current service, and any future reforms, is urgently required.
New labour market data published
The latest data on the labour market in the UK was published last week. There are many documented issues with the data at the moment due to the challenges faced by the Labour Force Survey, which means the headline figure are no longer considered accredited Official Statistics.
If you can set that aside for a moment, the headline results show on the surface a strong Labour market in Scotland, with high employment (74.1%) and low unemployment (3.8%). Inactivity rates remain slightly higher than the UK at 22.9%.
There are a number of other data sources published alongside the LFS data which is used to supplement our understanding of what is going on in the Scottish economy. One of these is the payrolled employment data, known as the PAYE Real-Term Information, which is published every month by the ONS. This draws on administrative records, and so is likely to be more reliable in terms of employment (although, of course, tells us nothing about unemployment or inactivity).
This data shows that payrolled employment is almost 3% higher in Scotland than pre-pandemic levels. However, we had a look at replicating the sectoral breakdowns in this interesting piece by think.ing, which looks at government-dominated sectors vs the rest.
Chart:Payrolled employment in all sectors, government dominated sectors (public administration, health and education, and total excluding government, Scotland, January 2020=100
Source: ONS
This shows that once the government dominated sectors are excluded, payroll employment has been falling since March 2024, and is now almost back at the levels seen in January 2020. In contrast, government dominated sectors are 8% about pre-COVID levels.
Given some of the challenges facing the private sector in the first half of 2025, including large increases in employer National insurance contributions which will come in in April, the trend in private sector employment is concerning, and points to a weakness masked if we just look at employment in total.
However, it is worth emphasising again that this is just payrolled employment, and does not cover self-employment.
A dedicated advisory board, support for unpaid carers and enshrining care home residents’ rights to see loved ones are at the heart of revised plans for the National Care Service.
Social Care Minister Maree Todd outlined the next steps for reform to Parliament yesterday after plans to progress the National Care Service Bill were paused for further consideration in November 2024.
A new non-statutory advisory board – comprising of people with lived experience of accessing care, social care workers, care providers, trade unions, the NHS and local government – will be established to provide guidance and drive improvement within the sector. It is expected to meet for the first time in the spring.
The introduction of Anne’s Law, which upholds the rights of residents in care homes to be visited by families or friends, will remain in the legislation to reform social care, alongside a right to breaks for unpaid carers.
The Scottish Government Bill will also improve information-sharing across health settings and the ability for individuals to access and manage information about their care, while progressing plans for a national social work partnership.
Ms Todd said: “We want to deliver a National Care Service that improves the experience of everyone who relies on social care, social work and community health in Scotland.
“Change is urgently needed to reform the social care sector in Scotland but it has to be meaningful and sustainable change. That’s why we paused the Bill for further consideration, to fully capture the views expressed by all stakeholders, members of the public and the Parliament.
“The advisory board will include people with lived experience of social care, ensuring it has those who access services at its heart. It will allow us to drive forward vital reform more quickly than our original proposals.
“The Bill gives adult care home residents a legal right to see their loved ones with the implementation of Anne’s Law and recognises the significant contribution of unpaid carers to Scotland’s communities by introducing a right to breaks.
“There will be enhanced information-sharing to improve the coordination of individuals’ care, and we will work in partnership with the sector to bring forward reform that future-proofs the social work service in Scotland.
“People need sustainable change to social care and these actions will allow that to happen as quickly as possible.”
COSLA Leaders will meet at the end of January to take a position on the National Care Service Bill.
To attendees and those who wished to be kept in touch about conference developments:
Hi,
Thank you for attending the workshop on Saturday or for expressing an interest in campaign developments. We will produce a written report on the conclusions arising out of the discussion at the plenary session of the workshop.
Attached is the agenda for the workshop on Saturday,
One of the key issues to be discussed at the workshop is the City Council’s response to the proposed cut in funding to third sector organisations.
The cut will take effect on 30/6/25. However, we understand that Council action to mitigate the effects of the cuts will be discussed during the Council’s budget setting meeting on 20/2/25.
There may need to be a lobby of the Council meeting.
Regards,
Des Loughney Secretary Edinburgh TUC
EDINBURGH SOCIAL CARE CAMPAIGN – THE WAY FORWARD
Unitecd Augustine Church, George IV Bridge, Edinburgh EH1 1EL
Workshop Saturday 18th January 2025
AGENDA
Chair: Ian Mullen (UNISON City of Edinburgh Council Branch)
9.30 am – 10.00 am: Tea/ coffee and biscuits.
10.00 am – 11 am. Introduction to workshop
Des Loughney – Secretary, UNITE Edinburgh Not For Profit Branch (1)
Councillor Tim Pogson – Vice Chair of the Edinburgh Integration Joint Board (2)
Denise Ritchie: Fair Work Project Officer, Scottish Trades Union Congress (3)
Linda Sommerville: Deputy General Secretary, Scottish Trades Union Congress. (3)
11am to 12.30pm Working Groups ( two)
12.30 pm to 1.00 pm – Plenary Session and summing up.
Speakers:
Des Loughney will comment on the impact of the proposed EIJB cuts on services and third sector worker terms and conditions. The impact includes compulsory redundancies and downgrading of contracts of employment from guaranteed working weeks to zero hour contracts,
Councillor Tim Pogson will update us on the response of the Council to the proposed EIJB cuts. The City Council is seeking to mitigate the impact of the cuts on the third sector.
Denise Ritchie and Linda Sommervile will brief the workshop on proposed campaigning activity at a local level and a Scottish level.
Services dealing with ‘extraordinary surge’ in flu cases
Health Secretary Neil Gray underlined the ‘resolve and resilience’ of the NHS as he praised the dedication of Scotland’s health and social care workforce in facing up to an ‘extraordinary surge’ in Influenza A cases.
The number of patients admitted to hospital as an emergency and testing positive for flu has surpassed the recent peak of the winter of 2022/23.
Following the latest in a series of meetings with First Minister John Swinney, health boards, the Scottish Ambulance Service, Public Health Scotland and NHS 24 earlier this week, Mr Gray praised the NHS response to the increased pressures on the system, in a statement to parliament.
He also thanked members of the public for continuing to follow guidance on the best way to access services, and for doing their bit to reduce the spread of infections in the community.
He stated that, as of 15 December, more than 1.2 million adult flu vaccinations have been administered. Those eligible to be vaccinated have until March to do so, with many health boards offering drop-in clinics.
Mr Gray said expert healthcare advice is available without the need for an appointment through the NHS Pharmacy First Scotland service, adding that £13.6 million of additional funding has been invested in General Practices to enable the recruitment and retention of staff.
Services such as Discharge to Assess and Hospital at Home are also key to helping health and social care partnerships to reduce delayed discharges, ensuring people who are clinically ready to leave hospital can do so.
Mr Gray said: “The resilience and determination shown by staff in the face of pressures across the health and care sector is inspiring.
“Every part of our health service has gone above and beyond to serve the country during the hardest months of the year.
“I’d like to thank the ambulance service staff for their sacrifice and devotion to their task, staying at work beyond the end of their shift as they wait to turnaround at hospitals.
“I’d also like to thank social care staff doing extra shifts to make up for staff being off sick with flu and GPs working at the weekends to offer appointments and bolster the resilience of the entire system.
“Hospital staff, like the porter I met at St John’s in Livingston on Christmas Eve, are working hard to turnaround beds as quickly as possible.
“This is the reality of public service – relentless, skilled, devoted and dedicated work to serve the people that need it most.
“Thanks to the incredible efforts of NHS staff and sure-handed planning, we are facing this with resilience and resolve.”
Preliminary Notice of Anti Cuts Conference – Saturday 18th January 2025
Augustine United Church – George IV Bridge Edinburgh
9.30 am – Doors Open – Tea/Coffee and Biscuits
10.00am – 1pm Conference
The Conference is being convened by Edinburgh Trade Union Council and the Scottish Trades Union Congress (STUC).
The purpose of the Conference is to consider how best to fight the social care and health service cuts that are being planned by the Edinburgh Integration Joint Board (EIJB).
Crucial budget decisions are going to be made by the Scottish Government and the City Council over the next two or three months which will determine the level of cuts.
The conference will discuss how best to lobby to obtain the resources needed to meet service demands. This will include the services provided by the 64 third sector organisations Edinburgh that are threatened with cuts and redundancies.
The conference is open to the public. The agenda will be an introductory session, workshops and a final plenary session. The conference will have input from speakers from the STUC. We will invite a speaker from amongst the Councillors on the EIJB and a speaker representative of Edinburgh community health organisations.
We hope the conference will be able to draw up a City wide plan for lobbying and campaigning.
More details of the conference will be circulated on Monday 6th January 2025. Any comments or queries in the meantime will be responded to on 23/12/24 and 27/12/24.
